Diseminovana intravaskularna koagulopatija u akutnoj nepromijelocitnoj mijeloidnoj leukemiji- učestalost, kliničko-laboratorijske karakteristike i prognozni značaj
Sažetak
Uvod/Cilj: Diseminovana intravaskularna koagulopatija (DIK) je prisutna kod 90% bolesnika sa akutnom promijelocitnom leukemijom (APL). Učestalost DIK-a kod ostalih tipova akutnih mijeloidnih leukemija (ne-APL AML) je znatno manja (10-40%) i do sada ne postoje studije koje su ispitivale uticaj DIK-a na ranu smrt kod ovih bolesnika.Cilj rada bio je analiza učestalosti DIK-a, njegovih kliničko-laboratorijskih karakteristika, kao i uticaj na preživljanje i ranu smrt bolesnika sa ne-APL AML.
Metode: Retrospektivnom analizom je obuhvaćeno 176 bolesnika sa ne-APL AML koji su dijagnostikovani i lečeni u Klinici za hematologiju KCS u periodu od 2015 do 2020. Dijagnoza DIK-a je postavljena na osnovu ISTH (International Society on Thrombosis and Haemostasis) kriterijuma.
Rezultati: Prosečna starost bolesnika iznosila je 53,8±14,5 godine, uz prevaleciju muškog pola (99/176; 56,2%). Manifestni DIK konstatovan je kod 74/176 bolesnika (42%) koji su značajno češće imali hemoragijski sindrom (p=0,01). Faktori rizika za nastanak DIK-a bili su: starije životno doba (p<0,01), prisustvo komorbiditeta (p=0,01), leukocitoza (p<0,001) i visoka koncentracija LDH (p<0,001). FAB podtip ne-APL AML, citogenetska grupa rizika i ekspresija CD56 nisu uticali na nastanak DIK-a (p>0,05). Nije utvrđena razlika u ranoj smrtnosti, ishodu i preživljavanju bolesnika ne-APL AML bolesnika sa i bez DIK-a (p>0,05).
Zaključak:Starije životno doba, prisustvo komorbiditeta, leukocitoza i visoke koncentracije LDH nose značajan rizik za razvoj DIK-a kod bolesnika sa ne-APL AML. Prisustvo manifestnog DIK-a ne utiče negativno na ranu smrtnost, ishod i preživljavanje bolesnika sa ne-APL AML, ukoliko se dijagnoza DIK-a postavi na vreme i preduzme neodložna, adekvatna i intenzivna primena suportivne terapije derivatima i komponentama krvi.
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