List the major complications that can result from a new diagnosis of acute leukemia.
Consider points of discussion:
- Tumor Lysis Syndrome:
- Presence of two or more abnormal laboratory values of either uric acid, potassium, phosphorus, or calcium at presentation, or a 25% change in values from the pre-treatment measurements.
- Clinical TLS is defined as the presence of laboratory TLS, plus renal dysfunction, seizures, cardiac arrhythmia, or sudden death.
- Hyperleukocytosis (Blast count >100 x 109L): Increased number of blasts in the microcirculation causing decreased tissue perfusion and hemorrhage. Must be managed urgently with cytoreduction
- Disseminated intravascular coagulation and fibrinolysis (particularly in the setting of Acute promyelocytic leukemia)
- Neutropenic fever
- Neutropenic enterocolitis
- Transfusion associated graft versus host disease: all patients should receive irradiated blood products