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Leucostasis — SCE Medical Oncology MCQ

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HardOncological EmergenciesLeucostasisSCE Medical Oncology

A 70-year-old man with newly diagnosed AML (WBC 180 × 10⁹/L) presents with headache, visual disturbance and confusion. Fundoscopy shows bilateral papilloedema and retinal haemorrhages. What is the diagnosis and emergency management?

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Correct answer: D — Leucostasis — immediate leukapheresis, start hydroxyurea, avoid red cell transfusion until WBC reduced

Leucostasis (symptomatic hyperleukocytosis) occurs when very high WBC (typically >100 × 10⁹/L in AML) causes microvascular sludging in the brain and lungs. Emergency management includes: leukapheresis to rapidly reduce WBC, hydroxyurea to cytoreducuce, and avoidance of red cell transfusion (increases viscosity) until WBC falls. Induction chemotherapy should begin promptly. DIC should be managed concurrently. Leucostasis is more common in AML than ALL.

Reference: ESMO 2024 Oncological Emergencies; British Society of Haematology hyperleukocytosis guidelines