Leukostasis and hyperleukocytosis: Difference between revisions
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== Background  ==
== Background  ==
 
*Hyperleukocytosis is lab abnormality of WBC >50-100K
*Pathologic diagnosis where WBC plugs seen in microvasculature
*Leukostasis is symptomatic hyperleukocytosis; it is a medical emergency
*High blast cell counts, blood viscosity is increased
**Most commonly seen in pts w/ AML or CML in blast crisis
*Blood flow is slowed by aggregates of tumor cells, and the primitive leukemic cells are capable of invading through endothelium and causing hemorrhage
**High blast cell count > WBC plugs in microvasculature
*Usually seen in pts with AML, not seen in CML or CLL
***Brain and lung are most commonly affected
*WBC count usu >100k, can happen as low as 50K
*Brain and lung are most commonly affected


== Clinical Features  ==
== Clinical Features  ==
*Brain Leukostasis
*Brain Leukostasis
**headache
**Headache
**stupor
**Dizziness
**dizziness
**Tinnitus
**tinnitus
**Visual disturbances
**visual disturbances
**Ataxia
**ataxia
**Confusion
**confusion
**Stupor
**coma
**Coma
**sudden death
**Sudden death
 
*Pulmonary Leukostasis
*Pulmonary Leukostasis
**respiratory distress
**Respiratory distress
**hypoxemia
**Hypoxemia
**respiratory failure
**Respiratory failure


== Diagnosis  ==
== Diagnosis  ==
*High degree of suspicion to make diagnosis
*High degree of suspicion needed to make the diagnosis
*WBC count usu >100k, can happen as low as 50K + symptoms from tissue hypoxia
*WBC count usually >100K; can have symptoms w/ WBC as low as 50K
*CXR usu show interstial or alveolar infiltrates
*CXR
**Interstial or alveolar infiltrates


== Treatment  ==
== Treatment  ==
#IV hydration
#Hyperleukocytosis (asymptomatic)
##Prevent dehydration which can worsen condition
##Hydoxyurea may be all that is required
#Chemotherapy
#Leukostasis
##Only treatment proven to improve survival
##IV hydration
#Hydroxyurea + leukapheresis  
###Prevent dehydration which can worsen condition
##Can be use for cytoreduction if chemo will be delayed
##Chemotherapy
###Only treatment proven to improve survival
##Hydroxyurea + leukapheresis  
###Can be use for cytoreduction if chemo will be delayed


== Disposition  ==
== Disposition  ==

Revision as of 03:21, 23 October 2011

Background

  • Hyperleukocytosis is lab abnormality of WBC >50-100K
  • Leukostasis is symptomatic hyperleukocytosis; it is a medical emergency
    • Most commonly seen in pts w/ AML or CML in blast crisis
    • High blast cell count > WBC plugs in microvasculature
      • Brain and lung are most commonly affected

Clinical Features

  • Brain Leukostasis
    • Headache
    • Dizziness
    • Tinnitus
    • Visual disturbances
    • Ataxia
    • Confusion
    • Stupor
    • Coma
    • Sudden death
  • Pulmonary Leukostasis
    • Respiratory distress
    • Hypoxemia
    • Respiratory failure

Diagnosis

  • 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

  1. Hyperleukocytosis (asymptomatic)
    1. Hydoxyurea may be all that is required
  2. Leukostasis
    1. IV hydration
      1. Prevent dehydration which can worsen condition
    2. Chemotherapy
      1. Only treatment proven to improve survival
    3. Hydroxyurea + leukapheresis
      1. Can be use for cytoreduction if chemo will be delayed

Disposition

  • Admit to ICU

Source

  • Harrison's Internal Medicine Oncologic Emergencies
  • Uptodate
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