At the same level of thrombocytopenia, patients with acute lymphoblastic leukemia (ALL), receive more prophylactic platelet transfusion in comparison to immune thrombocytopenia (ITP). Routine investigation cann’t differentiate the risk of bleeding between ALL and ITP. Sonoclot is a global test of coagulation, a bed side tool, also assesses platelet function. It is widely used in cardiac surgery and hepatology to assess need for blood plasma and platelet transfusion. Aim of the study was to evaluate role of sonoclot in assessing the risk of bleeding in ALL with severe thrombocytopenia.
In this prospective observational study, twenty-five cases of ALL and fifty cases of ITP (control) were included. All patients included had platelet counts lower than 20000/μL and there was no evidence of any active bleeding. Blood samples were evaluated by conventional coagulation tests as well as by Sonoclot. Sonoclot measures activated clotting time (ACT), clot rate (R1) and platelet function (PF).
Comparison of ALL and Control (ITP)
|ITP (n = 50)||ALL (n = 25)|
|Parameters||(mean ± SD)||(mean ± SD)||p||Normal Value|
|Platelet (/μL)||9536.73 ± 5048.05||12240 ± 4576.02||NS||150000-450000|
|Prothombin time (seonds)||14.1 ± 1.43||14.72 ± 2.13||NS||11-14|
|Activated partial thromboplastin time (seconds)||29.66 ± 1.99||29.77 ± 2.13||NS||25-35|
|ACT (seconds)||251.1 ± 37.97||260.16 ± 51.2||NS||100-155|
|CR (unit)||22.17 ± 6.43||19.56 ± 4.55||0.371||9-35|
|PF (unit)||1.54 ± 0.72||0.94 ± .83||0.007||>1.6|
Both the groups were matched for platelet count. There was no statistically significant difference between two groups when prothrombin time and activated partial thromboplastin time were compared. On sonoclot analysis, the ACT did not show any difference in the two groups, and though clot rate (CR) was different in two groups, it was not statistically significant. However, platelet function (PF) was significantly lower in the ALL than the ITP group (Table).
This is the first study to the best of our knowledge demonstrating the use of sonoclot in ALL with severe thrombocytopenia. We conclude that sonoclot, a point of care device, can assess the risk of bleeding amongst patients with ALL.
Clinical trial identification
Legal entity responsible for the study
Has not received any funding.
All authors have declared no conflicts of interest.