RESUMEN
ABSTRACT: We show that red cell exchange (RCE) treats hyperleukocytosis in acute leukemia. RCE provided similar leukoreduction to standard therapeutic leukoreduction and could be superior in patients with severe anemia or monocytic leukemias or when requiring rapid treatment.
Asunto(s)
Leucemia Monocítica Aguda , Leucemia Mieloide Aguda , Leucostasis , Adulto , Humanos , Leucostasis/terapia , Leucemia Mieloide Aguda/terapia , Leucemia Monocítica Aguda/terapia , Enfermedad Aguda , Leucaféresis , Leucocitosis/terapiaRESUMEN
In this case report a patient presents with high-output cardiac failure in the clinical setting of acute leukemia and leukostasis. Case particulars are presented, literature is reviewed and a potential mechanistic explanation is proposed to describe presentation and clinical findings.
Asunto(s)
Gasto Cardíaco Elevado/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Leucemia Mieloide Aguda/diagnóstico , Leucostasis/diagnóstico , Gasto Cardíaco Elevado/fisiopatología , Insuficiencia Cardíaca/fisiopatología , Humanos , Leucemia Mieloide Aguda/patología , Leucostasis/patología , Masculino , Persona de Mediana EdadRESUMEN
Rupture of the spleen can be classified as spontaneous, traumatic, or pathologic. Pathologic rupture has been reported in infectious diseases such as infectious mononucleosis, and hematologic malignancies such as acute and chronic leukemias. Splenomegaly is considered the most relevant factor that predisposes to splenic rupture. A 66-year-old man with acute myeloid leukemia evolved from an unclassified myeloproliferative neoplasm, complaining of fatigue and mild upper left abdominal pain. He was pale and presented fever and tachypnea. Laboratory analyses showed hemoglobin 8.3 g/dL, white blood cell count 278 × 109/L, platelet count 367 × 109/L, activated partial thromboplastin time (aPTT) ratio 2.10, and international normalized ratio (INR) 1.60. A blood smear showed 62% of myeloblasts. The immunophenotype of the blasts was positive for CD117, HLA-DR, CD13, CD56, CD64, CD11c and CD14. Lactate dehydrogenase was 2384 U/L and creatinine 2.4 mg/dL (normal range: 0.7-1.6 mg/dL). Two sessions of leukapheresis were performed. At the end of the second session, the patient presented hemodynamic instability that culminated in circulatory shock and death. The post-mortem examination revealed infiltration of the vessels of the lungs, heart, and liver, and massive infiltration of the spleen by leukemic blasts. Blood volume in the peritoneal cavity was 500 mL. Acute leukemia is a rare cause of splenic rupture. Male gender, old age and splenomegaly are factors associated with this condition. As the patient had leukostasis, we hypothesize that this, associated with other factors such as lung and heart leukemic infiltration, had a role in inducing splenic rupture. Finally, we do not believe that leukapheresis in itself contributed to splenic rupture, as it is essentially atraumatic...
Asunto(s)
Humanos , Masculino , Anciano , Leucemia Mieloide Aguda , Leucostasis , Rotura del Bazo , EsplenomegaliaAsunto(s)
Leucemia Mieloide Aguda/genética , Leucostasis/genética , Adolescente , Adulto , Anciano , Femenino , Duplicación de Gen , N-Metiltransferasa de Histona-Lisina , Humanos , Leucemia Mieloide Aguda/metabolismo , Leucemia Mieloide Aguda/patología , Leucostasis/metabolismo , Leucostasis/patología , Masculino , Persona de Mediana Edad , Mutación , Proteína de la Leucemia Mieloide-Linfoide/genética , Proteína de la Leucemia Mieloide-Linfoide/metabolismo , Proteínas Nucleares/genética , Proteínas Nucleares/metabolismo , Nucleofosmina , Estudios Retrospectivos , Adulto Joven , Tirosina Quinasa 3 Similar a fms/genética , Tirosina Quinasa 3 Similar a fms/metabolismoAsunto(s)
Urgencias Médicas , Oncología Médica , Obstrucción de las Vías Aéreas , Viscosidad Sanguínea , Hematuria , Hipercalcemia , Hiponatremia , Hipertensión Intracraneal , Leucocitosis , Leucostasis , Derrame Pericárdico , Compresión de la Médula Espinal , Síndrome de la Vena Cava Superior , Síndrome de Lisis Tumoral , Obstrucción del Cuello de la Vejiga UrinariaRESUMEN
Leukostasis is a relatively uncommon but potentially catastrophic complication of acute myelogenous leukemia (AML). Prompt leukoreduction is considered imperative to reduce the high mortality rate in this condition. Leukapheresis, usually associated with chemotherapy, is an established approach to diminish blast cell counts. We report a single center experience in managing leukostasis with leukapheresis. Fifteen patients with leukostasis of 187 patients with AML (8.02%) followed at our institution were treated with leukapheresis associated with chemotherapy. The procedures were scheduled to be performed on a daily basis until clinical improvement was achieved and WBC counts were significantly reduced. Overall and early mortalities, defined as that occurred in the first 7 days from diagnosis, were reported. A high proportion of our patients with leukostasis (46.66%) had a monocytic subtype AML (M4/M5, according to French-American-British classification). The median overall survival was 10 days, despite a significant WBC reduction after the first apheresis procedure (from 200.7 × 109/L to 150.3 × 109/L). Almost half of patients (7/15) had an early death. Therapeutic leukapheresis, associated or not to chemotherapy, is an effective approach to reduce WBC counts in patients with AML and leukostasis; however, this therapeutic procedure does not appear to change significantly the sombre prognosis observed in the majority of patients with this complication. Other forms of treatment must be found to reduce the high mortality rate related to leukostasis.
Asunto(s)
Leucaféresis , Leucemia Mieloide Aguda/complicaciones , Leucostasis/etiología , Leucostasis/terapia , Adulto , Anciano , Femenino , Humanos , Leucemia Mieloide Aguda/sangre , Recuento de Leucocitos , Leucostasis/sangre , Leucostasis/mortalidad , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Insuficiencia del Tratamiento , Adulto JovenAsunto(s)
Leucemia Mielógena Crónica BCR-ABL Positiva/diagnóstico por imagen , Leucostasis/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Tuberculosis Pulmonar/diagnóstico por imagen , Brasil , Diagnóstico Diferencial , Enfermedades Endémicas , Femenino , Humanos , Leucemia Mielógena Crónica BCR-ABL Positiva/complicaciones , Leucemia Mielógena Crónica BCR-ABL Positiva/genética , Leucostasis/etiología , Enfermedades Pulmonares/etiología , Radiografía , Tuberculosis Pulmonar/epidemiología , Adulto JovenRESUMEN
Mujer de 66 años con tres días de evolución de fiebre, máculas violáceas y dolor en miembros inferiores asociado a deterioro del estado general. Antecedente de leucemia mieloide aguda. La biopsia de piel evidenció oclusión de vasos de mediano y pequeño calibre por mielocitos atípicos. Se describen los hallazgos clínicos e histopatológicos con el fin de reconocer esta rara y progresiva condición descrita en pacientes con síndromes mieloproliferativos.