Emergency providers are likely to encounter patients with acute and chronic leukemias. The first presentation to the ED may be for symptoms related to blast crisis and leukostasis. Making a timely diagnosis and immediately consulting a hematologist can be life-saving. Presenting symptoms are due to complications of bone marrow infiltration and hyperleukocytosis with WBC counts over 100,000. Presentations may include fatigue (anemia), bleeding (thrombocytopenia), shortness of breath, and/or neurological symptoms owing to hyperleukocytosis and subsequent leukostasis. Blast crisis with leukostasis is a Heme/Onc emergency. Treatment of symptomatic cases involves induction chemotherapy and/or leukapheresis. Asymptomatic hyperleukocytosis can be treated with hydroxyurea.
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Geremiha Emerson has no disclosures. Colin Kaide: Callibra, Inc.-Discharge 123 medical software company. Medical Advisory Board Portola Pharmaceuticals. I have no relationship with a commercial company that has a direct financial interest in subject matter or materials discussed in article or with a company making a competing product.
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