II. Definitions

  1. Blast Crisis
    1. Chronic Myelogenous Leukemia late stage progression to >20% blasts in blood or marrow
    2. Results in very high White Blood Cell Counts, Anemia, infection risk, Leukostasis, Tumor Lysis Syndrome

III. Mechanism

  1. Late complication of Chronic Myelogenous Leukemia (CML)
  2. Lymphoblasts increase in the Bone Marrow at the expense of other cell lines
  3. White Blood Cells increase causing Leukostasis resulting in end organ decreased perfusion

IV. Complications

  1. Anemia
    1. Avoid Blood Transfusion if possible (may worsen Blast Crisis)
    2. pRBC Transfuse for hemodynamic instability or uncontrolled Hemorrhage
  2. Thrombocytopenia
    1. Spontaneous Intracranial Hemorrhage risk when Platelet Count <20,000
    2. Platelet Transfusion for Platelet Count <20,000 (<50,000 if current bleeding)
  3. Increased infection risk
    1. Functional Neutropenia or Immunocompromised
    2. Treat focal infections with broad spectrum antibiotics
  4. Leukostasis (Hyperviscosity Syndrome)
    1. See Leukostasis for management
    2. CNS and cardiac hypoperfusion from sludging of white cells (>50,000/ul)
    3. Presents with Altered Mental Status, CVA, CHF or Pulmonary Edema
  5. Tumor Lysis Syndrome
    1. See Tumor Lysis Syndrome for management
    2. Presents with fever, Fatigue, weakness, Nausea, Vomiting
    3. Rapid cell death and turnover resulting Electrolyte abnormalities
      1. Hyperkalemia
      2. Hyperphosphatemia
      3. Hyperuricemia
      4. Hypocalcemia
      5. Acute Kidney Injury
      6. Arrhythmia
      7. Seizure

V. References

  1. Dubbs and Swaminathan in Swadron (2021) Crit Dec Emerg Med 21(12): 18-20

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Related Studies

Ontology: Lymphoblastosis (C0877177)

Concepts Pathologic Function (T046)
Italian Linfoblastosi
Japanese リンパ芽球症, リンパガキュウショウ
Czech Lymfoblastóza
English Lymphoblastosis
Hungarian lymphoblastosis
Portuguese Linfoblastose
Spanish Linfoblastosis
Dutch lymfoblastose
French Lymphoblastose
German Lymphoblastose

Ontology: Blast crisis in myelogenous leukaemia (C0919644)

Concepts Neoplastic Process (T191)
Italian Crisi blastica in leucemia mieloide
French Crise blastique de leucémie myéloïde, Crise blastique de la leucémie myélogène
Portuguese Crise de blastos em leucemia mielogénica, Crise blástica na leucemia mielogenosa
Japanese 骨髄性白血病の芽球発症, コツズイセイハッケツビョウノガキュウハッショウ
Czech Blastická krize u myeloidní leukemie
Hungarian Blastos crisis myelogen leukemiában, Blast crisis myelogen leukaemiában
English Blast crisis in myelogenous leukaemia, Blast crisis in myelogenous leukemia
Spanish Crisis blástica en leucemia mielógena
Dutch blastencrisis in myelogene leukemie
German Blastenkrise bei myeloischer Leukaemie