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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
- Fever
- 80% of patients
- May be due to inflammation associated with leukostasis or concurrent infection
- Brain Leukostasis
- Pulmonary Leukostasis
Differential Diagnosis
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
References