Schellongowski P, Staudinger T
Universitätsklinik für Innere Medizin I, Intensivstation 13i2, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090 Wien, Österreich.
Internist (Berl). 2013 Sep;54(9):1051-60. doi: 10.1007/s00108-013-3260-5.
The occurrence of hyperleukocytosis (leukocytes > 100.000/μl) is associated with complications such as leukostasis, tumor lysis and consumption coagulopathy in patients with acute leukemia much more often than in patients with chronic malignant hematological diseases. To manage these situations may be complex as organ failure is often imminent or manifest, infectious complications arise and indications for induction chemotherapy are usually urgent. Prophylaxis and therapy of the tumor lysis syndrome consists of hydration, lowering of uric acid and the management of electrolyte disturbances. Leukostasis requires immediate reduction of the leukocyte count by leukapheresis, administration of hydroxycarbamide and, ultimately, by causative and specific treatment of the underlying disease itself. In patients with curable diseases or favorable long-term prognosis, transfer to the intensive care unit must be evaluated early in the course of impending organ dysfunction, especially in cases of acute respiratory failure.
与慢性恶性血液系统疾病患者相比，急性白血病患者发生高白细胞血症（白细胞计数>100,000/μl）时更常伴有诸如白细胞淤滞、肿瘤溶解和消耗性凝血病等并发症。处理这些情况可能很复杂，因为器官衰竭往往迫在眉睫或已经出现，会出现感染性并发症，且诱导化疗的指征通常很紧急。肿瘤溶解综合征的预防和治疗包括水化、降低尿酸以及处理电解质紊乱。白细胞淤滞需要通过白细胞单采术立即降低白细胞计数，给予羟基脲，最终对基础疾病本身进行病因治疗和特异性治疗。对于患有可治愈疾病或长期预后良好的患者，在即将出现器官功能障碍时，尤其是在急性呼吸衰竭的情况下，必须尽早评估是否转入重症监护病房。
