Leukostasis Flashcards
what is leukostasis?
happens when WBC >100K
see blast mediated vaso-occlusive event
can occur with AML, ALL, and less commonly with CLL and CML
leukostasis presentation
see hyperleukocytosis and seen in AML
blood slows because aggregates of tumor cells and myeloid blasts traverse the endothelium and cause hemorrhage in brain and lungs
cerebral leukostasis presentation
stupor, headache, dizziness, tinnitus, visual disturbance, ataxia, confusion, coma and death
high risk for ICH that remains for up to 1 week after reduction in white cell count
80% of pts have fever because of inflammation or concomitant infection.
see focal deficits and retinal vein hemorrhages
pulmonary leukostasis can be seen as
respiratory distress and hypoxemia
can lead to respiratory failure
CXR may be normal
Arterial blood gas may reveal a falsely low pO2 due to metabolically active cancer cells consuming oxygen. PUlse oximetry provides a more accurate representation of oxygen saturation.
SEe priapism, MI, leg ischemia and retina vein thrombosis
what is leukocytosis triaging?
it’s a medical emergency
tx needs cytoreduciton to lower WBC count
1st line treatment is with
induction chemotherapy - only way to lower mortality
use cytarabine and anthracycline and daunoruibcin and idarubicin and mitoxantrone
can give hydroxyurea
Need to give IVF and allopurinol or rasburicase to prevent tumor lysis syndrome
what is hemaphresis
removal of constituent of blood
leukapheresis is
removal of WBC to decrase risk of luekostasis.
symptomatic leukostasis and pt cannot get induction chemistry or it’s delayed. what to do?
do leukapheresis and hydroxyurea
when to delay induction chemotherapy?
if there’s renal insufficiency or severe metabolic disturbances or does not have CVC access.
IS there any role for steroids like dexamethasone and leukostasis?
seems to help only in acute promyelocytic anemia.
still induction chemotherapy is the only way to reduce mortality in symptomatic leukostasis pts
