HWN Suggests

The White Count: Acute Hyperleukocytosis and Leukostasis

When patients have hyperleukocytosis, they should be evaluated for any signs or symptoms of respiratory distress or neurological symptoms, including headaches, vision changes, confusion, or dizziness. Such clinical findings are indications of leukostasis, an emergent condition in which signs of tissue hypoxia are found. Less common findings can include EKG changes demonstrating a myocardial infarction or right heart strain, renal insufficiency, bowel infarction, and acute limb ischemia.

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 A Medical Emergency: “Leukostasis”

Leukostasis, a medical emergency situation, refers to hyperleukocytosis combined with organ failure. Because of its poor prognosis and the high incidence of early mortality of patients with leukostasis, prompt and efficient therapy is needed.

 Leukostasis

Sometimes the most serious oncologic emergencies present very benignly: a slow nose bleed (portending DIC), a low grade fever (neutropenic bacteremia), vague weakness/fatigue (an undiagnosed leukemia)…

Articles of Interest

Hyperleukocytosis and Leukostasis in the PICU

Generally avoid RBC transfusions as this can increase viscosity and exacerbate leukostasis

Leukostasis and Tumor Lysis Syndrome

Today’s case was a middle-aged male with a history of untreated CML who presented with gum bleeding, hypoxia, and altered mental status, found to have accelerated phase CML, leukostasis, and tumor lysis syndrome.

Newly Diagnosed Chronic Myeloid Leukemia With Leukostasis

The risk of leukostasis is higher in the setting of myeloid leukemia with white blood cell counts greater than 100,000/µL. Leukapheresis and targeted therapy with intensive supportive care should be initiated promptly, since these measures can increase the chance of survival.