Leukostasis is another life-threatening complication of leukemia where extremely high white blood cell counts lead to blood vessel obstruction, leading to ischemia and organ failure.
Immediate intervention is crucial.
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Immediate intervention is crucial.
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#PhysiologyFriday #Skytorial #MedStudentSky #OncSky
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🩸 Hyperleukocytosis = WBC >100,000
🩸 Leukostasis = symptomatic hyperleukocytosis
Physiology:
🩸 Increased blasts ➡️ release of cytokines that increase selectins and cell adhesion molecules ➡️ adhesion to endothelial cells ➡️ hyperviscosity ➡️ hypoxia
🩸 AML (most common) with WBC >150,000
🩸 ALL with WBC >400,000
🩸 CML accelerated phase or blast crisis
🩸 CLL with WBC >1,000,000
🩸Dyspnea, tachypnea, pulmonary crackles
🩸Headache, confusion, dizziness, blurry vision, seizures, focal deficits, coma
Complications:
🩸Stroke
🩸Myocardial infarction
🩸AKI
🩸Hypoxemic respiratory failure
🩸Priapism
🩸TLS
🩸Respiratory distress
🩸Neurological changes
🩸Other end organ damage
🩸Hyperleukocytosis
Novotny et. al (2005) created the attached grading score to predict the probability of leukostasis.
🩸CBC with peripheral blood smear
🩸BMP (BUN, Cr)
🩸ABG and CXR in dyspneic patients
🩸Blood cultures if infection suspected
🩸CT/MRI Head if neurological changes
🩸Fundoscopy
🩸Pseudohyperkalemia (WBC destruction after sampling)
🩸Pseudohypoxemia (high uptake of O2 by blasts, pulse ox is a better measure of O2)
🩸Pseudothrombocytosis (leukocyte fragments mistaken as platelets)