Raikar Sunil S, Felker James, Patel Kavita N, Lew Glen, Sidonio Robert F
Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University, Atlanta, GA.
J Pediatr Hematol Oncol. 2018 Oct;40(7):e470-e472. doi: 10.1097/MPH.0000000000001114.
Coagulopathy in pediatric leukemia patients is typically associated with acute promyelocytic leukemia or after asparaginase use in acute lymphoblastic leukemia. Rarely seen in acute lymphoblastic leukemia, we report 2 patients who presented with normal coagulation markers, but subsequently developed severe hypofibrinogenemia and bleeding in induction before administration of asparaginase. In both cases, cryoprecipitate was administered as initial treatment for bleeding associated with the hypofibrinogenemia. One patient was refractory to cryoprecipitate replacement and required treatment with human fibrinogen concentrate due to the persistence of hypofibrinogenemia with significant bleeding. The hypofibrinogenemia was transient in both cases and resolved within a few weeks.
儿童白血病患者的凝血功能障碍通常与急性早幼粒细胞白血病或急性淋巴细胞白血病使用天冬酰胺酶后有关。在急性淋巴细胞白血病中很少见，我们报告了2例患者，他们在使用天冬酰胺酶之前的诱导期出现正常的凝血指标，但随后出现严重的低纤维蛋白原血症和出血。在这两种情况下，冷沉淀均作为与低纤维蛋白原血症相关出血的初始治疗方法。1例患者对冷沉淀替代治疗无效，由于低纤维蛋白原血症持续且有明显出血，需要用人纤维蛋白原浓缩物治疗。这两种情况下的低纤维蛋白原血症都是短暂的，在几周内就得到了解决。
