Advanced Practice - Hyperleukocytosis syndrome!
The Bottom Line
- Consult heme onc on any patient with a hematologic malignancy who presents with very high WBC counts and new neuro/pulm complaints
- Extremely elevated WBC counts (>50-100K), usually in the setting of AML/CML and less commonly in ALL/CLL
- Very high concentrations of leukocytes leades to leukostasis
- Leukostasis results in microvascular occlusion, especially in the brain and lungs
- Neuro: Confusion, HA, stroke-like symptoms
- Pulm: Dyspnea, tachypnea, hypoxia
- WBC count usually >100,000
- Anemia/thrombocytopenia are common
- CNS imaging may demonstrate edema, infarction, or hemorrhage
- Pulmonary imaging may demonstrate alveolar or interstitial infiltrates
- Emergent leukophoresis in conjunction with hematology/oncology consultation to rapidly lower WBC count
- IVF may help encourage microvascular blood flow
- Consider antibiotics for pulmonary manifestations as infections are common in these patients
Emerson G, Kaide CG. Rapid Fire: Acute Blast Crisis/Hyperviscosity Syndrome. Emerg Clin North Am 2018:36; 603-608.