Images in Clinical Medicine
Hyperleukocytosis in Acute Myeloid Leukemia
N Engl J Med 2003; 349:767August 21, 2003
- Article
A 26-year-old woman was referred for progressive fatigue, dyspnea, blurred vision, and near-syncope. At presentation, she had marked pallor, pyrexia, diffuse nontender lymphadenopathy, and both preretinal and retinal hemorrhages. The initial laboratory examination revealed a leukocyte count of 249,000 per cubic millimeter, a hemoglobin concentration of 29 g per liter (normal range, 115 to 160), and a platelet count of 48,000 per cubic millimeter. A peripheral-blood smear (Panel A, Wright–Giemsa, ×500), showed numerous blast forms. After the peripheral-blood samples drawn at presentation had settled, they revealed a large buffy coat of green leukemic cells (Panel B, arrow); blood from an age-matched healthy woman is shown on the left. The green color reflects the heavy concentration of myeloperoxidase found in the leukemic blasts. The results of a bone marrow biopsy confirmed the diagnosis of acute myeloid leukemia, subtype M2, according to the French–American–British (FAB) classification.
Hyperleukocytosis in acute myeloid leukemia is an ominous sign associated with the development of intravascular thrombi of leukemic cells (leukostasis) in the lungs and brain, which can lead to pulmonary and cerebral infarctions and early death. The patient initially had a remission, but despite autologous stem-cell transplantation followed by interleukin-2 therapy, she had a relapse one year later.
Michael J. Mauro, M.D.
Oregon Health & Science University, Portland, OR 97239-3098
