AML and leukostasis

We discussed a case of a man with weakness, found to have hyperleukocytosis. He was diagnosed with AML. There was a concern for leukostasis due to the tremendous amount of blasts on peripheral smear.We reviewed characteristics of AML vs ALL vs CML vs CLL and discussed four emergencies (TLS, DIC / bleeding, febrile neutropenia, and leukostasis), with a deeper discussion about leukostasis.

AML
– Adults (60s);  sxs: fatigue (anemia) + bleeding / bruising (thrombocytopenia) + infection (ineffective neutrophils);  dx by peripheral smear or bone marrow biopsy with >20% blasts;  Auer rods can be seen on smear

Leukostasis
– Hyperleukocytosis = total WBC > 50k to 100k
– Lots of blasts → ↑ blood viscosity → blockage/ischemia
– Respiratory distress and neurologic symptoms (eg stroke) are leading causes of early death
– Treatment: cytoreduction (chemotherapy, hydroxyurea, leukapheresis-controversial)

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