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DOI: 10.1055/s-0037-1613942
Elastase Mediated Fibrinolysis in Acute Promyelocytic Leukemia
Publikationsverlauf
Received
05. November 1999
Accepted after revision
14. Februar 2000
Publikationsdatum:
14. Dezember 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/200006/lookinside/thumbnails/10-1055-s-0037-1613942-1.jpg)
Summary
The bleeding syndrome of acute promyelocytic leukemia (APL) is complex and consists of disseminated intravascular coagulation (DIC) and hyperfibrinolysis. Elastase, derived from malignant promyelocytes, is believed to mediate the fibrinogeno- and fibrinolysis by aspecific proteolysis. In this study we measured the role of elastase in fifteen patients with APL by using an assay for elastase degraded fibrin(ogen) and the results were compared with those obtained in patients with sepsis induced DIC.
High levels of elastase were observed in sepsis and APL. The levels of fibrinogen and fibrin degradation products were significantly higher in APL patients compared to patients with sepsis induced DIC. Nevertheless, the level of elastase degraded fibrin(ogen) was higher in the sepsis group (635.3 ng/ml, compared to 144.3 ng/ml in APL; p <0.0001). So, the enormous increase in fibrin and fibrinogen degradation products in APL cannot be explained by elastase activity. This study suggests a minor role for elastase mediated proteolysis in the hemorrhagic diathesis in APL patients.
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References
- 1 Dombret H, Scrobohaci ML, Ghorra P, Zini JM, Daniel MT, Castaigne S, Degos L. Coagulation disorders associated with acute promyelocytic leukemia: corrective effect of all-trans retinoic acid treatment. Leukemia 1993; 07: 2-9.
- 2 De Stefano V, Teofili L, Sica S, Mastrangelo S, Di Mario A, Rutella S, Salutari P, Rumi C, d’Onofrio G, Leone G. Effect of all-trans retinoic acid on procoagulant and fibrinolytic activities of cultured blast cells from patients with acute promyelocytic leukemia. Blood 1995; 86: 3535-41.
- 3 Rodeghiero F, Avvisati G, Castaman G, Barbui T, Mandelli F. Early deaths and anti-hemorrhagic treatments in acute promyelocytic leukemia a GIMEMA retrospective study in 268 consecutive patients. Blood 1990; 75: 2112-7.
- 4 Tallman MS, Kwaan HC. Reassessing the hemostatic disorder associated with acute promyelocytic leukemia. Blood 1992; 79: 543-53.
- 5 Barbui T, Finazzi G, Falanga A. The Impact of All-trans-Retinoic Acid on the Coagulopathy of Acute Promyelocytic Leukemia. Blood 1998; 91: 3093-102.
- 6 Kario K, Matsuo T, Kodam K, Matuso M, Yamamoto K, Kobayashi H. imbalance between thrombin and plasmin activity in disseminated intravascular coagulation. Haemostasis 1992; 22: 179-86.
- 7 Bauer KA, Rosenberg RD. Thrombin generation in acute promyelocytic leukemia. Blood 1984; 64: 791-6.
- 8 Booth NA, Bennett B. Plasmin-alpha-2-antiplasmin complexes in bleeding disorders characterised by primary or secondary fibrinolysis. Br J Haematol 1984; 56: 545.
- 9 Reddy VB, Kowas-Vern A, Hoppensteadt DA, Kumar A, Walenga JM, Fareed J, Shumacher HR. Global and hemostatic markers in acute myeloid leukemia. Am J Clin Pathol 1990; 94: 397.
- 10 Viljoen M, Roux LJ, Pretorius JP, Coetzee IH, Viljoen E. Hemostatic competency and elastase-α1-proteinase inhibitor levels in surgery, trauma, and sepsis. J Trauma:Injury, Infect and Crit care 1995; 39: 381-5.
- 11 Samis JA, Garret M, Manuel RP, Nesheim ME, Giles AR. Human neutrophil elastase activates human factor V but inactivates thrombin-activated human factor V. Blood 1997; 90: 1065-74.
- 12 Gralnick HR, Abrell E. Studies of the procoagulant and fibrinolytic activity of promyelocytes in acute promyelocytic leukaemia. Br J Haematol 1973; 24: 89-99.
- 13 Falanga A, Iacoviello L, Evangelista V, Belotti D, Consonni R, D`Orazio A, Robba L, Donati MB, Barbui T. Loss of blast cell procoagulant activity and improvement of hemostatic variables in patients with acute promyelocytic leukemia administered all-trans-retinoic acid. Blood 1995; 86: 1072-81.
- 14 Hoegee de Nobel E, Voskuilen M, Briet E, Brommer EJ, Nieuwenhuizen W. A monoclonal antibody-based quantitative enzyme immunoassay for the determination of plasma fibrinogen concentrations. Thromb Haemost 1988; 60: 415-8.
- 15 Bos R, Laterveer-Vreeswijk GH, Lockwood D, Szecwcyk K, Nieuwenhuizen W. A new enzyme immunoassay for soluble fibrin in plasma with a high discriminating power for thrombotic disorders. Thromb Haemost 1999; 81: 54-9.
- 16 Koppert PW, Kuipers W, Hoegee de Nobel B, Brommer EJ, Koopman J, Nieuwenhuizen W. A quantitative enzyme immunoassay for primary fibrinogenolysis products in plasma. Thromb Haemost 1987; 57: 25-8.
- 17 Koppert PW, Hoegee de Nobel E, Nieuwenhuizen W. A monoclonal antibody-based enzyme immunoassay for fibrin degradation products in plasma. Thromb Haemost 1988; 59: 310-5.
- 18 Bos R, van Leuven CJM, Stolk J, Hiemstra PS, Ronday HK, Nieuwenhuizen W. An enzyme immunoassay for polymorphonuclear leucocytemediated fibrinogenolysis. Eur J Clinic Invest 1997; 27: 148-56.
- 19 Sterrenberg I, Blonk A, van Liempt GJ, Hermans J, Nieuwenhuizen W. Purification and properties of early (X-like) and late (D-like) fibrinogen fragments, produced by leukocyte elastase. In: Fibrinogen, Structure, Functional Aspects, Metabolism. Haverkate F, Henschen A, Nieuwenhuizen W, Straub PW. eds. Berlin: Walter de Gruyter; 1983: 235-53.
- 20 Machovich R, Owen WG. The elastase-mediated pathway of fibrinolysis. Blood Coag Fibrinol 1990; 01: 79-90.