{"doi":"10.1111/ijlh.12636","title":"A study of disseminated intravascular coagulation in acute leukemia reveals markedly elevated D‐dimer levels are a sensitive indicator of acute promyelocytic leukemia","abstract":"<jats:title>Summary</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>While the presence of disseminated intravascular coagulation (<jats:styled-content style=\"fixed-case\">DIC</jats:styled-content>) has been implicated in worse clinical outcome in acute leukemia, the relationship between different subtypes of acute leukemia and the clinicopathologic features of <jats:styled-content style=\"fixed-case\">DIC</jats:styled-content> has not been systematically well studied.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>In this study, we retrospectively reviewed 149 cases of newly diagnosed acute leukemia and assessed the utility of evaluating red blood cell morphologic features, and coagulation parameters in determining the presence of <jats:styled-content style=\"fixed-case\">DIC</jats:styled-content> as well as differentiating subtypes of acute leukemia.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Review of our cohort demonstrates a novel finding, that elevated D‐dimer concentrations ≥19 000 ng/<jats:styled-content style=\"fixed-case\">mL</jats:styled-content> fibrinogen equivalent units (<jats:styled-content style=\"fixed-case\">FEU</jats:styled-content>) are a sensitive diagnostic indicator of acute promyelocytic leukemia (<jats:styled-content style=\"fixed-case\">APL</jats:styled-content>) with moderate specificity, sensitivity 96%, specificity 92% in acute leukemia subtyping. Similar to other studies, <jats:styled-content style=\"fixed-case\">APL</jats:styled-content> showed an increased incidence of <jats:styled-content style=\"fixed-case\">DIC</jats:styled-content> (<jats:italic>P</jats:italic> &lt; 0.01) compared to other subtypes of acute leukemia. Surprisingly, the presence of schistocytes on the peripheral blood smear was not a statistically significant indicator of <jats:styled-content style=\"fixed-case\">DIC</jats:styled-content>, sensitivity of 36% and specificity of 89%. Finally, the presence of <jats:styled-content style=\"fixed-case\">DIC</jats:styled-content> was not a significant indicator of poorer prognosis amongst all patients with <jats:styled-content style=\"fixed-case\">AML</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Overall we identify elevated D‐dimer concentrations ≥19 000 ng/<jats:styled-content style=\"fixed-case\">mL FEU</jats:styled-content> are a sensitive indicator of acute promyelocytic leukemia (<jats:styled-content style=\"fixed-case\">APL</jats:styled-content>), with a sensitivity of 96% and specificity of 92% in the subtyping of acute leukemias, and that the presence of schistocytes in peripheral blood smears is not a diagnostically sensitive screening test for <jats:styled-content style=\"fixed-case\">DIC</jats:styled-content> with a sensitivity of 36%.</jats:p></jats:sec>","journal":"International Journal of Laboratory Hematology","year":2017,"id":598099,"datarank":0.515098080672772,"base_score":3.4339872044851463,"endowment":3.4339872044851463,"self_citation_contribution":0.515098080672772,"citation_network_contribution":0.0,"self_endowment_contribution":0.515098080672772,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":30,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":4,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1532423,"name":"J. S. Oak","orcid":null,"position":1,"is_corresponding":false},{"id":1532424,"name":"M. J. Cascio","orcid":"0000-0002-5537-7740","position":2,"is_corresponding":false},{"id":1532426,"name":"M. Alcasid","orcid":null,"position":3,"is_corresponding":false},{"id":1532427,"name":"E. Goodman","orcid":null,"position":4,"is_corresponding":false},{"id":1532428,"name":"B. C. Medeiros","orcid":null,"position":5,"is_corresponding":false},{"id":1532429,"name":"D. A. Arber","orcid":null,"position":6,"is_corresponding":false},{"id":1532430,"name":"J. L. Zehnder","orcid":null,"position":7,"is_corresponding":false},{"id":456410,"name":"Robert