Among 181 patients with various hematopoietic malignancies studied during recent 10 years, 43 patients were compatible with the modified Colman's criteria for overt DIC. The frequent basic diseases were: APL (100%, 13 of 13 patients), CML with blastic crisis (50%, 4/8), ALL (36%, 4/11), Hodgkin's disease (IV) (30%, 3/10), ATL (27%, 3/11) and non-Hodgkin's lymphoma (IV) (24%, 6/25). Most patients had more than 2 abnormal test results at the time on admission. This indicated that latent DIC was probably rather common among these patients prior to chemotherapy. The chemotherapy was the most frequent cause for overt DIC. In 17 cases, overt DIC appeared to be caused solely by the chemotherapy [ALL (27%, 3 of 11 patients), AMMoL (23%, 3/13), AML (18%, 3/17) and non-Hodgkin's lymphoma (IV) (16%, 4/25)].
The most impaired hemostatic parameters during the induction chemotherapy were fibrinogen, ELT, paracoagulation tests and FDP. The changes in these parameters were found to resemble those in overt DIC. The shortened APTT (PTT), seen especially in patients with AML, has been attributed to an increased procoagulant activity or activated procoagulant phase in the process of DIC.
Chemothrapy should be continued in all patients to control the underlying disease, however, this therapy may intensify or induce DIC. In this respect, we recommend, once chemotherapy is begun, frequent hemostatic studies to monitor any changes in the hemostatic parameters and to identify a possible subsequent need for anticoagulants.
