Rapid Fire: Acute Blast Crisis/Hyperviscosity Syndrome

Geremiha Emerson; Colin G Kaide

doi:10.1016/j.emc.2018.04.005

Rapid Fire: Acute Blast Crisis/Hyperviscosity Syndrome

Emerg Med Clin North Am. 2018 Aug;36(3):603-608. doi: 10.1016/j.emc.2018.04.005. Epub 2018 Jun 11.

Authors

Geremiha Emerson¹, Colin G Kaide²

Affiliations

¹ Department of Emergency Medicine, Wexner Medical Center at The Ohio State University, 760 Prior Hall, 376 West 10th Avenue, Columbus, OH 43210, USA. Electronic address: Geremiha.Emerson@osumc.edu.
² Department of Emergency Medicine, Wexner Medical Center at The Ohio State University, 760 Prior Hall, 376 West 10th Avenue, Columbus, OH 43210, USA.

PMID: 30037446
DOI: 10.1016/j.emc.2018.04.005

Abstract

Emergency providers are likely to encounter patients with acute and chronic leukemias. In some cases, the first presentation to the emergency department may be for symptoms related to blast crisis and leukostasis. Making a timely diagnosis and consulting a hematologist can be life saving. Presenting symptoms are caused by complications of bone marrow infiltration and hyperleukocytosis with white blood cell counts over 100,000. Presentations may include fatigue (anemia), bleeding (thrombocytopenia), shortness of breath, and/or neurologic symptoms owing to hyperleukocytosis and subsequent leukostasis. Treatment of symptomatic cases involves induction chemotherapy and/or leukapheresis. Asymptomatic hyperleukocytosis can be treated with hydroxyurea.

Keywords: Acute myeloid leukemia; Blast; Chronic myeloid leukemia; Hydroxyurea; Hyperviscosity; Leukapheresis; Leukostasis; Petechiae.

Publication types

Case Reports
Review

MeSH terms

Blast Crisis / etiology*
Blast Crisis / therapy
Chronic Disease
Humans
Leukapheresis / methods*
Leukostasis / complications*
Leukostasis / therapy
Male
Middle Aged
Syndrome