Fatigue

1. Hyperleukocytosis may be the first presentation of acute myeloid leukemias and prognosticates high morbidity and mortality making immediate therapy imperative. 2. Neurologic deficits, respiratory failure with pulmonary infiltrates, fever and visual changes are frequent presentations of hyperleukocytosis due to leukocyte infiltrates or vessel occlusion. Antibiotics are warranted although the etiology may not be infectious. 3. Hyperleukocytosis can result in other oncologic emergencies such as leukostasis, tumor lysis syndrome, and/or disseminated intravascular coagulation involving multiple organ systems. Evaluation and work up should be directed by symptoms; consider evaluation for intracranial hemorrhage. 4. Differentiate between the true hyperkalemia of tumor lysis syndrome and pseudohyperkalemia of hyperleukocytosis with ECG and a heparinized plasma sample before treating. 5. Urgent cytoreduction with Hydroxyurea (Hydrea) and/or leukapheresis may need to be initiated in parallel to induction chemotherapy. If necessary, transfer to an institution that is able to provide these services immediately.