Leukostasis and hyperleukocytosis: Difference between revisions
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==Background == | ==Background== | ||
*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 | ||
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*20-40% of patients with leukostasis die within 1st week of presentation | *20-40% of patients with leukostasis die within 1st week of presentation | ||
==Clinical Features == | ==Clinical Features== | ||
*[[Fever]] | *[[Fever]] | ||
**80% of patients | **80% of patients | ||
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**Interstial or alveolar infiltrates | **Interstial or alveolar infiltrates | ||
==Treatment == | ==Treatment== | ||
*Hyperleukocytosis (asymptomatic) | *Hyperleukocytosis (asymptomatic) | ||
**Hydoxyurea may be all that is required | **Hydoxyurea may be all that is required | ||
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***Can be use for cytoreduction if chemo will be delayed | ***Can be use for cytoreduction if chemo will be delayed | ||
==Disposition == | ==Disposition== | ||
*Admit to ICU | *Admit to ICU | ||
Revision as of 18:50, 3 August 2016
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 patients
- May be due to inflammation associated with 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
Evaluation
Work-Up
- CBC
- DIC labs
- DIC occurs in up to 40% of patients
- FDP, d-dimer, fibrinogen, coags
- Tumor Lysis Syndrome labs
- TLS occurs in up to 10% of patients
- Chemistry
- Uric acid
- Calcium
- Phosphate
Evaluation
- High degree of suspicion needed to make the diagnosis
- WBC count usually >100K; can have symptoms with 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