Bakhshi Sameer, Singh Rajkumar Bikramjit, Munot Khushboo, Pathania Subha
Indian J Pediatr. 2014 Aug;81(8):817-20. doi: 10.1007/s12098-013-1187-4.
The authors evaluated complications in pediatric acute leukemia with "very high" leukocytosis (VHL) prior to rasburicase availability and without leukopheresis. From Jun 2003 through Dec 2009, 45 out of 457 (10 %) pediatric acute leukemia patients had VHL. Median WBC for acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) patients was 296,500/mm3 (200,000-615,220) and 206,300/mm3 (106,100-541,900) respectively. Laboratory and clinical tumor-lysis-syndrome was seen in 37.7 % and 13.3 % patients respectively; none required dialysis; 6.6 % died due to CNS/pulmonary bleed. Thrombocytopenia <31,000/mm3 was associated with hypocalcemia (p = 0.04) and mortality (p = 0.04), and hypoalbuminemia with kidney dysfunction (p = 0.04). In resource-limited setting, VHL patients with thrombocytopenia may warrant rasburicase with or without leukopheresis, and aggressive platelet support.
作者评估了在尚无拉布立酶且未进行白细胞去除术的情况下，小儿急性白血病伴“极高”白细胞增多症（VHL）的并发症情况。2003年6月至2009年12月期间，457例小儿急性白血病患者中有45例（10%）出现VHL。急性淋巴细胞白血病（ALL）和急性髓细胞白血病（AML）患者的白细胞中位数分别为296,500/mm³（200,000 - 615,220）和206,300/mm³（106,100 - 541,900）。分别有37.7%和13.3%的患者出现实验室及临床肿瘤溶解综合征；无人需要透析；6.6%的患者死于中枢神经系统/肺部出血。血小板减少<31,000/mm³与低钙血症（p = 0.04）及死亡率（p = 0.04）相关，低白蛋白血症与肾功能不全相关（p = 0.立酶，无论是否进行白细胞去除术，并给予积极的血小板支持。 04）。在资源有限的情况下，血小板减少的VHL患者可能需要使用拉布
