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.


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