A 63-year-old man was admitted to our hospital because of leukocytosis. On admission, the white blood cell count was 78,600/μl with 94.5% leukemic cells. He was diagnosed as having acute lymphoblastic leukemia (ALL), because the leukemic cells were negative for peroxidase and non-specific esterase. Immunological examination of the leukemic cells showed that B1, B4, J5, OKIa1, and TdT were positive and cytoplasmic Igμ was negative, indicating common ALL. The coagulation studies showed that FDP increased to 40 μg/ml and prothrombin time was prolonged to 16.2 seconds. The diagnosis of disseminated intravascular coagulation (DIC) was made. Since we could not find any causes of DIC other than ALL, it was considered to be due to ALL. Moreover, marked increase in LDH level (1,159 mU/ml), especially in LDH2 and LDH3, was noted. After DVP therapy was started, DIC was exacerbated, but was well controlled by the treatment with fresh frozen plasma, platelet concentrate and FOY.
When we investigated the presence of DIC and its relationship to peripheral blood findings, bone marrow findings and LDH level in 21 patients with ALL who had been treated at our hospital for the last 8 years, we found that patients with LDH level higher than 1,000 mU/ml, as found in the present case, had significantly higher incidence of DIC than other patients.
