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 Table of Contents  
Year : 2022  |  Volume : 7  |  Issue : 1  |  Page : 68-72

Comparative study of hemostasis file in newly diagnosed leukemia patients and healthy persons at the Hematology and Blood Transfusion Department, National Hospital, Abuja

1 Department of Haematology and Blood Transfusion, National Hospital, Abuja, Nigeria
2 Science Laboratory Department, Laboratory, Asokoro District Hospital, Abuja, Nigeria
3 Department of Logistics and Supply Chain Management, Malaysia University of Science and Technology, Petaling Jaya, Malaysia
4 Department of Compliance and Quality Control, Laboratory Services, Management Sciences for Health, Akesis, Abuja, Nigeria
5 Department of Public Health, Triune Biblical University Global Extension, Brooklyn, NY, USA

Date of Submission22-Apr-2021
Date of Decision10-Aug-2021
Date of Acceptance26-Aug-2021
Date of Web Publication27-Jun-2022

Correspondence Address:
Dr. Nuhu Andrew Yashim
Department of Haematology and Blood Transfusion, National Hospital, Abuja
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bjhs.bjhs_35_21

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BACKGROUND: Hemostasis is a complicated and multifaceted condition that often leads to the stoppage of bleeding from injuries. At presentation, blood coagulation irregularities are common in patients with acute leukemia.
AIM AND OBJECTIVE: This study aimed to compare hemostasis profiles of newly diagnosed leukemia patients with healthy persons.
METHODOLOGY: This is a cross-sectional study carried out at the Hematology and Blood Transfusion Department of the National Hospital Abuja, Nigeria, from June 2018 and May 2020 among 30 newly diagnosed leukemia patients and 30 healthy persons. Complete blood counts, platelets, hemoglobin, total white blood count, packed cell volume prothrombin time (PT), activated partial thromboplastin time (APTT), erythrocyte sedimentation rate (ESR), and fibrinogen were assayed on patients' venous blood using the standard methods. Data analysis was done using software IBM-SPSS version 25. Associations between the variables were determined using Student's t-test taking a P < 0.05 as significant.
RESULTS: The mean and median age of the leukemia patients was 45.8 ± 10.73 and 41 years, respectively. The mean value of PT (21.2 ± 0.9 seconds) and APTT (39.0 ± 1.4 seconds) was raised significantly (P < 0.001) in leukemia patients than in control (4.8 ± 0.3 s) and (13.9 ± 0.3 s). The mean value of ESR among leukemia patient was 41.7 ± 4.6 mm/h, while it was 29.6 ± 0.4 mm/h in control (P < 0.001). Mean value of fibrinogen reduced significantly 181.9 ± 3.70 mg/dl in leukemia patients as compared to control 261.6 ± 5.21 mg/dl (P < 0.001).
CONCLUSION: This study found significant differences in hematological and hemostasis profiles levels between leukemia and healthy persons, which shows the presence of inflammation.

Keywords: Fibrinogen, hematological parameters, hemostasis, leukemia

How to cite this article:
Yashim NA, Obazee DY, Ajani OF, Abiodun PO, Ajani LA, Sanni FO. Comparative study of hemostasis file in newly diagnosed leukemia patients and healthy persons at the Hematology and Blood Transfusion Department, National Hospital, Abuja. BLDE Univ J Health Sci 2022;7:68-72

How to cite this URL:
Yashim NA, Obazee DY, Ajani OF, Abiodun PO, Ajani LA, Sanni FO. Comparative study of hemostasis file in newly diagnosed leukemia patients and healthy persons at the Hematology and Blood Transfusion Department, National Hospital, Abuja. BLDE Univ J Health Sci [serial online] 2022 [cited 2022 Aug 15];7:68-72. Available from: https://www.bldeujournalhs.in/text.asp?2022/7/1/68/348271

  Introduction Top

Hemostasis is described as the collection of processes that prevent the flow of blood from the blood vessels or a state of balance between anticoagulation and pro-coagulation reactions that can be influenced by the factors such as bleeding disorder in leukemia patients.[1] Several parts of the body, including the blood vessel walls, blood clotting processes, fibrinogen, fibrinolytic, and phagocyte, are involved in hemostasis.[2] Another vital component of hemostasis is blood platelets (Plt).[3],[4] At presentation, blood coagulation irregularities are common in patients with acute leukemia, although these irregularities are usually mild and may not constitute any clinical harm. Sometimes, the abnormality may be very severe to the extent that it leads to excessive bleeding due to thrombocytopenia.[5]

