blood count itself, but complications such as leukostasis, tumor lysis syndrome ( TLS) and disseminated intravascular coagulation (DIC) put the. Pol Merkur Lekarski. Jan;6(31) [Leukostasis syndrome in a case of chronic lymphocytic leukemia]. [Article in Polish]. Durzyński T(1), Konopka L. It can induce leukostasis, tumor lysis syndrome and disseminated intravascular coagulopathy and has significant prognostic implications with.

Author: Shakree Shami
Country: Poland
Language: English (Spanish)
Genre: History
Published (Last): 25 July 2009
Pages: 105
PDF File Size: 19.61 Mb
ePub File Size: 2.9 Mb
ISBN: 748-7-15860-842-7
Downloads: 7700
Price: Free* [*Free Regsitration Required]
Uploader: Taukora

Hyperleukocytosis and leukostasis: management of a medical emergency.

Articles by O’Doherty, U. Klin Padiatr 6: The side effects with hydroxyurea are minimal and typically occur in patients who take hydroxyurea for prolonged periods. Bleeding and thrombotic complications secondary to coagulopathy or cytopenias are always on the differential and can cause clinical complications that can mimic the presentation of leukostasis.

Therefore, leukapheresis should be considered to be a temporizing measure. All were retrospective and had moderate to high confounding bias. Nervous system symptoms include mental status changes, delirium, confusion, headache, dizziness, leukostasiz tinnitus. ATRA can cause headache.

Hyperleukocytosis, leukostasis and leukapheresis: practice management.

Allergic disorders Asthma [3] Hay fever [3] Syndrlme allergies [3] Allergic skin diseases [3] Pemphigus [3] Dermatitis herpetiformis Parasitic infections [3] Some forms of malignancy Hodgkin’s lymphoma [3] Some forms of Non-Hodgkin lymphoma [3] Systemic autoimmune diseases [3] e.

This article may be in need of reorganization to comply with Wikipedia’s layout guidelines. Leuk Lymphoma 39 A typical dosing strategy used in our practice is grams HU po q 6 hours. Extrapulmonary signs and symptoms in the central nervous system can range from headache to mild confusion eyndrome somnolence to coma. Disseminated intravascular coagulation syndrpme occur in a significant number of patients with presentation of various degrees of thrombin generation, followed by decreased fibrinogen and increased fibrinolysis.

Catherine Jones MD Published electronically: Diagnosis Diagnostic criteria and tests Other possible diagnoses 4.

Supportive care is necessary in all patients with leukostasis. Primary lymphedema Congenital lymphedema Lymphedema praecox Lymphedema tarda Lymphedema—distichiasis syndrome Milroy’s disease Secondary lymphedema Bullous lfukostasis Factitial lymphedema Postinflammatory lymphedema Postmastectomy lymphangiosarcoma Waldmann disease. Cytoreduction methods include chemotherapy, utilizing the drug hydroxyurea Hydroxyurea is usually used in asymptomatic hyperleukocytosisand the less common leukapheresis procedure.


Leukostasis is a diagnostic challenge for clinicians due to non-specific symptoms and radiographic presentation. Ground glass opacities, micronodules, or airspace consolidation. Laboratory abnormalities seen in those with leukostasis include a markedly elevated white blood cell count hyperleukocytosis and electrolyte abnormalities seen with tumor lysis syndrome such as high concentrations of potassiumphosphorusand uric acid in the blood and a low level of calcium in the blood due to being bound by high amounts of circulating phosphorus.

Leukocytapheresis is often used prophylactically to prevent leukostasis or to improve its clinical symptoms. Once a definitive diagnosis is made, disease-specific therapies aimed at cytoreduction can be considered. Prognosis of patients suffering from hyperleukocytosis is dependent on the cause and type of leukemia the patient has.

Novotny et al 12 have proposed a clinical grading scale to leu,ostasis the risk of leukostasis in patients with hyperleukocytic leukemia.

White blood cell levels either rise in distinct white blood levels or in unison with others, a patient may be suffering from neutrophilialymphocytosismonocytosiseosinophiliabasophllia or a rise in immature blast cells.

Chemotherapy should be implemented as quickly as possible to prevent rapid accumulation of circulating blasts. History of positive fluid intake, multiple transfusion, cardiotoxic medication, and renal failure. Hyperleukocytosis is arbitrarily defined as greater thanwhite blood cells per microliter of blood. Leukostasis is different from leukemic infiltration which is a neoplastic process where leukemic cells invade organs.

Leuk Res 38 4: It is appropriate to request an emergent medical oncology and pathology consultation regardless of time of day. Despite the frequent use of leukocytapheresis in the management of acute leukostasiz, no randomized trials evaluating the use of leukocytapheresis in the treatment of hyperleukocytosis have been published.

Determine if the patient has a known diagnosis of a hematologic malignancy. Chronic myeloid leukemia – The majority of patients suffering from chronic myeloid leukemia usually suffer from hyperleuckocytosis.


The pathogenesis likely involves both changes in blood viscosity and the deformability of leukemic cells the synsrome of the cells to change shape when passing through blood vessels. The most common symptom is the patient is usually febrilewhich is often linked with inflammation and possible infection. Previous Section Next Section.

Hyperleukocytosis can lead to leukostasis, tumor lysis syndrome, and disseminated intravascular coagulation DIC. An accumulation of these symptoms leads to decreased levels of statistical survival compared to patients diagnosed with asymptomatic hyperleukocytosis alone. IVFs crystalloid should be started promptly. Major types of leukocytosis and their mechanisms depend on the types of Leukemia that cause them.


The clinical presentation of leukostasis is usually nonspecific. Make sure the test is sent on ICE to minimize metabolic activity of blasts. Platelet loss is a similar concern in leukemic patients undergoing leukocytapheresis. Medical Subject Headings, — Pulmonary embolus hypercoagulable state. For lung diseases such as pneumonia and tuberculosiswhite blood cell count is leukoatasis important for the diagnosis of the disease, as leukocytosis is usually present.

Radiation doses of cGy have been applied to the whole brain. The goal of leukocytapheresis is dependent on the starting WBC count and the patient’s symptoms. The main indication for leukapheresis is leukostasis and possibly asymptomatic hyperleukocytosis. When the anticoagulant is citrate, this requires the administration of calcium, which may cause calcium-phosphate precipitation and worsen tumor lysis syndrome. Semin Thromb Hemost 33 4: You can help by adding to it. Lwukostasis signs – Dyspnea and hypoxia with or without diffuse interstitial or alveolar infiltrates on imaging studies.