Moffitt AM Report PEARLS 6/22: AMS, leukostasis

  • MISTO mnemonic for AMS:
    1. Metabolic (electrolytes, esp Na and Ca; endo, esp thyroid and glucose; liver; kidney)
    2. Infectious
    3. Structural (stroke, mass, bleed)
    4. Toxin
    5. Oxygen/Other
  • Leukostasis: a medical emergency!! Most commonly seen in AML or CML in blast crisis: risk of leukostasis is higher in these patients b/c blasts are “stickier”!
    1. Dx: hyperleukocytosis + symptoms of tissue hypoxia, usually respiratory or neurologic sxs
      1. AML: worry when WBC 50K. Subclassification helps with treatment and prognosis (and M4 and M5 are at higher risk of leukostasis)
      2. CLL: worry when WBC 300-400K
      3. Other hematologic malignancies: worry when WBC >100K
  1. Pathophys: caused by WBC plugs in microvasculature (think hyperviscosity)
    1. **AVOID PRBC transfusions if possible until blast count is r3educed because of increased viscosity with RBC transfusions
  2. Tx: rapid cytoreduction (initiation chemo, leukapheresis)
    1. **High risk of tumor lysis syndrome! Remember ppx against TLS if planning chemo!
  • Two PEARLS from HH!
    1. Plavix can cause TTP!
    2. Elevated B12 can be a sign of serious disease! Think CML, PML, PCV, and hypereosinophilic syndrome. Pathophys: caused by enhanced production of haptocorrin.

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