Four patients with acute nonlymphocytic leukemia and leukocyte counts of more than 200,000/mm3 developed respiratory distress due to pulmonary leukostasis within 10–48 hours after initiation of chemotherapy. Clinically, the patients manifested fever, dyspnea, tachypnea, diffuse pulmonary rales, pleural effusions, and severe hypoxemia. Chest roentgenograms displayed diffuse pulmonary infiltrates, vascular engorgement, cardiomegaly, and pleural effusions. Three patients died from progressive respiratory failure despite ventilatory support. Pulmonary histology revealed thrombi composed of leukemic blast cells which obstructed and distended the lumens of pulmonary arterioles, capillaries, and venules. Electron microscopy studies of lung tissue showed pulmonary alveolar endothelium and basement membrane damage and interstitial edema. The pathophysiologic basis of pulmonary leukostasis and potential treatment modalities are discussed.
A patient with chronic granulocytic leukemia (CGL) initially presented with ischemic necrosis of three fingers. His peripheral white blood cell count (WBC) of 256,000/cu mm was associated with an elevated whole blood viscosity. These factors seemed related to his vascular insufficiency. In a further study of 10 patients with CGL, a direct correlation was found between an increasing WBC (or cytocrit) and whole blood viscosity. In CGL an elevated WBC causing an increased whole blood viscosity may be associated with vascular insufficiency, leukostasis, and the hyperviscosity syndrome.
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