Bloom R, Taveira Da Silva A M, Bracey A
Am J Med. 1979 Oct;67(4):679-83. doi: 10.1016/0002-9343(79)90256-0.
In a 49 year old man with blast crisis and massive leukocytosis due to chronic myelogenous leukemia, severe hypoxic respiratory failure developed despite a normal chest film. Correction of hypoxemia was observed after reduction of the white blood cell count by hydroxy-urea therapy. A similar episode occurred prior to death, and necropsy examination revealed extensive plugging of the pulmonary vasculature by leukemic blast cells but no infection or pulmonary edema. An inverse linear correlation was demonstrated between the peripheral white blood cell count and the efficiency of oxygen transfer in the lung as determined by the arterial to alveolar oxygen tension ratio. We postulate that mechanical obstruction and/or leukocyte mediated capillary endothelial injury caused the severe leukocyte mediated capillary endothelial injury caused the severe hypoxemia. Abnormalities of pulmonary gas exchange may be common in leukemic patients with markedly increased leukocyte counts.
一名49岁因慢性粒细胞白血病发生原始细胞危象和大量白细胞增多的男性患者，尽管胸部X光片正常，但仍出现了严重的低氧性呼吸衰竭。经羟基脲治疗使白细胞计数降低后，低氧血症得到纠正。在死亡前发生了类似的情况，尸检显示白血病原始细胞广泛阻塞肺血管，但无感染或肺水肿。外周血白细胞计数与通过动脉血氧分压与肺泡血氧分压比值测定的肺内氧转运效率之间呈负线性相关。我们推测，机械性阻塞和/或白细胞介导的毛细血管内皮损伤导致了严重的低氧血症。肺气体交换异常在白细胞计数明显增加的白血病患者中可能很常见。
