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Leukemia, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Neoplasms of WBCs that have undergone a malignant transformation

  • Hyperleukocytosis:

    • Occurs with WBC >100,000/mm3

    • Leads to occlusions of small vessels primarily in brain or lungs

    • Prese...

Diagnosis

Signs and Symptoms

Chronic Myelogenous Leukemia

  • Asymptomatic

  • Fatigue

  • Weight loss

  • Left upper quadrant pain, tenderness

  • Abdominal fullness

  • Splenomegaly (most common)

  • Later stage:

    • Headaches

    • Bone pain

    • Arth...

Treatment

Initial Stabilization/Therapy

  • 100% oxygen for hypoxia/shortness of breath

  • IV access with 0.9% NS

  • Initiate platelet transfusion for severe bleeding from thrombocytopenia.

  • Begin broad-spectrum ant...

Follow-Up

Disposition

Admission Criteria

  • Newly diagnosed leukemia with:

    • Symptomatic anemia

    • WBC >30,000

    • Thrombocytopenia

  • ICU admission for unstable patients with disseminated intravascular coagulation, bl...

Pearls and Pitfalls

  • Monitor for tumor lysis and secondary hyperkalemia.

  • Hyperleukocytosis may present as respiratory failure or hemorrhage.

Additional Reading

  • Abramson  N, Melton  B. Leukocytosis: Basics of clinical assessment. Am Fam Physician.  2000;62:2053–2060.

  • Higdon  ML, Higdon  JA. Treatment of oncologic emergencies. Am Fam Phy...

Codes

ICD9

  • 204.10 Chronic lymphoid leukemia, without mention of having achieved remission

  • 205.10 Chronic myeloid leukemia, without mention of having achieved remission

  • 208.90 Unspecified leukemia, withou...

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