Hidou M, Caramella J P, Deletang D, Claude E, Strouk R
Département d'Anesthésie-Réanimation Chirurgicale, Hôpital de Vittel.
Ann Fr Anesth Reanim. 1990;9(4):390-2. doi: 10.1016/s0750-7658(05)80254-0.
A case is reported of a 78-year-old woman with a history of chronic leukemia and who developed after emergency appendicectomy a fatal respiratory distress syndrome related to pulmonary leukostasis. Clinically, the patient had fever, dyspnea and severe hypoxaemia. Chest x-ray showed diffuse pulmonary infiltrates. The patient died from progressive respiratory failure despite ventilatory support. Post mortem lung biopsies were taken for pathologic examination. They showed thrombi composed of leukaemic blast cells which obstructed and distended the lumens of pulmonary arterioles and capillaries. The respiratory distress is attributed to pulmonary leukostasis. Toxic substances released from the leukostatic leukaemic cell or local hypoxia due to vascular occlusion produce this endothelial cell and basement membrane damage. An infectious origin or endogenous pyrogen substances released from leukaemic monocytes may explain the fever. The frequent occurrence of pulmonary leukostasis in patients with leukocyte count greater than 100,000/mm3 point out the need for prevention or therapy of pulmonary leukostasis in these high-risk patients. They need chemotherapy and, if rapid reduction is not observed, leukopheresis which may favourably influence the outcome of patients.
报告了一例78岁女性病例，该患者有慢性白血病病史，在急诊阑尾切除术后发生了与肺白细胞淤滞相关的致命性呼吸窘迫综合征。临床上，患者有发热、呼吸困难和严重低氧血症。胸部X线显示弥漫性肺部浸润。尽管给予了通气支持，患者仍死于进行性呼吸衰竭。死后进行了肺活检以进行病理检查。结果显示由白血病原始细胞组成的血栓阻塞并扩张了肺小动脉和毛细血管的管腔。呼吸窘迫归因于肺白细胞淤滞。白细胞淤滞的白血病细胞释放的有毒物质或血管阻塞导致的局部缺氧会造成这种内皮细胞和基底膜损伤。白血病单核细胞释放的感染源或内源性致热物质可能解释发热原因。白细胞计数大于100,000/mm3的患者中肺白细胞淤滞的频繁发生指出了对这些高危患者进行肺白细胞淤滞预防或治疗的必要性。他们需要化疗，如果未观察到白细胞快速减少，则需要进行白细胞去除术，这可能会对患者的预后产生有利影响。
