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]. DurzyƄski T(1), Konopka L. It can induce leukostasis, tumor lysis syndrome and disseminated intravascular coagulopathy and has significant prognostic implications with.

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A major limitation of this modality is that it often takes a considerable amount of time line placement, coordination between several hospital departments or American Red Cross to implement this approach.

Neurologic Symptoms can range from mild confusion to somnolence to stupor and coma.

Marked elevations in WBCs lead to an increased fractional volume of leukocytes leukocritand this leads to an increased blood viscosity. Potassium levels may be falsely elevated release of intracellular cations from blasts in test tube.

They might be associated with the disease itself, with complications from treatment, or with the consequences of an impaired immune status. Patients were divided into 4 groups not present, possible, probable, and highly probable based on severity of pulmonary, neurologic, and other symptoms. PLoS One 9 4: All patients with hyperleukocytosis should have a DIC panel PT, PTT, fibrinogen, fibrin split products, D-dimer and peripheral smear performed at the time of diagnosis.

Special considerations for nursing and allied health professionals. A typical dosing strategy used in our practice is grams HU po q 6 hours. Specific Treatment There are no randomized data to support the selection of a particular cytoreductive therapy and thus there is no standard of care. Specific medications, including corticosteroidslithium and beta agonists have the ability cause hyperleukocytosis.

As stated before, these counts are critical and associated with Leukemias. Learning Objective To gain an understanding of the pathophysiology of leukostasis and the role of leukocytapheresis as a therapeutic invention. The specifics of selection and timing of remission induction immuno-chemotherapy for both acute and chronic leukemias are beyind the scope of this section.


Treatments aim to rapidly reduce white blood cell counts while also treating the underlying disorder. Currently, there are no widely accepted guidelines available for leukapheresis and no specific criteria for when to initiate or when to stop treatment. In a study evaluating the impact of leukocytapheresis and cranial irradiation on early mortality and intracranial hemorrhage, no improvement in survival or decrease in intracranial hemorrhage was observed.

Other supportive measures include oxygen support, ventilator management, blood component transfusion as indicated, and serum uric acid level control. The treatment of pulmonary leukostasis requires the same approach as with the patient with hyperleukocytosis.


The clinical presentation of leukostasis is usually nonspecific. Individuals affected by leukostasis may present with respiratory symptoms such as coughdifficulty breathingbreathing too quicklyor inadequate levels of oxygen in the blood requiring support with leukostaiss mechanical ventilator.

Pulmonary embolus hypercoagulable state. Therefore, it is recommended that the decision to perform leukocytapheresis should in no way delay more definitive treatment such as syndromee and chemotherapy. Once patients leukoetasis developed signs and symptoms consistent with clinical leukostasis, leukocytoreduction must be implemented emergently.

One option is to prime the apheresis machine with RBCs. This is especially useful in the situation where the definitive diagnosis has not yet been established, as this medical treatment can be effective in both myeloid and lymphoid malignancies. A chest x-ray can be normal in those with leukostasis or may demonstrate an alveolar pattern of infiltrates. Patients with AML, especially M5, have the highest risk. It should be considered leukosyasis the differential diagnosis of patients with hematologic malignancy presenting with shortness of breath, desaturation, and elevated WBCs.

In this chapter, the pathophysiology of leukostasis, performance of leukocytapheresis, and efficacy of this treatment are reviewed. Serial CBCs should be performed q hr to assess progress of leukocytoreduction. However, starting with conventional induction chemotherapy increases the tumor lysis syndrome and DIC and can worsen leukostasis compared to low dose chemotherapy followed by induction chemotherapy. Symptoms can range from mild confusion to leuoostasis to stupor and coma.


Zofran can cause headache. Leukapheresis and targeted therapy with intensive supportive care should be started promptly since these measures can improve survival. Related Content Load related web page information.

Are cranial irradiation and invasive cytoreduction necessary? When the anticoagulant is citrate, this requires the administration of calcium, which may cause calcium-phosphate precipitation and worsen tumor lysis syndrome. Differentiation syndrome ATRA, arsenic.

Search for related content. Keep in mind that pulse oximetry will be more accurate than an arterial blood gas ABG study if this diagnosis is suspected.

Maintaining an active type and screen is mandatory.

[Leukostasis syndrome in a case of chronic lymphocytic leukemia].

Leukapheresis in management of hyperleukocytosis in children’s leukemias. Cytoreduction is also a critical course of treatment in order to rapidly decrease white blood cell counts. The pathophysiology of leukostasis is not well understood, but inadequate delivery of oxygen to the body’s cells is the end result.

Chemotherapy should be implemented as quickly as possible to prevent rapid accumulation of circulating blasts. Most commonly the pulmonary and CNS microvascular beds are affected. The pathophysiology of hyperleukocytosis and leukostasis is not well established. Therefore, leukapheresis should be considered to be a temporizing measure.

Allergic disorders Asthma [3] Hay fever [3] Drug 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.

Induction chemotherapy is an essential treatment for patients with hematologic malignancy. Services Email this article to a friend Alert me when this elukostasis is cited Alert me if a correction is posted Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Download to citation manager.