Leukostasis and hyperleukocytosis
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
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
References
This article is issued from
Wikem.
The text is licensed under Creative
Commons - Attribution - Sharealike.
Additional terms may apply for the media files.