Fibrinolysis has also been associated with increased haemorrhagic problems in patients with acute leukaemia,[3],[6] but thrombo-hemorrhagic complications are a major cause of morbidity and mortality leukemia patients, particularly patients with chronic myeloid leukemia.[7]

Homeostasis is very much physiological and involves various complex processes that often lead to the stoppage of bleeding from injuries.[8] The coagulation process is initiated with the disruption of endothelium followed by the blood circulation to tissue factor and collagen. Eventually, this starts a complex event that begins with the adhesion of blood Plt and the subsequent rapid development of a stable clot.[9] Hemostasis can be classified into primary or secondary. Primary hemostasis is the exposure of sub-endothelial collagen that triggers adhesion of Plt, discharge of granule, and initial aggregation, while secondary hemostasis is the development of thrombin and generation of a fibrin cloth; a significant thrombin burst created at the site of vascular damage by the initiation of the coagulation cascade. Secondary hemostasis is caused by the production of fibrin, which stabilizes the platelet, resulting in irreversible bleeding cessation.[9] This study aimed to compare the hemostasis profile of newly diagnosed leukemia patients and healthy persons at the hematology and blood transfusion department of National Hospital, Abuja, Nigeria.

  Methodology Top

Study design

The study was carried out on newly diagnosed leukemia patients and healthy controls at the hematology and blood transfusion department of the National Hospital, Abuja, Nigeria. The study was a cross-sectional study conducted between June 2018 and May 2020.

Study population and experimental procedure

The population of the study included 30 newly diagnosed leukemia patients and 30 healthy persons. The exclusion criteria included patients with a history of a bleeding disorder, patients with hemostatic disorder, renal and liver disease patients, being on medication that can affect the hemostatic system, being pregnant, and cases of infections that may likely affect hemostasis and those unwilling to participate in the study. All newly diagnosed leukemia patients that met inclusion criteria seen at the hematology and blood transfusion department of the national hospital, Abuja during the study period were included. An equivalent number of the noncancer individuals was recruited as control.

Complete blood counts, Plt, hemoglobin (Hb), total white blood count (WBC), packed cell volume (PCV) prothrombin time (PT), activated partial thromboplastin time (APTT), erythrocyte sedimentation rate (ESR), and fibrinogen were assayed on patients' venous blood. An automated electronic cell counter was used to calculate complete blood counts. Standard methods were used to assay the coagulation profiles PT, APTT, ESR, and fibrinogen. A three (3.0) ml blood was collected from each patient into a trisodium citrate anticoagulant vial and centrifuged for 15 min at 3000 rpm. PT, APTT, and Fibrinogen was analyzed by standard methods within 48 h. To measure PT, platelet-poor plasma was mixed with phospholipid-containing thromboplastin reagent (HAEMOSIL) and 25 mM of calcium chloride (CaCl2) at 37°C while the time taken for fibrin clot formation was calculated. APPT was measured by calculating the required time for the formation of clots from the time platelet-poor plasma mixed with phospholipid-cephalin, kaolin (contact activator), and calcium at 37°C. The measurement of fibrinogen levels was done using clauss assay, taking the normal range as 233–496 mg/dl.

Data analysis

Data analysis was performed using the software IBM-SPSS version 25. Associations between variables were determined using Student's t-test, taking a P < 0.05 as significant.

Ethical consideration

Written informed consent was taken from all the participants before they participated in the study. The investigators confirmed that all procedures conducted in experiments with human subjects complied with the institutional and/or national study committee ethical guidelines. Ethical approval was obtained from the National Hospital, Abuja, Research Ethics Committee with NHA/EC/102/2018/V.I/.

  Results Top

This study comprised 30 newly diagnosed leukemia patients (Case) and 30 healthy persons (Control). There were 32 (53.3%) males and 28 (46.7%) females in the study, and each group comprised 16 (53.3%) males and 14 (46.7%) females. The mean and median age of the leukaemia patients was 45.8 ± 10.73 and 41 years, respectively, while the mean age for the control group was 40.9 ± 8.59 and the median was 40.0 years.

