Treatment (1 of 13)
The presented with blurry vision. Why is that a concern?
Leukostasis occurs in patients with leukemia and very high white cell counts (it is also called symptomatic hyperleukocytosis). While it is a pathological diagnosis (presence of white cell plugs in the microvasculature) it may be inferred clinically when a patient with leukemia and hyperleukocytosis presents with clinical evidence of decreased tissue perfusion such as respiratory or neurological distress. The prevalence of leukostasis varies between different kinds of leukemia. Which one of the following types of leukemia has the lowest risk?
Let’s return to the case and consider other findings the patient might have related to leukostasis. The central nervous system and lungs are the common sites for symptomatic vascular obstruction, but other organs may be involved including the heart and kidney.
What are some neurological findings?Click for Answer
What are some respiratory findings?Click for Answer
Leukostasis is a medical emergency. If unrecognized, the 1-week mortality can be as high as 40%. What are the general modes of treatment?
Does this patient have an increased risk for tumor lysis syndrome?
How would you determine whether this patient has tumor lysis syndrome?Click for Answer
This patient had a low hemoglobin. Would you recommend red cell transfusion when he first presented?
The patient had blurry vision but denied other symptoms of leukostasis. His tumor lysis and DIC labs were negative.
Course in hospital:
- The patient was admitted to the hospital to the malignant hematology service for a total of 6 days.
- During day 1 of hospitalization, the patient received hydroxyurea 2g q8h until his counts decreased to less than 100 x 109/L (total of 5 days); his blurry vision resolved on day 2.
- WBC trend
- day 2 108 x 109/L
- day 3 140 x 109/L
- day 4 96 x 109/L
- day 5. 61 x 109/L
- He was started on dasatinib on the second day of hospitalization
- He was started on allopurinol and received IVF 100cc/hour for TLS prophylaxis