TY - CHAP M1 - Book, Section TI - Acute Leukemia A1 - Carlson, Karen-Sue B. A2 - Hall, Jesse B. A2 - Schmidt, Gregory A. A2 - Kress, John P. Y1 - 2015 N1 - T2 - Principles of Critical Care, 4e AB - Untreated acute leukemia is rapidly fatal, but a percentage of patients can be cured. In the absence of cure, many can achieve a significant duration of high-quality life depending on preleukemia comorbidities, and should therefore be considered for therapy.Medical complications of the acute leukemias are often reversed with treatment of the underlying disease.Bleeding or infectious complications account for the majority of deaths in patients with acute leukemias.Laboratory findings define and are prominent in tumor lysis syndrome and include hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia.Rasburicase can be used to treat hyperuricemia, but must be avoided for patients with known hypersensitivity, methemoglobinemia, or G6PD deficiency.Urinary alkalinization is not recommended for prevention of tumor lysis syndrome.Cytogenetics and molecular studies are important prognostic indicators in AML and ALL.Prophylactic platelet transfusion is indicated for thrombocytopenia associated with acute leukemia.Disseminated intravascular coagulation (DIC) should be aggressively treated with transfusion support with fresh frozen plasma and cryoprecipitate during the initial treatment of acute leukemias.Acute promyelocytic leukemia (APL) should be suspected in patients with pancytopenia and severe DIC.All-trans retinoic acid (ATRA) therapy should be rapidly initiated if APL is suspected, and invasive procedures including placement of a central venous catheter should be avoided until the DIC has resolved.Rapid cytoreduction by hydroxyurea and leukapheresis are mainstays of therapy for hyperleukocytosis. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesssurgery.mhmedical.com/content.aspx?aid=1126247598 ER -