Acute blast crisis/hyperviscosity syndrome: Blasting off!

Abstract

Emergency providers are likely to encounter patients with acute and chronic leukemias. The first presentation to the ED may be for symptoms related to blast crisis and leukostasis. Making a timely diagnosis and immediately consulting a hematologist can be life-saving. Presenting symptoms are due to complications of bone marrow infiltration and hyperleukocytosis with WBC counts over 100,000. Presentations may include fatigue (anemia), bleeding (thrombocytopenia), shortness of breath, and/or neurological symptoms owing to hyperleukocytosis and subsequent leukostasis. Blast crisis with leukostasis is a Heme/Onc emergency. Treatment of symptomatic cases involves induction chemotherapy and/or leukapheresis. Asymptomatic hyperleukocytosis can be treated with hydroxyurea.