The Bottom Line

• Consult heme onc on any patient with a hematologic malignancy who presents with very high WBC counts and new neuro/pulm complaints

Hyperleukocytosis syndrome

• Extremely elevated WBC counts (>50-100K), usually in the setting of AML/CML and less commonly in ALL/CLL

• Very high concentrations of leukocytes leades to leukostasis

• Leukostasis results in microvascular occlusion, especially in the brain and lungs

Signs/Symptoms

• Neuro: Confusion, HA, stroke-like symptoms

• Pulm: Dyspnea, tachypnea, hypoxia

Workup

• WBC count usually >100,000

• Anemia/thrombocytopenia are common

• CNS imaging may demonstrate edema, infarction, or hemorrhage

• Pulmonary imaging may demonstrate alveolar or interstitial infiltrates

Treatment

• Emergent leukophoresis in conjunction with hematology/oncology consultation to rapidly lower WBC count

• IVF may help encourage microvascular blood flow

• Consider antibiotics for pulmonary manifestations as infections are common in these patients

Reference:

Emerson G, Kaide CG. Rapid Fire: Acute Blast Crisis/Hyperviscosity Syndrome. Emerg Clin North Am 2018:36; 603-608.