As shown in [Figure 1], the mean value of PT was 21.2 ± 0.9 s in leukemia patients and 4.8 ± 0.3 s in control. Furthermore, the mean value of APTT was 39.0 ± 1.4 s among patients as compared with 13.9 ± 0.3 s in control. The mean value of ESR among the patient group was 41.7 ± 4.6 mm/h while it was 29.6 ± 0.4 mm/h in control.
Figure 1: Prothrombin time, APTT, and erythrocyte sedimentation rate of leukaemia patients and healthy people. *Significant at P < 0.05

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As shown in [Figure 2], the mean value of fibrinogen was 181.9 ± 3.70 mg/dl in leukemia patients, whereas it was 261.6 ± 5.21 mg/dl in the control group.
Figure 2: Fibrinogen concentration of leukaemia patients and control. *Significant at P < 0.05

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The mean Hb (13.08 g/dl), PCV (39.17%), and Plt (246.77 x 109L) of controls were significantly higher than the case (P < 0.0001). On the other hand, leukaemia patients had significantly higher values of WBC (20.68 x 10 9L) than the controls (4.91 x 109L), P< 0.0010 [Table 1].
Table 1: Haematological parameters of leukaemia patients and control

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  Discussion Top

This study included 30 newly diagnosed leukemia patients and 30 healthy people with M:F ratio of 1.14:1. This is similar to 1:1 that was observed in a recent study of leukemia in Calabar, Nigeria[10] and 1.3: 1 that was seen in a 5-year review of leukemia patients in Ibadan, South-West Nigeria.[11] Studies from the some other parts of the world have also shown that leukemia affects more males than females with male-to-female ratio ranging from 1.3 to 2.2:1.[7],[12],[13],[14] The mean and median age of the leukemia patients was 45.8 and 41 years which is in agreement with a previous reporting South-West, Nigeria[11] though slightly lower than 59 years reported in Calabar[15] and higher than 35.53 years reported in Indian.[7] The variation might be due to the geographical locations.[15]

Plt, Hb, and PCV were significantly (P < 0.001) reduced in leukemia patients compared with the healthy people while the WBC was significantly (P < 0.001) raised in leukaemia patients that the control. Majhail et al.[16] also supported this result explaining how about 5% to 30% of adult patients with acute leukemias present with hyperleukocytosis are much likely to have very high WBC counts (>100,000 cells/mm3) and symptoms of leukostasis. Low platelet productions (thrombocytopenia) problems have been associated with consumption of Plt and other clotting and with hyperfibrinolysis effects which result in hemorrhage (bleeding) from several sites in cancer patients.[4],[17],[18] Thrombocytopenia complications are also described as a risk factor for hemostatic disorders.[7] Plt are involved in the inflammatory processes of the body system which results in the Plt consumption and instantaneous bone marrow response.[19],[20]

Our study found prolonged PT and APTT among leukemia patients as compared to control group. Sehgal et al.[21] also reported a similar result of the APTT of leukemia patients being significantly prolonged (P = 0.033). This finding agrees with information obtained from the literature.[3],[7],[22] Prolonged PT and APTT are among the abnormalities that have been documented in cancer patients in addition to increased and decreased levels factors (II, V, VIII, IX, XI, and XII), and fibrinogen.[1],[23],[24],[25]

The result also showed a significantly (P < 0.0010) higher mean value of ESR (41.7 mm/h) in leukemia patients as compared to 29.6 mm/h in control. ESR has been described as one of the important determinants of the disease acute phase response, which helps to identify the presence of inflammation and its response to treatment.[26],[27],[28] ESR is affected by anemia as well as certain forms of inflammatory diseases.[29] Studies have also proven that elevated ESR as found in this study among leukemia patients is often related to explanatory disease.[26],[30]

Significant reduction (P < 0.001) of fibrinogen level (181.9 mg/dl) was found leukemia patients when compared to control (261.6 mg/dl) in this study. Previous studies involving cancer patients showed the significance of fibrinogen levels in some solid malignancies such as leukaemia.[7],[31] ovarian and endometrial malignancies.[32],[33] renal cell,[34] oesophageal,[35],[36] hepatocellular,[37] and non-small cell lung cancers.[38],[39] Scholars have associated very low fibrinogen levels in leukemia patients with increased risk of bleeding episodes.[31] Wada et al.[40] also reported that among patients with leukemia, the frequency of organ failure was markedly high in patients with high plasma levels of fibrinogen. Among patients without leukemia, the frequency of organ failure increased concomitantly with increased plasma fibrinogen levels.

  Conclusion Top

The significant differences observed in the haemostasis parameters of leukaemia patients and healthy individuals call for early screening and treatment to avoid complications such as blood coagulation irregularities and subsequently reduce the associated mortality rates.

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Conflicts of interest

There are no conflicts of interest.

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