Disseminated intravascular coagulation as the presenting feature of lymphoblastic leukemia. Study of a case

Disseminated intravascular coagulation is relatively common as initial clinical presentation of certain myeloblastic leukemias, particularly acute promyelocytic leukemia, occurring less frequently in association with acute non-myeloid leukemias. The occurrence of such coagulopathy as presenting feature of a lymphoblastic leukemia is exceptional as demonstrated by the scarcity of reports in the literature and by the authors experience, having encountered only one case out of 86 consecutive patients with acute lymphoblastic leukemia. The laboratory findings in this case are commented upon, and particular emphasis is made on the measurement of coagulation factors II, V, VII-X, and VIII, the study of fibrin formation and fibrinolysis, and the changes in these parameters brought about by therapy with heparin, coagulation factors (fibrinogen, platelets), and cytostatic drugs. The coagulation abnormalities were corrected once the blast population was destroyed by chemotherapy, with the exception of persisting fibrinopenia secondary to the corticosteroid treatment included in the chemotherapy protocol. Disseminated intravascular coagulation was manifested in this case by gingivorrhagia, ecchymosis and hematuria. The probable etiological role of lymphoblasts in the development of disseminated intravascular coagulation is discussed.