acute leukemia and hyperkeukocytosis
- related: Oncology
- tags: #literature #hemeonc
- include hyperleukocytosis in presentation
- schistocytes: DIC
- aka leukostasis
- blasts > 50 with symptoms
-
80 very concerning
-
100 ppx leukopheresis
- develops from acute leukemia, problem from too much blasts
- brain and lungs most commonly involved
- pseudohypoxemia and pseudohyperkalemia: so many cells in blood samples drawn up that gobble up all oxygen = artificially low PaO2 than SpO2 on monitor. Lysis in the sample leads to artificially high K. (very high WBC can cause false hypoxemia leukocyte larceny)
- recent years shift in management
- cytoreduction is core (treatment of underlying malignancy)
- leukapheresis: actually mixed data on efficacy. In general practice moved away from leukaphresis1
This patient does not meet criteria for hyperleukocytosis, which is a total leukemic blood cell count of 50,000-100,000/μL (50-100 × 109/L), most typically seen in patients with hematologic malignancies such as acute myeloid leukemia (AML) or chronic myeloid leukemia (CML). Patients with CML rarely develop symptoms of leukostasis in the chronic phase, but it can be seen in myeloid blast crisis with very high blast counts. Leukostasis can occur when WBCs coalesce in the microvasculature, and most commonly presents with respiratory distress and/or neurological symptoms. It is characterized by a high blast cell count and evidence of decreased tissue perfusion. Pulmonary signs and symptoms include dyspnea and hypoxia, with variable interstitial or alveolar infiltrates on chest radiography. A hallmark is decreased PO2 on arterial blood gas measurement due to oxygen uptake by the large numbers of blast cells. Pulse oximetry should be used to assess SpO2. Neurological signs and symptoms include visual changes, headache, dizziness, tinnitus, gait instability, and decreased levels of consciousness. Patients with hyperleukocytosis have an increased risk of intracranial hemorrhage that persists for at least a week after the reduction of the WBC count, perhaps from a reperfusion injury. Leukapheresis is used as initial therapy for leukostasis, as rapid lowering of the WBC count is essential, but is not indicated in this case.