Leukostasis and hyperleukocytosis: Difference between revisions
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*Hyperleukocytosis is lab abnormality of WBC >50-100K | *Hyperleukocytosis is lab abnormality of WBC >50-100K | ||
*Leukostasis is symptomatic hyperleukocytosis; it is a medical emergency | *Leukostasis is symptomatic hyperleukocytosis; it is a medical emergency | ||
**Most commonly seen | **Most commonly seen with [[AML]] or [[CML]] in [[blast crisis]] | ||
**High blast cell count > WBC plugs in microvasculature | **High blast cell count > WBC plugs in microvasculature | ||
***Brain and lung are most commonly affected | ***Brain and lung are most commonly affected | ||
*20-40% of | *20-40% of patients with leukostasis die within 1st week of presentation | ||
== Clinical Features == | == Clinical Features == | ||
*Fever | *[[Fever]] | ||
**80% of pts | **80% of pts | ||
**May be due to inflammation associated w/ leukostasis or concurrent infection | **May be due to inflammation associated w/ leukostasis or concurrent infection | ||
*Brain Leukostasis | *Brain Leukostasis | ||
**Headache | **[[Headache]] | ||
**Dizziness | **[[Dizziness]] | ||
**Tinnitus | **[[Tinnitus]] | ||
**Visual disturbances | **Visual disturbances | ||
**Ataxia | **[[Ataxia]] | ||
**Confusion | **Confusion | ||
**Stupor | **Stupor | ||
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*Pulmonary Leukostasis | *Pulmonary Leukostasis | ||
**Respiratory distress | **Respiratory distress | ||
**Hypoxemia | **[[Hypoxemia]] | ||
***ABG may show falsely decreased PaO2; pulse oximetry is more accurate | ***[[ABG]] may show falsely decreased PaO2; pulse oximetry is more accurate | ||
**Respiratory failure | **Respiratory failure | ||
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*CBC | *CBC | ||
*DIC labs | *DIC labs | ||
**DIC occurs in up to 40% of pts | **[[DIC]] occurs in up to 40% of pts | ||
**FDP, d-dimer, fibrinogen, coags | **FDP, d-dimer, fibrinogen, coags | ||
*Tumor Lysis Syndrome labs | *Tumor Lysis Syndrome labs | ||
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*High degree of suspicion needed to make the diagnosis | *High degree of suspicion needed to make the diagnosis | ||
*WBC count usually >100K; can have symptoms w/ WBC as low as 50K | *WBC count usually >100K; can have symptoms w/ WBC as low as 50K | ||
*CXR | *[[CXR]] | ||
**Interstial or alveolar infiltrates | **Interstial or alveolar infiltrates | ||
Revision as of 07:08, 29 August 2015
Background
- Hyperleukocytosis is lab abnormality of WBC >50-100K
- Leukostasis is symptomatic hyperleukocytosis; it is a medical emergency
- Most commonly seen with AML or CML in blast crisis
- High blast cell count > WBC plugs in microvasculature
- Brain and lung are most commonly affected
- 20-40% of patients with leukostasis die within 1st week of presentation
Clinical Features
- Fever
- 80% of pts
- May be due to inflammation associated w/ leukostasis or concurrent infection
- Brain Leukostasis
- Pulmonary Leukostasis
Differential Diagnosis
Oncologic Emergencies
Related to Local Tumor Effects
- Malignant airway obstruction
- Bone metastases and pathologic fractures
- Malignant spinal cord compression
- Malignant Pericardial Effusion and Tamponade
- Superior vena cava syndrome
Related to Biochemical Derangement
- Hypercalcemia of malignancy
- Hyponatremia due to SIADH
- Adrenal insufficiency
- Tumor lysis syndrome
- Carcinoid syndrome
Related to Hematologic Derangement
Related to Therapy
- Chemotherapy-induced nausea and vomiting
- Cytokine release syndrome
- Chemotherapeutic drug extravasation
- Differentiation syndrome (retinoic acid syndrome) in APML
- Stem cell transplant complications
- Catheter-related complications
- Tunnel infection
- Exit site infection
- CVC obstruction (intraluminal or catheter tip thrombosis)
- Catheter-related venous thrombosis
- Fracture of catheter lumen
- Oncologic therapy related adverse events
Diagnosis
Work-Up
- CBC
- DIC labs
- DIC occurs in up to 40% of pts
- FDP, d-dimer, fibrinogen, coags
- Tumor Lysis Syndrome labs
- TLS occurs in up to 10% of pts
- Chemistry
- Uric acid
- Calcium
- Phosphate
Evaluation
- High degree of suspicion needed to make the diagnosis
- WBC count usually >100K; can have symptoms w/ WBC as low as 50K
- CXR
- Interstial or alveolar infiltrates
Treatment
- Hyperleukocytosis (asymptomatic)
- Hydoxyurea may be all that is required
- Leukostasis
- IV hydration
- Prevent dehydration which can worsen condition
- Chemotherapy
- Only treatment proven to improve survival
- Hydroxyurea + leukapheresis
- Can be use for cytoreduction if chemo will be delayed
- IV hydration
Disposition
- Admit to ICU