S. Ohgami","orcid":"0000-0003-1881-3440","position":8,"is_corresponding":false},{"id":1532422,"name":"N. Shahmarvand","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"A study of disseminated intravascular coagulation in acute leukemia reveals markedly elevated D‐dimer levels are a sensitive indicator of acute promyelocytic leukemia","abstract":"<jats:title>Summary</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>While the presence of disseminated intravascular coagulation (<jats:styled-content style=\"fixed-case\">DIC</jats:styled-content>) has been implicated in worse clinical outcome in acute leukemia, the relationship between different subtypes of acute leukemia and the clinicopathologic features of <jats:styled-content style=\"fixed-case\">DIC</jats:styled-content> has not been systematically well studied.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>In this study, we retrospectively reviewed 149 cases of newly diagnosed acute leukemia and assessed the utility of evaluating red blood cell morphologic features, and coagulation parameters in determining the presence of <jats:styled-content style=\"fixed-case\">DIC</jats:styled-content> as well as differentiating subtypes of acute leukemia.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Review of our cohort demonstrates a novel finding, that elevated D‐dimer concentrations ≥19 000 ng/<jats:styled-content style=\"fixed-case\">mL</jats:styled-content> fibrinogen equivalent units (<jats:styled-content style=\"fixed-case\">FEU</jats:styled-content>) are a sensitive diagnostic indicator of acute promyelocytic leukemia (<jats:styled-content style=\"fixed-case\">APL</jats:styled-content>) with moderate specificity, sensitivity 96%, specificity 92% in acute leukemia subtyping. Similar to other studies, <jats:styled-content style=\"fixed-case\">APL</jats:styled-content> showed an increased incidence of <jats:styled-content style=\"fixed-case\">DIC</jats:styled-content> (<jats:italic>P</jats:italic> &lt; 0.01) compared to other subtypes of acute leukemia. Surprisingly, the presence of schistocytes on the peripheral blood smear was not a statistically significant indicator of <jats:styled-content style=\"fixed-case\">DIC</jats:styled-content>, sensitivity of 36% and specificity of 89%. Finally, the presence of <jats:styled-content style=\"fixed-case\">DIC</jats:styled-content> was not a significant indicator of poorer prognosis amongst all patients with <jats:styled-content style=\"fixed-case\">AML</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Overall we identify elevated D‐dimer concentrations ≥19 000 ng/<jats:styled-content style=\"fixed-case\">mL FEU</jats:styled-content> are a sensitive indicator of acute promyelocytic leukemia (<jats:styled-content style=\"fixed-case\">APL</jats:styled-content>), with a sensitivity of 96% and specificity of 92% in the subtyping of acute leukemias, and that the presence of schistocytes in peripheral blood smears is not a diagnostically sensitive screening test for <jats:styled-content style=\"fixed-case\">DIC</jats:styled-content> with a sensitivity of 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in leukemia and cellular processes","Venous Thromboembolism Diagnosis and Management","Inflammatory Biomarkers in Disease Prognosis","Adolescent","Adult","Aged","Aged, 80 and over","Biomarkers, Tumor","Biopsy","Blood Coagulation","Blood Coagulation Tests","Chromosome Aberrations","Disseminated Intravascular Coagulation","Erythrocytes, Abnormal","Female","Fibrin Fibrinogen Degradation Products","Humans","Leukemia, Promyelocytic, Acute","Leukocytes","Male","Middle Aged","Mutation","Prognosis","Reproducibility of Results","Retrospective Studies","Sensitivity and Specificity","Young Adult"],"mesh_terms":["Adolescent","Adult","Aged","Aged, 80 and over","Biopsy","Blood Coagulation","Blood Coagulation Tests","Chromosome Aberrations","Disseminated Intravascular Coagulation","Erythrocytes, Abnormal","Female","Fibrin Fibrinogen Degradation Products","Humans","Leukocytes","Male","Middle Aged","Mutation","Prognosis","Retrospective Studies","Sensitivity and Specificity","Biomarkers, 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