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• W4387248875 abstract "SESSION TITLE: Critical Care Case Report Posters 8 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Leukostasis is a well-recognized syndrome in acute leukemia (5–30%) and extremely rare in chronic leukemia [1]. Although very uncommon, leukostasis poses a life-threatening complication for chronic lymphocytic leukemia (CLL) by impairing the respiratory, nervous, or renal systems. This following case discusses how CLL can lead to respiratory failure and pseudohyperkalemia. CASE PRESENTATION: An 84-year-old male with a history of relapsing/refractory CLL with persistent disease presented to the emergency department for dyspnea on exertion. Labs were significant for WBC count of 183X10⁹/L, absolute lymphocyte counts 171x10⁹/L, potassium ranging from 7.5 -9 mmol/L, and uric acid level of 12.2 mg/dL. The patient was suspected to have tumor lysis syndrome and was started on allopurinol, IV hydration, and rasburicase. It was later discovered that potassium levels were falsely elevated and within normal limits on point of care testing. The hospital course was complicated with worsening shortness of breath requiring high flow and ultimately leading to mechanical ventilation as WBC counts increased. The patient was transferred to ICU and treated with leukapheresis with significant improvement in hypoxia, WBC counts, and pseudohyperkalemia. DISCUSSION: Symptomatic hyperleukocytosis (leukostasis) leads to the elevation of cellular and acellular proteins resulting in hyperviscosity, and tissue hypoxia, leading to symptoms and signs involving the respiratory and central nervous systems. Leukostatis is thought to be uncommon in CLL because of the high deformability, low adherence, and small size of CLL cells [2]. Clinical manifestations include respiratory comprise, neurological symptoms, and less commonly limb ischemia, MI, and renal involvement. Leukostasis is a medical emergency with a high risk of disseminated intravascular coagulation and tumor lysis syndrome (TLS). TLS may occur spontaneously or as the result of chemotherapy, which calls for aggressive hydration, allopurinol, and rasburicase. Due to increased WBC mass and volume during centrifuge, cell lysis occurs leading to pseudohyperkalemia, it could be challenging to distinguish between hyperkalemia from TLS. Similar to our case, who had a persistently elevated potassium level but no changes to their ECG. Potassium point-of-care testing yields more precise results and prevents potentially lethal iatrogenic hypokalemia. Leukapheresis is considered an important modality in the management of leukostasis with induction chemotherapy or chemoreductive agent as definitive treatment. A single leukapheresis can reduce counts transiently by 20-50% and improve symptoms [3]. Although it's frequently used in management it shows no mortality benefit. Induction chemotherapy is a key component in successful treatment as it reduces the overall leukemia cell burden, leading to a more sustained response. In patients who are unable to receive chemotherapy, a chemoreductive agent likely hydroxyurea can be considered, with full effect usually taking 24-48 hours. CONCLUSIONS: Leukostatis is a life-threatening emergency, which requires a high level of suspicion and should strongly be considered a differential diagnosis in patients with CLL who present with hyperleukocytosis and acute pulmonary complaints. Leukapheresis is a key step in improvement of oxygenation in leukostasis. It's also important to keep in mind that point of care testing of potassium in CLL patients to prevent overcorrection. REFERENCE #1: [1] Siegel, Rebecca L et al. Cancer statistics, 2016. CA: a cancer journal for clinicians vol. 66,1 (2016): 7-30. doi:10.3322/caac.21332 REFERENCE #2: [2] Lichtman, M A, and J M Rowe. Hyperleukocytic leukemias: rheological, clinical, and therapeutic considerations. Blood vol. 60,2 (1982): 279-83. REFERENCE #3: [3] Ganzel, Chezi et al. Hyperleukocytosis, leukostasis and leukapheresis: practice management. Blood reviews vol. 26,3 (2012): 117-22. doi:10.1016/j.blre.2012.01.003 DISCLOSURES: No relevant relationships by Ramnik Bhogal No relevant relationships by Muhammad afzal Khan No relevant relationships by Mounica Malyala" @default.
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• W4387248875 date "2023-10-01" @default.
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• W4387248875 title "ACUTE HYPOXIC RESPIRATORY FAILURE IN CHRONIC LYMPHOCYTIC LEUKEMIA SECONDARY TO LEUKOSTASIS" @default.
• W4387248875 doi "https://doi.org/10.1016/j.chest.2023.07.1853" @default.
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