Hypofibrinogenemia and coagulation factor deficiencies with L-asparaginase treatment

Thirteen patients with acute leukemia were treated with L-asparaginase. Abnormalities of blood coagulation and fibrinolysis developed in all 13 patients. Decreased levels of fibrinogen, Factors V, VII-X, VIII, and IX with decreased plasminogen concentration and fibrinogen degradation products in serum were the most common abnormalities. Two patients developed hemorrhagic or thrombotic complications related to this abnormal hemostasis. The underlying mechanism of these changes is thought to be limited disseminated intravascular coagulation combined with decreased synthesis of coagulation factors.