International Journal of Hematology

, Volume 110, Issue 6, pp 743–750 | Cite as

Supportive care for hemostatic complications associated with pediatric leukemia: a national survey in Japan

  • Shinya OsoneEmail author
  • Keitaro Fukushima
  • Michihiro Yano
  • Mariko Kakazu
  • Hirozumi Sano
  • Yoko Kato
  • Yuichi Shinkoda
  • Kunihiro Shinoda
  • Naoko Mori
  • Souichi Adachi
Original Article


Optimal supportive care for disseminated intravascular coagulation (DIC) and hemostatic complications by asparaginase is indispensable for the successful treatment of pediatric leukemia. However, the situation regarding this type of care in Japan is unclear. We conducted a questionnaire-based survey at 155 institutions treating childhood leukemia in Japan. The questionnaire asked about the supportive care provided by each institution to acute leukemia patients with DIC and asparaginase-induced hemostatic alterations. Ninety-eight institutions responded. The most common diagnostic criteria for DIC were those established by the Japanese Ministry of Health and Welfare. Regardless of the etiology underlying DIC, recombinant human thrombomodulin and synthetic protease inhibitors were used as anticoagulation therapy by around 70% and 40% of institutions, respectively. Additionally, 92%, 93%, and 73% of institutions measured plasma antithrombin, fibrinogen, and D-dimer/fibrin degradation products, respectively, more than twice per week during induction therapy for acute lymphoblastic leukemia. Survey responses indicate that 95% and 24% of the institutions used antithrombin replacement and fresh-frozen plasma, respectively. Supportive care for DIC and/or asparaginase-induced hemostatic alterations at Japanese pediatric centers was intensive and differs markedly from protocols in other countries. The efficacy of supportive care should be evaluated prospectively in the setting of pediatric leukemia.


Leukemia Children Disseminated intravascular coagulation Asparaginase-induced thrombosis Supportive care 



Acute lymphoblastic leukemia


Disseminated intravascular coagulation


The Japanese Pediatric Leukemia/Lymphoma Study Group


Fibrin degradation products


Fresh-frozen plasma


The Japanese Ministry of Health and Welfare


The Japanese Society on Thrombosis and Hemostasis


The Japanese Association for Acute Medicine


The International Society on Thrombosis and Hemostasis


Recombinant human thrombomodulin





We thank all participants listed in Supplemental material 2 for answering the questions.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Supplementary material

12185_2019_2740_MOESM1_ESM.docx (27 kb)
Supplementary file1 (DOCX 26 kb)
12185_2019_2740_MOESM2_ESM.docx (17 kb)
Supplementary file2 (DOCX 16 kb)


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Copyright information

© Japanese Society of Hematology 2019

Authors and Affiliations

  1. 1.Department of Pediatrics, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
  2. 2.Department of PediatricsDokkyo Medical University School of MedicineTochigiJapan
  3. 3.Department of PediatricsAkita University HospitalAkitaJapan
  4. 4.Pediatric Hematology and Oncology DepartmentOkinawa Prefectural Medical Center and Children’s Medical CenterOkinawaJapan
  5. 5.Department of PediatricsSapporo Hokuyu HospitalHokkaidoJapan
  6. 6.Department of PediatricsJikei University School of MedicineTokyoJapan
  7. 7.Department of PediatricsKagoshima City HospitalKagoshimaJapan
  8. 8.Department of PediatricsGifu Municipal HospitalGifuJapan
  9. 9.Akabane Zaitaku ClinicTokyoJapan
  10. 10.Human Health Sciences, Graduate School of MedicineKyoto UniversityKyotoJapan

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