Hematology Question 37 Instructor

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

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