Document Detail


Co-existence of thrombocytopenia and hyperleukocytosis ('critical period') as a risk factor of haemorrhage into the central nervous system in patients with acute leukaemias.
MedLine Citation:
PMID:  12038519     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The aim of this work was to examine whether the risk of death i.a. due to haemorrhage into the central nervous system (CNS) is higher during some phases of acute myeloblastic leukaemia (AML), lymphoblastic leukaemia (ALL), and the blastic phase of chronic myelogenous leukaemia (BP) when two important risk factors that worsen the prognosis are simultaneously present: low thrombocytopenia and hyperleukocytosis. Clinical and post-mortem neuropathological examination was performed in 143 patients, aged 17-76 years, who died from AML (80 cases), BP (38), and ALL (25). Periods with co-existence of thrombocytopenia below 25 x 10(9) per l and hyperleukocytosis above 100 x 10(9) per l were identified after plotting the results and were termed the 'critical period' (CP). The study showed that the risk of death was disproportionately high during the CP. This finding was obtained in all patient groups, although it involved mainly patients with AML and BP, i.e. leukaemias with the highest frequency of hyperleukocytosis in peripheral blood. It is suggested that the risk of death during the CP is so high because leukaemic cells are a potent synergistic factor to thrombocytopenia in causing CNS haemorrhage. When a CP is detected, hyperleukocytosis and thrombocytopenia should be controlled and treated aggressively: leukapheresis and platelet concentrates should be administered. Patients with CP should not be given packed red blood cells, in order to avoid a further increase in blood viscosity, which is already high due to hyperleukocytosis. In fact, anaemia during the CP should be regarded as a potentially life-saving factor.
Authors:
Przemysław Nowacki; Barbara Zdziarska; Cezary Fryze; Ignacy Urasiński
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Haematologia     Volume:  31     ISSN:  0017-6559     ISO Abbreviation:  Haematologia (Budap)     Publication Date:  2002  
Date Detail:
Created Date:  2002-05-31     Completed Date:  2002-11-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0130266     Medline TA:  Haematologia (Budap)     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  347-55     Citation Subset:  IM    
Affiliation:
Department of Neurology, Pomeranian Medical University, Szczecin, Poland.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adolescent
Adult
Aged
Cerebral Hemorrhage / etiology*,  pathology
Female
Humans
Leukemia / complications*,  mortality
Leukocytosis / complications*,  mortality
Male
Middle Aged
Probability
Risk Factors
Thrombocytopenia / complications*,  mortality

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