Clinico-hematological and Coagulation Profiles in Newly Diagnosed Acute Myeloid Leukemia Patients Treated With Intensive Induction Chemotherapy .

Acute myeloid leukemia (AML) is a heterogeneous hematological malignancy characterized by clonal proliferation of myeloid precursors in the bone marrow, leading to impaired hematopoiesis and bone marrow failure\[1,2\]. Which results in ineffective erythropoiesis and megakaryopoiesis , clinically manifesting as relatively rapid bone marrow failure compared to chronic and indolent leukemias. This lead to inadequate production of red blood cells and platelets. Patients with AML frequently present with cytopenias, including thrombocytopenia, which significantly increases the risk of bleeding complications. Bleeding is a major clinical concern in AML, with studies reporting that 40-70% of patients experience bleeding manifestations at diagnosis\[3,4\]. Disseminated intravascular coagulation is a particularly significant complication in AML, occurring in 10-40% of patients at presentation. The presence of overt DIC at diagnosis has been shown to be a strong predictor of both bleeding and thrombotic events, as well as early mortality in AML patients\[7,8\]. The pathogenesis of DIC in AML is thought to involve the release of tissue factor-like material and cytokines from leukemic blasts, which activate the coagulation cascade and lead to widespread fibrin formation and consumption of clotting factors. This consumptive coagulopathy results in a paradoxical state where patients are at risk for both thrombosis and severe bleeding\[7,8\]. In addition to DIC, primary hemostatic defects have been identified as important contributors to bleeding risk in AML. Studies have demonstrated that von Willebrand factor (vWF) activity, specifically vWF ristocetin cofactor activity (vWF:RCo), is significantly reduced in AML patients at diagnosis and correlates with the severity of bleeding manifestations\[9,10\]. Lower vWF:RCo activity has been observed in patients with major bleeding episodes, suggesting its potential as a prognostic marker for bleeding risk independent of other laborator