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Acute myeloid leukemia (AML) is characterized by clonal expansion of undifferentiated myeloid precursors, resulting in impaired hematopoiesis and bone marrow failure producing marked thrombocytopenia with small dysfunctional platelets hence increasing risk of hemorrhage. Thrombo-hemorrhagic complications in patients with hematologic malignancies are frequently seen as in those with solid tumors. Acute leukemia is often complicated with DIC due to abnormal expression of coagulation-related factors in leukemic cells and external factors, such as infection and vascular endothelial damage caused by chemotherapy.
Protein Z is a vitamin K-dependent glycoprotein. It exerts anticoagulant activity through inhibition of factor Xa with protein Z-dependent protease inhibitor (ZPI) by 1000-fold. Significant association was found between low protein Z levels and arterial vascular diseases, pregnancy complications and venous thrombo-embolic diseases such as disseminated intravascular coagulation (DIC), stroke and anti-phospholipids syndrome. On the other hand, it has been suggested that protein Z deficiency is associated with hemorrhagic disorders.
The aim of our study is to measure the level of protein Z and correlate it with bleeding disorders in naïve AML patients.
This prospective study was conducted on 60 adult naïve Acute Myeloid Leukemia patients comparing 30 healthy control participants at Ain-Shams University Hospital, Internal Medicine Department, Hematology Unit.
The patient and control groups were both matched as regard age and sex and both were aged >16 years old.
All the patients were naïve acute myeloid leukemia before receiving induction chemotherapy regimen. Written consent was taken from all the patients and controls for participation in this study. All patients and control groups withdrew blood samples for measurement of human protein Z level. The study data were collected from medical notes and laboratory data. All patients were followed up for 28 days from starting dosage of induction chemotherapy regimen.
In our study we found that Protein Z level was higher in control group in comparison to studied group with high statistically significance.
After recording the results and using the suitable statistic methods, we found that Protein Z level was higher in patients with bleeding episodes during induction than those without bleeding without statistically significance while statistically significance was detected only between protein Z level and GIT bleeding in studied patients.
Protein Z level was high in thrombocytopenic patients without statistically significance while it was high in patients with normal PT and PTT without statistically significance detected.
Moreover high statistically significance was detected on serial follow up of platelet count and prothrombin time of patients group during the induction chemotherapy up to day 28.
In this held study Protein Z levels were higher in patients with high fibrinogen levels than patient with normal or low fibrinogen levels without statistically significance.
At the end of our conducted study we found that Protein Z level was higher in patients received (2+5) induction chemotherapy regimen in comparison to those received (3+7) with statistically significance.