Rapid Fire: Acute Blast Crisis/Hyperviscosity Syndrome

Emerson, Geremiha; Kaide, Colin G.

doi:10.1016/j.emc.2018.04.005

Cited by 6 publications

(4 citation statements)

References 7 publications

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“…Previously reported findings have demonstrated that cytoreductive surgery could reduce the whole blood viscosity and increase the velocity of the retinal venous blood [ 35 – 37 ], which in turn suggests that increased viscosity contributes to abnormalities in the microcirculation. In this context, the negative relationship between VD and INR in the present study may also result from the hyperviscosity in patients with leukemia, because the increased viscosity state not only reduces the microvascular perfusion, but also enhances the risk of disseminated intravascular coagulation, which manifests with increased INR [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Detection of Retinal Microvascular Changes with Optical Coherence Tomography Angiography in Patients with Acute Leukemia Without Retinopathy

Zhou,

Hashimoto,

Wei

et al. 2024

Ophthalmol Ther

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Introduction Acute leukemia often affects microcirculation perfusion. This study aimed to investigate retinal microvascular changes in patients with acute leukemia without retinopathy during clinical remission using optical coherence tomography angiography (OCTA) and to determine the correlation of these changes with systemic laboratory values. Methods Thirty-eight patients in remission from acute leukemia with no retinopathy (NLR group) and 36 age-matched healthy individuals (control group) were included in this cross-sectional study. OCTA parameters, including the central foveal thickness (CFT), foveal avascular zone (FAZ) area, FAZ perimeter, acircularity index (AI), foveal density (FD300), and the vessel densities (VDs) of the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris were analyzed in a 6 × 6 mm 2 macular scan. Correlation and multiple linear regression analyses were conducted to identify potential systemic characteristics associated with these OCTA metrics. Results AI ( P = 0.034) and FD300 ( P < 0.001) differed significantly between the NLR and control groups. The VD of SCP in the parafovea ( P = 0.001) and of DCP in both the parafovea ( P = 0.011) and perifovea ( P = 0.001) were significantly lower in the NLR group than in the control group. In a multiple linear regression analysis, the reduced VD of the perifoveal DCP was significantly correlated with the increased international normalized ratio (standardized beta [STD β ] = − 0.356; P = 0.047). Conclusions Macular microvascular changes can be observed during remission from acute leukemia antecedent to clinically visible retinal lesions. Hematological disturbances may be associated with microvascular impairments in preclinical leukemic retinopathy.

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Section: Discussionmentioning

confidence: 99%

Detection of Retinal Microvascular Changes with Optical Coherence Tomography Angiography in Patients with Acute Leukemia Without Retinopathy

Zhou,

Hashimoto,

Wei

et al. 2024

Ophthalmol Ther

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“…x10 9 /L [10,11]]. It constitutes a hematologic emergency that can lead to leukostasis, vascular obstruction, and resultant hypoxic tissue damage.…”

Section: Discussionmentioning

confidence: 99%

“…With an extremely elevated WBC of 774 x10 9 /L, this patient was at risk for complications of serum hyperviscosity. Hyperleukocytosis also places patients at risk for disseminated intravascular coagulation and tumor lysis syndrome, both of which manifested during the patient's ED visit with elevated international normalized ratio, Ddimer, lactate dehydrogenase, prothrombin time/partial thromboplastin time, hypercalcemia, hyperkalemia, with decreased fibrinogen and platelet level [11].…”

Section: Discussionmentioning

confidence: 99%

Rare Presentation of Bilateral Central Retinal Vein Occlusion and Leukemic Retinopathy in a Young Adult Diagnosed with T-cell Acute Lymphoblastic Leukemia

Uhr¹,

Thau²,

Chung³

et al. 2020

Cureus

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Simultaneous bilateral central retinal vein occlusion (CRVO) is a rare presentation that warrants consideration of an underlying hyperviscosity state. Increased serum viscosity can lead to the hematologic emergency of leukostasis with resultant vascular obstruction and hypoxic tissue damage. The following case demonstrates the first case of bilateral CRVO in a young adult secondary to acute lymphoblastic leukemia (ALL). A 23-year-old female presented to the emergency department (ED) with two days of worsening bilateral blurry vision and bitemporal headache. Her ocular exam was significant for bilateral intraretinal hemorrhages consistent with CRVO with chest radiograph demonstrating widened mediastinum with perihilar lymphadenopathy and serologic testing revealing ALL with blast crisis. The patient was subsequently admitted to the oncology service for induction chemotherapy. Patients with new headache and bilateral vision changes should prompt a thorough neurological and ophthalmologic exam to assess for underlying systemic pathologies. Concurrent bilateral CRVO is a rare but specific finding for systemic hyperviscosity syndrome, blood dyscrasia, polycythemia, or other serious illness. Early recognition and treatment of the underlying condition can prevent further vision loss and overall morbidity and mortality.

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“…37,42 In liquid tumors, specifically acute myeloid leukemia, accumulation of blast cells can result in leukostasis and ischemic stroke (generally at white blood cell > 100,000/ μL, or platelets >1,000,000/μL). 43 Stroke can also be seen as a complication of chemotherapy or radiation (discussed in the section "Neurologic Complications of Cancer Treatment").…”

Section: Ischemic Strokementioning

confidence: 99%

Neurologic Complications in Patients with Cancer

2021

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Neurologic symptoms are commonly seen in patients with cancer and can be among the most challenging to diagnose and manage. It is often difficult to determine if new neurologic symptoms are secondary to direct effects of a malignant lesion, systemic complications of disease, paraneoplastic disorders, or side effects of cancer treatment itself. However, early diagnosis and treatment of each of these conditions can improve patients' quality of life and long-term functional outcomes. In this review, we describe a systematic approach to the diagnosis of new neurologic symptoms in patients with known malignancy. We have categorized the neurologic complications of cancer through a mechanistic approach, with an emphasis on ascertaining underlying pathophysiology to guide treatment choice. This review focuses on the acute neurologic complications of cancer that require hospital admission.

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Rapid Fire: Acute Blast Crisis/Hyperviscosity Syndrome

Cited by 6 publications

References 7 publications

Detection of Retinal Microvascular Changes with Optical Coherence Tomography Angiography in Patients with Acute Leukemia Without Retinopathy

Detection of Retinal Microvascular Changes with Optical Coherence Tomography Angiography in Patients with Acute Leukemia Without Retinopathy

Rare Presentation of Bilateral Central Retinal Vein Occlusion and Leukemic Retinopathy in a Young Adult Diagnosed with T-cell Acute Lymphoblastic Leukemia

Neurologic Complications in Patients with Cancer

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