Abstract
Emergency providers are likely to encounter patients with acute and chronic leukemias. The first presentation to the ED may be for symptoms related to blast crisis and leukostasis. Making a timely diagnosis and immediately consulting a hematologist can be life-saving. Presenting symptoms are due to complications of bone marrow infiltration and hyperleukocytosis with WBC counts over 100,000. Presentations may include fatigue (anemia), bleeding (thrombocytopenia), shortness of breath, and/or neurological symptoms owing to hyperleukocytosis and subsequent leukostasis. Blast crisis with leukostasis is a Heme/Onc emergency. Treatment of symptomatic cases involves induction chemotherapy and/or leukapheresis. Asymptomatic hyperleukocytosis can be treated with hydroxyurea.
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References
Vardiman JW, Harris NL, Brunning RD. The World Health Organization (WHO) classification of the myeloid neoplasms. Blood. 2002;100(7):2292–302.
Dutcher JP, Schiffer CA, Wiernik PH. Hyperleukocytosis in adult acute nonlymphocytic leukemia: impact on remission rate and duration, and survival. J Clin Oncol. 1987;5(9):1364–72.
Canaani J, et al. Long term impact of hyperleukocytosis in newly diagnosed acute myeloid leukemia patients undergoing allogeneic stem cell transplantation: an 9analysis from the acute leukemia working party of the EBMT. Am J Hematol. 2017;92(7):653–9.
Jabbour E, Kantarjian H. Chronic myeloid leukemia: 2014 update on diagnosis, monitoring, and management. Am J Hematol. 2014;89(5):547–56.
Lichtman MA. Rheology of leukocytes, leukocyte suspensions, and blood in leukemia possible relationship to clinical manifestations. J Clin Invest. 1973;52(2):350–8.
Lichtman MA, Weed RI. Peripheral cytoplasmic characteristics of leukocytes in monocytic leukemia: relationship to clinical manifestations. Blood. 1972;40(1):52–61.
Schiffer CA, Wiernik PH. Functional evaluation of circulating leukemic cells in acute non-lymphocytic leukemia. Leuk Res. 1977;1(4):271–7.
Stucki A, Rivier AS, Gikic M, et al. Endothelial cell activation by myeloblasts: molecular mechanisms of leukostasis and leukemic cell dissemination. Blood. 2001;97:2121.
Porcu P, et al. Hyperleukocytic leukemias and leukostasis: a review of pathophysiology, clinical presentation and management. Leuk Lymphoma. 2000;39(1–2):1–18.
Perazella MA, et al. Renal failure and severe hypokalemia associated with acute myelomonocytic leukemia. Am J Kidney Dis. 1993;22(3):462–7.
Awh CC, et al. Leukostasis retinopathy: a new clinical manifestation of chronic myeloid leukemia with severe hyperleukocytosis. Ophthalmic Surg Lasers Imaging Retina. 2015;46(7):768–70.
Ali AM, et al. Leukostasis in adult acute hyperleukocytic leukemia: a clinician’s digest. Hematol Oncol. 2016;34(2):69–78.
Bellevue R, et al. Pseudohyperkalemia and extreme leukocytosis. J Lab Clin Med. 1975;85(4):660–4.
Karp DD, Beck JR, Cornell CJ. Chronic granulocytic leukemia with respiratory distress: efficacy of emergency leukapheresis. Arch Intern Med. 1981;141(10):1353–4.
Lane TA. Continuous-flow leukapheresis for rapid cytoreduction in leukemia. Transfusion. 1980;20(4):455–7.
Eisenstaedt RS, Berkman EM. Rapid cytoreduction in acute leukemia: management of cerebral leukostasis by cell pheresis. Transfusion. 1978;18(1):113–5.
Bug G, et al. Impact of leukapheresis on early death rate in adult acute myeloid leukemia presenting with hyperleukocytosis. Transfusion. 2007;47(10):1843–50.
Giles FJ, et al. Leukapheresis reduces early mortality in patients with acute myeloid leukemia with high white cell counts but does not improve long term survival. Leuk Lymphoma. 2001;42(1–2):67–73.
Ganzel C, et al. Hyperleukocytosis, leukostasis and leukapheresis: practice management. Blood Rev. 2012;26(3):117–22.
Ruggiero A, et al. Management of hyperleukocytosis. Curr Treat Options in Oncol. 2016;17(2):7.
Harris AL. Leukostasis associated with blood transfusion in acute myeloid leukaemia. Br Med J. 1978;1(6121):1169–71.
Grund FM, Armitage JO, Patrick Burns C. Hydroxyurea in the prevention of the effects of leukostasis in acute leukemia. Arch Intern Med. 1977;137(9):1246–7.
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Geremiha Emerson has no disclosures. Colin Kaide: Callibra, Inc.-Discharge 123 medical software company. Medical Advisory Board Portola Pharmaceuticals. I have no relationship with a commercial company that has a direct financial interest in subject matter or materials discussed in article or with a company making a competing product.
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Kaide, C.G., Emerson, G. (2020). Acute Blast Crisis/Hyperviscosity Syndrome: Blasting Off! . In: Kaide, C., San Miguel, C. (eds) Case Studies in Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-22445-5_3
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DOI: https://doi.org/10.1007/978-3-030-22445-5_3
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