Background: Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood. Most of the patients have trombocytopenia  at presentation of the disease which may lead to bleedings but coagulation abnormalities are not frequent at initial diagnosis of childhood ALL.

Aims: The aim of this study is to evaluate the coagulation profile on the onset of ALL before the start of chemotherapy in children.

Methods: For this purpose the medical records of patients diagnosed with ALL were analyzed retrospectively. Eighty patients were included in the study. Laboratory results for prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen which were obtained  at their first admission to hospital were recorded.

Results: Of 80 patients 34 (42.5%) were female, 46 (57.5%) were male, they were aged between 7 months and 17.8 years. Seven (8.8%) patients were diagnosed with T-cell, 73 (91.2%) patients were diagnosed with precursor B-cell ALL. 
Fibrinogen levels ranged between 55 and 658 mg/dl. In 44 (55%) patients fibrinogen levels were in normal (200-400 mg/dl) range, in 29 (36.3%) patients,  fibrinogen was high (400-658 mg/dl), in 3 (3.7%) patients it was between 100-200 mg/dl and in 4 (5%) patients it was between 55-100 mg/dl. 
PT levels ranged between 11.5 s and 21.9 s. In 65 (81.2%) patients PT  was in normal (11.5-15.5 s) limits . In 15 (18.8%) patients PT was prolonged (15.5-21.9 s).
APTT levels ranged between 25.6 s and 35.2 s. In 48 (60%) patients APTT was in normal (25.6-35.2  s) levels. In six (7.5%) patients APTT was prolonged ( >35.2 s).  In 16 (20%) patients APTT shortened ( <25.6 s).

Conclusions: Childhood ALL may be associated with alterations in coagulation tests which can be predictor to bleeding or thrombotic events. Recognition of these abnormalities is important  in management of these complications.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/coagulation-abnormalities-at-presentation-of-childhood-acute-lymphoblastic-leukemia/