Hyperleukocytosis (>100 x 10(9)/L) is an uncommon presentation of chronic leukemias. It can present with a variety of symptoms secondary to leukostasis, a syndrome caused by the sludging of circulating leukemic blasts in the microvasculature. [ncbi.nlm.nih.gov]

• Mediastinal Lymphadenopathy

  lymphadenopathy Dyspnea (see Dyspnea ) Diagnosis CXR/Chest CT: may be normal Acute Lung Injury-ARDS (see Acute Lung Injury-ARDS ) Diagnosis CXR/Chest CT: lobar infiltrates, diffuse infiltrates, mediastinal lymphadenopathy Pleural Effuson (see Pleural [mdnxs.com]

  Chest X-ray demonstrated hilar lymphadenopathy, bilateral hilar, mediastinal lymphadenopathy, right middle lobe atelectasis and prominent interstitial markings. [ncbi.nlm.nih.gov]

• Anemia

  Other causes of leukocytosis include medications, splenectomy, hemolytic anemia and malignancy. [aafp.org]

  […] forming plugs of aggregated blasts Typically occurs at WBC count >50-100k only Occurs more commonly in myeloid types due to less deformability of myeloblasts and monoblasts (as compared to lymphoblasts) Blood Viscosity: usually normal due to coexistent anemia [mdnxs.com]

  Complications of CLL: 1) Immunodeficiency as outlined below 2) Autoimmune hemolytic anemia 3) Red cell aplasia 4) Transformation as above Immunodeficiency in CLL : This is B-cell disorder, so humoral immunodeficiency. [morningreporttgh.blogspot.com]

  This condition should be thought when features like anemia and bone pain is associated with retention of urine. [medresearch.in]

  […] lymphocytosis: ALC>4000/uL It's either reactive or clonal: Reactive includes: 1) Infections: - viral: HIV (in acute infection), EBV (mono), CMV, HHV6, HTLV-1 - bac: bordatella pertussis, bartonella (cat scratch disease) - toxo, babesiosis (also causes hemolytic anemia [errolozdalga.com]

• Lymphadenopathy

  He had splenomegaly but no lymphadenopathy or hepatomegaly. The tumor cells were CD5+, CD19+, CD20+, FMC-7+, and kappa light chain restricted. Immunohistochemistry showed expression of p53 and of cyclin D1. [ncbi.nlm.nih.gov]

  Dyspnea (see Dyspnea ) Diagnosis CXR/Chest CT: may be normal Acute Lung Injury-ARDS (see Acute Lung Injury-ARDS ) Diagnosis CXR/Chest CT: lobar infiltrates, diffuse infiltrates, mediastinal lymphadenopathy Pleural Effuson (see Pleural Effusion-Exudate [mdnxs.com]

  There is almost never splenomegaly or lymphadenopathy. HTLV-1 may produce a transient lymphocytosis (usually < 20.0 x10 9 /L) with fever,rash, and little lymphadenopathy. Most patients recover; however, some develop adult T cell leukemia. [med-ed.virginia.edu]

• Congestive Heart Failure

  Clinical sequelae of HVS can include congestive heart failure (CHF), ischemic acute tubular necrosis, and pulmonary edema with multiorgan system failure and death, if treatment is not promptly initiated. [journals.lww.com]

  Clinical sequelae of HVS can include congestive heart failure, ischemic acute tubular necrosis, and pulmonary edema with multiorgan system failure and death if treatment is not promptly initiated. [6] Thus, prompt recognition and expeditious treatment [emedicine.medscape.com]

  Congestive heart failure was ruled out by the echocardiogram, which showed mild enlargement of the right ventricle and atrium. CT angiogram ruled out pulmonary embolism as a cause of hypoxia and shortness of breath. [ncbi.nlm.nih.gov]

  Less frequently, patients with polycythemia vera develop myocardial infarction, stroke, venous thrombosis and congestive heart failure. Overall survival is long (10 to 20 years). [aafp.org]

  Congestive heart failure (NYHA Class III or IV) c. Myocardial infarction within 12 months prior to starting study treatment d. Unstable or poorly controlled angina pectoris, including Prinzmetal variant angina pectoris 20. [clinicaltrialsregister.eu]

• Pallor

  Common symptoms include: fever unusually pale skin (pallor) weakness and fatigue weight loss loss of appetite leading to anorexia enlarged liver, spleen, and lymph nodes; this happens in more than half of patients diagnosed with AML red or violet bumpy [aboutkidshealth.ca]

  Pallor was evident but no icterus and cyanosis was found. Liver was not palpable though spleen was palpable just below costal margins. Any other significant finding could not be elicited in systemic examination. [medresearch.in]

  […] adults: chronic lymphocytic leukemia None, or nonspecific symptoms Enlarged spleen or lymph nodes Leukocytosis (lymphocytes) ACUTE LEUKEMIAS Patients with an acute leukemia often present with signs and symptoms of bone marrow failure, such as fatigue and pallor [aafp.org]

