TREATING THE HEMATOLOGIC

EMERGENCIES IN ADULT WITH

ACUTE LEUKEMIA

By: tia amestiasih

• Only 40% of younger, 10% of older adult are
long term survivors
• Although curing the leukemia is always the
most formidable challenge, complications
from the disease itself and its treatment are
associated with significant morbidity and
mortality
 Complications
• Tumor lysis
• Hyperleukocytosis
• Cytarabine-induced toxicity
• Thrombohemorragic syndrome
• Leukemic meningitis
• Neutropenic fever
 TUMOR LYSIS SYNDROME (TLS)
Clinical manifest:
• Leukosit ↑↑↑
• Hb ↓↓
• Platelet ↓↓
 TLS
• TLS as a result or high turnover of the
malignant cells
• Primary TLS  befor treatment
• Secondary TLS  short time after the
beginning of treatment
• TLS  rapid cell lysis, tumor burden,
preexisting nephropaty
• The risk is dependent on the WBC and rate of
response to therapy
 Treatment
• Based on aggressive hydration
• Electrolyte correction
• Reduction of UA levels
• Young adult without comorbidies  4000 to
5000 ml of iv fluids per 24 hr be started 24 to
48 hr before induction chemotherapy
• Maintaning a urine output
• Allopurinol  prevents the formation of UA
but not decrease the level of UA
 HYPERLEUKOCYTOSIS
• The transfusion of blood to a patient with
hyperleukocytosis may be hazardous because
of increasing the blood viscocity and potential
for aggravating leukostasis
• Vascular obstruction - eyes, lungs,
extremities, heart, kidneys, penis
• Dyspnea
• Stupor
• Pulmonary infection
• Hypoxemia
• Hyperkalemia
 Tratment
• Leukapheresis
• Plasma replacement
• High dose corticosteroid
• HD
 TOXICITY
• Cytarabine
• Clinical manifes  ataxia; nystagmus;
dysmetria; dysarthria; seizure; cerebral
dysfunction; peripheral neurophaty
 Risk factors
• Age
• Cumulative dose
• Renal insufficiency
• Liver disfunction
 Treatment
• There is no effective treatment
• Prophylaxis  pyridoxine
hydrochloride
• Metilpredisolone
• Haemodialysis
 ASSASEMENT
Primary survey
• A
• B
• C
• D
• E
SECONDARY SURVEY
tia.amestiasih@gmail.com