hyperleukocytosis + acute lymphoblastic leukemia

8/12/2019 HYPERLEUKOCYTOSIS + ACUTE LYMPHOBLASTIC LEUKEMIA

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HYPERLEUKOCYTOSIS + ACUTE

LYMPHOBLASTIC LEUKEMIA

Presented by

Priya Darishini G 090100399

Privina Arivalagan 090100390

Supervised byProf. Dr. Hj. Bidasari Lubis, Sp.A(K)

DEPARTEMEN ILMU KESEHATAN ANAKPROGRAM PENDIDIKAN PROFESI DOKTER

FAKULTAS KEDOKTERANUNIVERSITAS SUMATERA UTARA

2013


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Hyperleukocytosis is defined as peripheral

blood leukocyte count exceeding

>100,000/mm3


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ETIOLOGY

Physiologic/Emotional

Ovulation,labor,pregnancy

Acute infection Acute hemmorhage

Drugs/poisoning

Metabolic causes Malignant neoplasm

Connective tissuedisease

Hematological disease


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PATOGENESIS

Sluggish flow with stasis

Aggregation of leukaemic cells

Formation of microthrombi

Release of toxic granules

Endothelial damage

Oxygen consumption by leukocytesTissue invasion


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PATHOPHYSIOLOGY

A percentage of WBC is marginated along blood vessel wall and is mobilized by

inflamatory stimuli

90% WBCs remain in storage in the bone marrow, with 7% to 8% in the tissue

compartment and the remainder in circulation

Gives rise to erythroblast, myeloblast and megakaryoblasts

Stems from production, maturation and survival of leukocytes


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2 Mechanisms:

Increase in bloodviscosity due to highTLC and leukocyte

aggregates, resulting instasis

Adhesive reaction betweendamaged endothelium ofvessel and leukemic blast

precipitating

hyperleukocytosis;the toxinsand cytokines exercebate

situation


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CLINICAL MANIFESTATION

Weakness,fatigue andpaleness

Bleeding

Infection

Headache,vision blurring,dyspnoe,somnolence to stuporshows medical

emergency


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diagnosis

Cbc

Peipheral

smear

Serumelectrolyte(phosphate

,kalium,calcium, uric

acid)

Bloodgas

analysis

Chest

x-ray

Ecg

Bmp


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MANAGEMENT

Vigorous hydration with intravenous fluids

Alkalinization of the urine

Prevention of tumor lysis syndrome

DIC or thrombocytopenia

Leukocytoreduction

Radiation

Leukapheresis


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COMPLICATIONS

Tumor lysissyndrome

Neurologic

Pulmonary

Vascular


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PROGNOSIS

High-riskgroups

Number ofleukocytes

Age,phenotype,andcytogenetic

response toprednisoneadministration

Highmorbidityandmortality


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DISCUSSION

Theory Patient

Definition: Hyperleukocytosis is defined as a white

blood cell (WBC) count exceeding >100,000/mm3.

Patientsleukocyte count was 133 570/mm

Epidemiology: Hyperleukocytosis occursapproximately in 9% until 13% of children with acute

lymphoblastic leukemia

Patient is diagnosed with Hyperleukocytosis + Acutelymphoblastic Leukemia

Etiology: Hematological diseases- splenectomy,

functional asplenia, leukemia and mieloproliferative

disorders, hemolytic anemia, transfusion reaction

Patient has leukemia; Acute Lymphoblastic Leukemia

Risk factor : Newly diagnosed or recurrent leukemia

is a risk factor

Patient was diagnosed with leukemia 3 months ago

Theory Patient


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Theory Patient

Clinical Manifestation :Progressive weakness,

fatigue and paleness, infection, and bleeding.

-Headache, vision blurring, exertional dyspnoea to

respiratory distress, hypoxia, mild confusion and

somnolence to stupor and coma.

-General symptoms of ALL can include weight loss,

severe night sweats, tiredness, fever, and loss of

appetite.

-Patient has weakness, fatigue and palenes

secondary to anemia

-Due to ALL patient has experienced weight los

tiredness, fever and loss of apetite.

Test and Diagnosis: Screening for TLS should be

done. Serum electrolytes(sodium, potassium,

calcium, phosphate), renal functions and uric acid

- Careful assesement for thrombocytopenia,coagulopathy

- A blood gas analysis

The pateints electrolytes (sodium, potassiu

calcium, phosphate) along with renal functions an

uric acid are all in normal range. However,bloo

gas analysis revealed acidosis.

Treatment: Vigorous hydration, Alkalinization of

the urine, Recombinant urate oxidase (rasburicase)

Patient is given hydration theraphy with 4:1 plu

meylon 25 mEq.

hyperleukocytosis + acute lymphoblastic leukemia

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