• Dentist

  Each chapter has been structured to trust that physicians, dentists, nurses, dental "stand by itself"; at the same time, obvious rela hygienists, and individuals in the supportive ser tionships with other chapters have been noted. vices involved in the [books.google.com]

  The patient was in her usual health until approximately 24 months earlier, when she was advised by her dentist to follow-up with her primary physician for significant cervical lymphadenopathy. [ncbi.nlm.nih.gov]

• Dyspnea

  A patient with hyperleukocytic myelomonocytic leukemia who presented to the emergency room with sudden pleuritic chest pain and dyspnea is reported. Clinical manifestations included dyspnea tachypnea and hyperventilation. [ncbi.nlm.nih.gov]

  (see Dyspnea ) Diagnosis CXR/Chest CT: may be normal Acute Lung Injury-ARDS (see Acute Lung Injury-ARDS ) Diagnosis CXR/Chest CT: lobar infiltrates, diffuse infiltrates, mediastinal lymphadenopathy Pleural Effuson (see Pleural Effusion-Exudate ) Diagnosis [mdnxs.com]

• Erythema

  […] comment in PubMed Commons below C) Venous Thromboembolism (VTE) is a common complication of cancer, with up to 15% of patients affected at some point in the disease course. 19 In deep venous thrombosis (DVT), pain, tenderness, swelling, warmth, edema, and erythema [emdocs.net]

• Blurred Vision

  A 76-year-old man presented with leukostasis syndrome, including oculodynia, blurred vision, and visual field defects, due to mantle cell lymphoma, prolymphocytoid variant, with marked leukocytosis, 1227 x 10(9)/l. [ncbi.nlm.nih.gov]

  The present case illustrates that pulmonary leucostasis may be presented by unilateral chest X-ray abnormalities and without clear neurological symptoms (headache and blurred vision). [casereports.bmj.com]

  Neurological : Symptoms include confusion, somnolence, stupor, delirium, coma, headache, dizziness, tinnitus, gait instability, blurred vision, diplopia and visual field defect. [ghrnet.org]

• Suggestibility

  Abstract Adhesion between leukemic cells and the vascular endothelium has been suggested to play a role in the development of leukostasis in myelocytic leukemia. [ncbi.nlm.nih.gov]

  Although morphology suggested acute lymphoblastic leukemia, a more specific diagnosis of blastoid variant mantle cell lymphoma was obtained in 12 hours by applying complementary techniques of flow cytometry and rapid cytogenetics. [dovepress.com]

• Confusion

  Neurologic symptoms such as temporary confusion, blurry vision, dizziness, ringing in the ears, ataxia, stupor, sleepiness, headaches, and coma may be seen. [en.wikipedia.org]

  Symptoms: (1) pulmonary: cyanosis, progressive dyspnea, tachypnea, hypoxemia (2) CNS: headache, confusion, altered mental status (3) cardiac: tachycardia, heart failure, ischemia, cardiac tamponade (4) fever without a focus of infection (5) ocular: retinal [meducator3.net]

  Lungs shortness of breath: this happens when tissues inside the body are not getting enough oxygen, causing a condition called hypoxia respiratory failure coughing Nervous system headache, vertigo, hearing loss unbalanced walking (ataxia) double vision confusion [aboutkidshealth.ca]

  […] acidosis, microthrombotization and bleeding to the lung parenchyma and acute respiratory failure CNS symptoms: hyperleukocytosis leads to broad spectrum of neurologic symptoms (headache, behavioral and mental status changes, disturbances of consciousness, confusion [telemedicina.med.muni.cz]

• Stroke

  Leukostasis is a high-risk condition and can lead to significant complications resulting from occlusion of blood vessels including transient ischemic attacks and strokes. [en.wikipedia.org]

  […] all the latest approaches in clinical laboratory medicine with new and updated coverage of: the chemical basis for analyte assays and common interferences; lipids and dyslipoproteinemia; markers in the blood for cardiac injury evaluation and related stroke [books.google.com]

  May cause noncardiogenic pulm edema, retinal hemorrhage, encephalopathy, stroke, renal failure, MI, heart failure. [morningreporttgh.blogspot.com]

  […] defined as white blood cell (WBC) count or blast count > 100,000/µL Usually due to acute or chronic leukemia Can lead to hyperviscosity / leukostasis syndrome Hyperviscosity / leukostasis symptoms: Cerebrovascular insufficiency (altered mentation, TIA, stroke [pathologyoutlines.com]

• Somnolence

  The most common symptoms are dyspnea and hypoxia, usually accompanied by visual changes, headaches, dizziness, confusion, somnolence, and coma. Prompt treatment is indicated since, if left untreated, it has a very high mortality rate. [en.wikipedia.org]

