II. Definitions
- Blast Crisis
- Chronic Myelogenous Leukemia late stage progression to >20% blasts in blood or marrow
- Results in very high White Blood Cell Counts, Anemia, infection risk, Leukostasis, Tumor Lysis Syndrome
III. Mechanism
- Late complication of Chronic Myelogenous Leukemia (CML)
- Lymphoblasts increase in the Bone Marrow at the expense of other cell lines
- White Blood Cells increase causing Leukostasis resulting in end organ decreased perfusion
IV. Complications
-
Anemia
- Avoid Blood Transfusion if possible (may worsen Blast Crisis)
- pRBC Transfuse for hemodynamic instability or uncontrolled Hemorrhage
-
Thrombocytopenia
- Spontaneous Intracranial Hemorrhage risk when Platelet Count <20,000
- Platelet Transfusion for Platelet Count <20,000 (<50,000 if current bleeding)
- Increased infection risk
- Functional Neutropenia or Immunocompromised
- Treat focal infections with broad spectrum Antibiotics
-
Leukostasis (Hyperviscosity Syndrome)
- See Leukostasis for management
- CNS and cardiac hypoperfusion from sludging of white cells (>50,000/ul)
- Presents with Altered Mental Status, CVA, CHF or Pulmonary Edema
-
Tumor Lysis Syndrome
- See Tumor Lysis Syndrome for management
- Presents with fever, Fatigue, weakness, Nausea, Vomiting
- Rapid cell death and turnover resulting Electrolyte abnormalities
V. References
- Dubbs and Swaminathan in Swadron (2021) Crit Dec Emerg Med 21(12): 18-20