HYPERLEUKOCYTOSIS + ACUTE

LYMPHOBLASTIC LEUKEMIA
Presented by
Priya Darishini G 090100399
Privina Arivalagan 090100390

Supervised by
Prof. Dr. Hj. Bidasari Lubis, Sp.A(K)
DEPARTEMEN ILMU KESEHATAN ANAK
PROGRAM PENDIDIKAN PROFESI DOKTER
FAKULTAS KEDOKTERAN
UNIVERSITAS SUMATERA UTARA
2013
Hyperleukocytosis is defined as peripheral
blood leukocyte count exceeding
>100,000/mm
3

ETIOLOGY
Physiologic/Emotiona
l
Ovulation,labor,pregn
ancy
Acute infection Acute hemmorhage
Drugs/poisoning
Metabolic causes Malignant neoplasm
Connective tissue
disease
Hematological disease
PATOGENESIS
Sluggish flow with stasis
Aggregation of leukaemic cells
Formation of microthrombi
Release of toxic granules
Endothelial damage
Oxygen consumption by leukocytes
Tissue invasion

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
2 Mechanisms:
Increase in blood
viscosity due to high
TLC and leukocyte
aggregates, resulting in
stasis
Adhesive reaction between
damaged endothelium of
vessel and leukemic blast
precipitating
hyperleukocytosis;the toxins
and cytokines exercebate
situation
CLINICAL MANIFESTATION
Weakness,
fatigue and
paleness
Bleeding
Infection
Headache,
vision blurring,
dyspnoe,somnol
ence to stupor
shows medical
emergency
diagnosis
Cbc
Peipheral
smear
Serum
electrolyte
(phosphate
,kalium
,calcium, uric
acid)
Blood
gas
analysis
Chest
x-ray
Ecg
Bmp
MANAGEMENT
Vigorous hydration with intravenous fluids
Alkalinization of the urine
Prevention of tumor lysis syndrome
DIC or thrombocytopenia
Leukocytoreduction
Radiation
Leukapheresis
COMPLICATIONS
Tumor lysis
syndrome
Neurologic
Pulmonary
Vascular
PROGNOSIS
High-risk
groups
Number of
leukocytes
Age,
phenotype,
and
cytogenetic
response to
prednisone
administratio
n
High
morbidity
and
mortality
DISCUSSION
Theory Patient
Definition: Hyperleukocytosis is defined as a white
blood cell (WBC) count exceeding >100,000/mm
3
.
Patients leukocyte count was 133 570/mm
Epidemiology: Hyperleukocytosis occurs
approximately in 9% until 13% of children with acute
lymphoblastic leukemia
Patient is diagnosed with Hyperleukocytosis + Acute
lymphoblastic 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
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 paleness
secondary to anemia
-Due to ALL patient has experienced weight loss,
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, potassium,
calcium, phosphate) along with renal functions and
uric acid are all in normal range. However,blood
gas analysis revealed acidosis.
Treatment: Vigorous hydration, Alkalinization of
the urine, Recombinant urate oxidase (rasburicase)
Patient is given hydration theraphy with 4:1 plus
meylon 25 mEq.