Correction of Hemostatic Imbalances Induced by L-Asparacinase Therapy in Children with Acute Lymphoblastic Leukemia

Abstract

Thirteen children with ALL and L-asp-induced alterations of the coagulation system were treated with fresh-frozen plasma and antithrombin III (AT III) concentrate. Fresh-frozen plasma was given three times daily to maintain fibrinogen levels > 100 mg/dl. AT III concentrate was administered in a continuous infusion over 24 h as long as replacement with fresh-frozen plasma was given. When fibrinogen was > 100 mg/dl and AT III < 80% of normal, only AT III concentrate was administered in a continuous infusion. In all patients treated with the replacement regimen described, fibrinogen levels were maintained > 100 mg/dl and AT III levels > 80%. No bleeding or thrombosis and no signs of disseminated intravascular coagulation were observed. Our study shows that correction of the alterations of the coagulation system induced by asparaginase can be achieved with a replacement regimen substituting both procoagulant material and the most important inhibitor of the coagulation system.

Key Words:

• acute lymphoblastic leukemia
• L-asp
• coagulation
• fresh-frozen plasma
• antithrombin III
• concentrate