Lymphoblast Crisis

Aka: Lymphoblast Crisis, Blast Crisis, Lymphoblastosis, Blast Crisis in Myelogenous Leukaemia

1. See Also
   1. Chronic Myelogenous Leukemia
2. 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
3. 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
4. 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
5. References
   1. Dubbs and Swaminathan in Swadron (2021) Crit Dec Emerg Med 21(12): 18-20