RT Book, Section
A1 Larson, Richard A.
A1 Hall, Michael J.
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Wood, Lawrence D.H.
SR Print(0)
ID 2293953
T1 Chapter 71. Acute Leukemia
T2 Principles of Critical Care, 3e
YR 2005
FD 2005
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071416405
LK accesssurgery.mhmedical.com/content.aspx?aid=2293953
RD 2022/05/20
AB Many  patients,  especially  children  and  younger  adults,  can  be  cured  of  acute  leukemia  with  the  use  of  intensive  chemotherapy  and  skillful  supportive  care.The  prognosis  for  the  leukemia  patient  depends  on  the  specific  type  of  leukemia,  defined  by  cytogenetics  and  immunophenotype,  its  stage,  prior  therapy,  and  coexisting  chronic  medical  problems.Infection  and  bleeding  are  due  to  the  severe  pancytopenia  caused  by  either  the  leukemia  itself  or  its  myelosuppressive  treatment;  these  problems  resolve  as  the  normal  bone  marrow  recovers.The  success  of  chemotherapy  for  acute  leukemia  depends  not  only  on  the  drug  susceptibility  of  the  individual  patient's  leukemia  but  also  on  the  ability  of  that  patient  to  survive  the  toxicity  of  treatment.Blood  transfusions  should  be  used  to  maintain  a  hematocrit  greater  than  30%  and  a  platelet  count  greater  than  10,000/μL.Hyperleukocytosis  with  malignant  myeloblasts  must  be  treated  as  a  medical  emergency  with  leukapheresis  and  chemotherapy.Central  nervous  system  (CNS)  leukemia  can  be  treated  successfully  with  radiotherapy,  intrathecal  chemotherapy,  and  high-dose  systemic  chemotherapy.Tumor  cell  lysis,  aminoglycoside  antibiotics,  disseminated  intravascular  coagulation,  elevated  lysozyme  levels,  hyperuricemia,  and  direct  infiltration  by  leukemia  cells  can  lead  to  acute  renal  failure,  which  is  often  reversible  with  proper  care.Necrotizing  enterocolitis  requires  aggressive  medical  management  with  antibiotics,  blood  transfusions,  nasogastric  suction,  bowel  rest,  and  maintenance  of  normal  serum  proteins  and  electrolytes.Hyperuricemia  is  proportional  in  severity  to  the  leukemia  tumor  burden,  and  it  responds  to  effective  chemotherapy  together  with  administration  of  fluids,  bicarbonate,  rasburicase,  and  allopurinol.