Assessment of Disseminated Intravascular Coagulation in Children with Acute Lymphoblastic Leukemia during Induction Chemotherapy in A Tertiary Care Hospital.

Abstract

The overall cure rate for childhood acute lymphoblastic leukemia (ALL) has improved from virtually zero to the current event-free survival rate (EFS) of more than 90.0%. Disseminated intravascular coagulation is the commonest hemostatic abnormality in patients with ALL. It might cause serious hemorrhagic complications and warrants proper medical attention in due time. To detect the frequency, identify the risk factors and outcome of disseminated intravascular coagulation in children with acute lymphoblastic leukemia during induction chemotherapy. This prospective observational study was carried out in 55 diagnosed cases of ALL children in the department of pediatric hematology and oncology, BSMMU from November 2020 to October 2021. Patients were on regular follow-up with special attention to bleeding manifestation, fever, diarrhea, respiratory distress. DIC was detected by using the International Society of Thrombosis and Haemostasis scoring system by using Prothrombin time, Platelet count, Serum fibrinogen and D-dimer. Investigation for diagnostic DIC evaluation was done on every patient at baseline, on day 7, day 14 and day 21. Statistical analysis of the results was obtained by using windows computer software with Statistical Packages for Social Sciences (SPSS-version 22.0). Out of 55 patients, DIC was encountered in 12(21.8%) patients. At diagnosis, DIC was found in 8 patients (14.54%), on day 7, DIC was found in 4 patients (8.0%). A total of 8(14.54%) patients have developed DIC at diagnosis, among them 4(50.0%) had persisted DIC after starting chemotherapy, 4 patients resolved. But 4 patients (8.5%) newly developed DIC during hospitalization (p=0.001). The use of Daunorubicin had 6.252 times significantly (p<0.05) increased risk to developed DIC with 95.0% CI (0.107 to 36.048%). Patients with DIC had more bleeding 10(83.3%) than the non-DIC group 20(46.6%). The mortality rate was higher, 3(25.0%) in the DIC group and 6(14.0%) in the non-DIC group. The frequency of DIC was 21.8% during the induction period, use of daunorubicin was identified as the risk factor for the development of DIC. Mortality was higher in patients with DIC.