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Coagulation Profile at Diagnosis in Patients with Acute Lymphoblastic Leukemia. OBJECTIVE: To evaluate the coagulation parameters at the time of diagnosis in pediatric acute lymphoblastic leukemia (ALL) patients. METHODS: A total of 65 newly diagnosed ALL patients upto 18 y of age along with 30 age and sex matched controls were included in the study. Coagulation tests including Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), Fibrinogen (FBG) assay, D-dimer (D-DI) assay, Coagulation inhibitor levels and tests for fibrinolysis were performed. RESULTS: At baseline, APTT of the patients was significantly prolonged (p 0.033), but PT and fibrinogen were comparable in the two groups. Protein C (PC) and Protein S (PS) were both significantly reduced in the cases, while antithrombin was comparable to control values (p < 0.001, p < 0.001 & p = 0.828 respectively). Tissue plasminogen activator levels (tPA) were significantly lower in the cases (p < 0.001) but Plasminogen activator inhibitor type 1 (PAI-1) values were comparable. D-DI levels were significantly high (p < 0.001). CONCLUSIONS: The onset of leukemia is associated with hemostatic derangement favouring hypercoagulability. The coagulopathy is due to thrombin activation (as evidenced by raised d-dimer). The decreased fibrinolysis (due to reduced tPA and raised PAI-1) and low levels of PC and PS contribute to the hypercoagulable state at the time of diagnosis.