Leukostasis

Basics

Description

  • Leukostasis is a clinical diagnosis described by a high white blood cell count (WBC) usually over 100,000 cells/μL
  • Most commonly seen in Acute Myeloid Leukemia. Uncommon with other hematologic malignancies
  • The hyperviscosity of WBCs inhibit adequate flow to the microvasculature of the body. This leads to poor organ perfusion causing respiratory distress from lung infiltrates, central nervous system abnormalities, thrombocytopenia, and coagulopathy
  • Significant complications can arise due to microvasculature plugging such as cerebral infarction, pulmonary insufficiency, and death

Epidemiology

Incidence And Prevalence Estimates

  • 20–40% of patients diagnosed with leukostasis die within the 1st week of symptom onset. Patients with the best outcomes have none or few signs/symptoms of neurologic or respiratory distress
  • The incidence and prevalence of hyperleukocytosis and leukostasis vary depending on the form of leukemia
  • Hyperleukocytosis is common in several leukemias, which include chronic myelogenous leukemia (CML) and chronic lymphocytic leukemia (CLL); however leukostasis is rare
  • The incidence of hyperleukocytosis in people with Acute Lymphoblastic Leukemia is <30% and rarely advances to symptomatic leukostasis

Etiology

  • CBC most common test ordered from emergency department
  • Hyperleukocytosis >100,000 in the setting of AML
  • In acute myelogenous leukemia with monocytic features the myeloid blast is larger in size compared to mature granulocyte and has impaired ability to change shape to flow in micro vessels
  • If left untreated, is associated with mortality rates as high as 40%. Rapid clinical recognition and management is required to improve outcomes of patients with leukocytosis

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