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 with [[AML]] or [[CML]] in [[Blast crisis]]
**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
*20-40% of patients with leukostasis die within 1st week of presentation


== Clinical Features ==
==Clinical Features==
*[[Fever]]
*[[Fever]]
**80% of patients
**80% of patients
**May be due to inflammation associated w/ leukostasis or concurrent infection
**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]]


==Differential Diagnosis==
==Differential Diagnosis==
{{Oncologic emergencies DDX}}
{{Oncologic emergencies DDX}}


== Diagnosis  ==
==Evaluation==
===Work-Up===
===Work-Up===
*CBC
*CBC
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**[[DIC]] occurs in up to 40% of patients
**[[DIC]] occurs in up to 40% of patients
**FDP, d-dimer, fibrinogen, coags
**FDP, d-dimer, fibrinogen, coags
*Tumor Lysis Syndrome labs
*[[Tumor Lysis Syndrome]] labs
**TLS occurs in up to 10% of patients
**TLS occurs in up to 10% of patients
**Chemistry
**Chemistry
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===Evaluation===
===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 w/ WBC as low as 50K
*WBC count usually >100K; can have symptoms with WBC as low as 50K
*[[CXR]]
*[[CXR]]
**Interstial or alveolar infiltrates
**Interstial or alveolar infiltrates


== Treatment  ==
==Management==
*Hyperleukocytosis (asymptomatic)
*Hyperleukocytosis (asymptomatic)
**Hydoxyurea may be all that is required
**[[Hydroxyurea]] may be all that is required
*Leukostasis
*Leukostasis
**IV hydration
**IV hydration
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**Chemotherapy
**Chemotherapy
***Only treatment proven to improve survival
***Only treatment proven to improve survival
**Hydroxyurea + leukapheresis  
**[[Hydroxyurea]] + leukapheresis  
***Can be use for cytoreduction if chemo will be delayed
***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==
 
<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
    • 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

Differential Diagnosis

Oncologic Emergencies

Related to Local Tumor Effects

Related to Biochemical Derangement

Related to Hematologic Derangement

Related to Therapy

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)
  • 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 neutropenic)

Disposition

  • Admit to ICU

References