Leukostasis and hyperleukocytosis: Difference between revisions
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Harrison's Internal Medicine Oncologic Emergencies & Uptodate | Harrison's Internal Medicine Oncologic Emergencies & Uptodate | ||
[Category:Heme/Onc]] | [[Category:Heme/Onc]] | ||
Revision as of 20:16, 16 October 2011
Background
- Pathologic diagnosis where WBC plugs seen in microvasculature
- High blast cell counts, blood viscosity is increased
- Blood flow is slowed by aggregates of tumor cells, and the primitive leukemic cells are capable of invading through endothelium and causing hemorrhage
- Usually seen in pts with AML, not seen in CML or CLL
- WBC count usu >100k, can happen as low as 50K
- Brain and lung are most commonly affected
Clinical Features
- Brain Leukostasis
- headache
- stupor
- dizziness
- tinnitus
- visual disturbances
- ataxia
- confusion
- coma
- sudden death
- Pulmonary Leukostasis
- respiratory distress
- hypoxemia
- respiratory failure
Diagnosis
- high degree of suspicion to make diagnosis
- WBC count usu >100k, can happen as low as 50K + symptoms from tissue hypoxia
- CXR usu show interstial or alveolar infiltrates
Treatment
- IV hydration to prevent dehydration that can worsen condition
- Avoid unnecessary transfusions
- Induction Chemo best treatment, improves survival
- Leukapheresis and Hydroxyurea can be use for cytoreduction while chemo being set up
Disposition
- Admit to ICU
Source
Harrison's Internal Medicine Oncologic Emergencies & Uptodate