Leukostasis can occur in leukemia when there is formation of leukemic cell aggregates with fibrin forming thrombi that occlude blood vessels and interfere with tissue oxygenation. The symptoms vary with the organs affected; one or more organs may be involved.



(1) pulmonary: cyanosis, progressive dyspnea, tachypnea, hypoxemia

(2) CNS: headache, confusion, altered mental status

(3) cardiac: tachycardia, heart failure, ischemia, cardiac tamponade

(4) fever without a focus of infection

(5) ocular: retinal vein distention, retinal hemorrhages, papilledema, visual blurring

(6) priapism in males


Chest X-ray may or may not show interstitial infiltrates.


A biopsy showing intravascular leukocytic thrombi occluding or distending small blood vessels is diagnostic.


Type of leukemia and white blood cell count:

(1) AML: risk very high with counts > 200,000 per µL, but it has been reported to occur with counts < 50,000 per µL

(2) ALL: occurs with counts > 100,000 per µL, with greater risk at counts > 200,000 per µL

(3) CML or CMML: occurs with counts > 150,000 per µL

(4) CLL: rare, but may occur with counts > 800,000 per µL


The workup for infectious agents is negative.


Symptoms tend to improve with reduction in the white cell count by leukopheresis and/or chemotherapy but some patients will progress and die.


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