  Extrapulmonary signs and symptoms in the central nervous system can range from headache to mild confusion to somnolence to coma. Patients may have focal neurologic deficits due to intracranial hemorrhage. [pulmonarychronicles.com]

  Table 1 Symptoms of leukostasis Organ Symptoms Lung dyspnea, hypoxemia, diffuse alveolar hemorrhage, respiratory failure Central nervous system confusion, somnolence, dizziness, headache, delirium, coma, focal neurological deficits Eye impaired vision [ncbi.nlm.nih.gov]

  Neurological : Symptoms include confusion, somnolence, stupor, delirium, coma, headache, dizziness, tinnitus, gait instability, blurred vision, diplopia and visual field defect. [ghrnet.org]

• Altered Mental Status

  Mental Status (see Delirium ) Cardiac Manifestations Myocardial Ischemia/Acute MI (see Coronary Artery Disease ): due to coronary occlusion Gastrointestinal Manifestations Intestinal Ischemia/Infarction (see Acute Mesenteric Ischemia ) Hematologic Manifestations [mdnxs.com]

  Symptoms: (1) pulmonary: cyanosis, progressive dyspnea, tachypnea, hypoxemia (2) CNS: headache, confusion, altered mental status (3) cardiac: tachycardia, heart failure, ischemia, cardiac tamponade (4) fever without a focus of infection (5) ocular: retinal [meducator3.net]

  Consequences of leukocyte infiltration into brain parenchyma may lead to altered mental status, headache and visual field defects. Onset of fever is common. [signavitae.com]

[…] reported to occur with counts < 50,000 per µL (2) ALL: occurs with counts > 100,000 per µL, with greater risk at counts > 200,000 per µL (3) CML or CMML: occurs with counts > 150,000 per µL (4) CLL: rare, but may occur with counts > 800,000 per µL The workup [meducator3.net]

• X-Ray Abnormal

  The present case illustrates that pulmonary leucostasis may be presented by unilateral chest X-ray abnormalities and without clear neurological symptoms (headache and blurred vision). [casereports.bmj.com]

• Leukocytosis

  However, extreme leukocytosis (195 to 323 x 10(9) cells/L) in peripheral blood was in striking contrast. [ncbi.nlm.nih.gov]

  Physiologic mechanisms of leukocytosis are listed in Table 1. [aafp.org]

The combined treatment with chemotherapy and radiation appears useful. [ncbi.nlm.nih.gov]

Specific treatments include lysis syndrome treatment in addition to aggressive intravenous hydration with allopurinol or rasburicase to decrease serum uric acid levels. [en.wikipedia.org]

Poor prognosis due to high early death rate secondary to leukostasis. The mechanisms at the origin of leukostasis are still poorly understood. [ncbi.nlm.nih.gov]

(aka Hyperleukocytic Syndrome) Epidemiology Prevalence : occurs with WBC count >50-100k in the acute leukemias Etiology Acute Myeloid Leukemia (AML) (see Acute Myeloid Leukemia ): most common etiology CML (see Chronic Myeloid Leukemia ): common etiology [mdnxs.com]

Etiology of Leukocytosis The investigation of leukocytosis begins with an understanding of its two basic causes: (1) the appropriate response of normal bone marrow to external stimuli and (2) the effect of a primary bone marrow disorder. [aafp.org]

By: Nicole Messenger, MD Faculty Reviewer: Chris Holthaus, MD Let’s do a rapid review of blast crisis and its etiology, since some of this material hasn’t been reviewed since our days in medical school. [everydayebm.org]

Individual sections are devoted to epidemiology, diagnostic strategy, lung infections, non-infectious pulmonary involvement, and treatment, including decision making in patients with acute respiratory failure. [books.google.com]

(aka Hyperleukocytic Syndrome) Epidemiology Prevalence : occurs with WBC count >50-100k in the acute leukemias Etiology Acute Myeloid Leukemia (AML) (see Acute Myeloid Leukemia ): most common etiology CML (see Chronic Myeloid Leukemia ): common etiology [mdnxs.com]

Little epidemiologic information is available on hyperviscosity symdrome. [emedicine.medscape.com]

He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]

[…] cells > 20% blasts in blood or bone marrow samples Adapted from American Cancer Society Blast Crisis Life-threatening hematologic emergency Increase in blast cells in the marrow results in blood hyperviscosity and relative reduction of other cell lines Epidemiology [coreem.net]

While the pathophysiology of leukostasis is not fully understood, recent research has elucidated many novel pathways that may have therapeutic implications in the future. [ncbi.nlm.nih.gov]

Being a medical emergency, early recognition of leukostasis and initiation of therapy prevents mortality. [ncbi.nlm.nih.gov]

Preventative measures and contentious monitoring of patients diagnosed with leukemia is critical in receiving treatment as early as possible to prevent and treat hyperleuckocytosis. [en.wikipedia.org]