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 | ||
*Blood viscosity increases | |||
*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 patients with leukostasis die within 1st week of presentation | |||
== Clinical Features | ==Clinical Features== | ||
*[[Fever]] | |||
**80% of patients | |||
**May be due to inflammation associated with leukostasis or concurrent infection | |||
*Brain Leukostasis | *Brain Leukostasis | ||
**Headache | **[[Headache]] | ||
**Dizziness | **[[Dizziness]] | ||
**Tinnitus | **[[Tinnitus]] | ||
**Visual disturbances | **[[Visual disturbances]] | ||
**Ataxia | **[[Ataxia]] | ||
**Confusion | **[[Confusion]] | ||
**Stupor | **Stupor | ||
**Coma | **[[Coma]] | ||
**Sudden death | **Sudden death | ||
*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]] | ||
== Diagnosis | ==Differential Diagnosis== | ||
{{Oncologic emergencies DDX}} | |||
==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 | *High degree of suspicion needed to make the diagnosis | ||
*WBC count usually >100K; can have symptoms | *WBC count usually >100K; can have symptoms with WBC as low as 50K | ||
*CXR | *[[CXR]] | ||
**Interstial or alveolar infiltrates | **Interstial or alveolar infiltrates | ||
== | ==Management== | ||
*Hyperleukocytosis (asymptomatic) | |||
**[[Hydroxyurea]] 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 | |||
*[[Allopurinol]] may help prevent [[Tumor lysis syndrome]] | |||
*Consider [[rasburicase]] | |||
*Broad spectrum [[antibiotics]] | |||
**The leading cause of death in blast crisis is infection (patients are functionally [[neutropenia|neutropenic]]) | |||
== Disposition | ==Disposition== | ||
*Admit to ICU | *Admit to ICU | ||
== | ==References== | ||
<references/> | |||
[[Category:Heme/Onc]] | [[Category:Heme/Onc]] | ||
Latest revision as of 02:32, 11 January 2022
Background
- Hyperleukocytosis is lab abnormality of WBC >50-100K
- Blood viscosity increases
- Leukostasis is symptomatic hyperleukocytosis; it is a medical emergency
- 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
- Respiratory distress
- Hypoxemia
- ABG may show falsely decreased PaO2; pulse oximetry is more accurate
- Respiratory failure
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
Management
- Hyperleukocytosis (asymptomatic)
- Hydroxyurea 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
- Allopurinol may help prevent Tumor lysis syndrome
- Consider rasburicase
- Broad spectrum antibiotics
- The leading cause of death in blast crisis is infection (patients are functionally neutropenic)
Disposition
- Admit to ICU