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Leukemia is a topic covered in the 5-Minute Emergency Consult.

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  • Neoplasms of WBCs that have undergone a malignant transformation
  • Hyperleukocytosis:
    • Occurs with WBC >100,000/mm3
    • Leads to occlusions of small vessels primarily in brain or lungs
    • Present with confusion, stupor, or shortness of breath

Chronic Myelogenous Leukemia
  • Overproduction of granulocytic WBCs (neutrophils)
  • Neutrophil function preserved
  • Thrombocytosis
  • Basophilia
  • Philadelphia chromosome present in bone marrow of >95%

Chronic Lymphocytic Leukemia
  • Most common leukemia in adults
  • Overproduction of monoclonal lymphocytes
  • Cells accumulate in lymph nodes, bone marrow, liver, spleen
  • Particularly prone to herpes virus infections

Acute Leukemias
  • Proliferation of undifferentiated immature cells:
    • Acute myelogenous leukemia (AML)—immature myeloid cells
    • Acute lymphocytic leukemia (ALL)—immature lymphoid cells (blasts)
  • Rapidly fatal


  • Cause unknown
  • Familial clustering in chronic lymphocytic leukemia (CLL)
  • Increased incidence of AML, ALL, and chronic myelogenous leukemia (CML) with ionizing radiation

Pediatric Considerations
  • Usually have ALL:
    • Most common pediatric cancer
  • 60–80% remission in those who are standard risk
  • Better overall prognosis, except if <1 yr of age
  • May develop leukostasis at lower levels
  • Allopurinol dose is 3 mg/kg.
  • Ceftazidime dose is 50 mg/kg.

Pregnancy Considerations
  • 90% of leukemias are AML or ALL.
  • Myeloid leukemias are more common.
  • CLL is very rare in pregnancy.
  • Chemotherapeutics may cause birth defects and/or preterm labor.
  • Same prognosis as nonpregnant; do not delay therapy.
  • Transfuse earlier than nonpregnant; keep hemoglobin >9.8 mg/dL.

Geriatric Considerations
More likely to present with CLL and CML

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Rosen, Peter, et al., editors. "Leukemia." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307370/all/Leukemia.
Leukemia. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307370/all/Leukemia. Accessed April 26, 2019.
Leukemia. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307370/all/Leukemia
Leukemia [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307370/all/Leukemia.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Leukemia ID - 307370 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307370/all/Leukemia PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -