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Acute monocytic leukemia presenting as acute respiratory failure
Elie Azoulay1, Fabienne Fieux, Delphine Moreau
1Medical Intensive Care Unit, Hematology Department, Saint-Louis Teaching Hospital, Paris 7 University, France. elie.azoulay@sls.ap-hop-paris.fr
American Journal of Respiratory and Critical Care Medicine
|February 8, 2003
Summary
Acute respiratory failure can be a rare presenting sign of acute monocytic leukemia. Patients often experience rapid respiratory decline, especially after chemotherapy initiation, highlighting the need for prompt recognition and intensive care.
Area of Science:
- Hematology
- Pulmonology
- Oncology
Background:
- Acute respiratory failure is an uncommon initial presentation of acute leukemia.
- Acute monocytic leukemia can manifest with rapidly progressive respiratory distress.
Purpose of the Study:
- To describe the clinical characteristics and outcomes of patients with acute respiratory failure due to acute monocytic leukemia.
- To emphasize the importance of recognizing leukemic pulmonary infiltration and anticipating post-chemotherapy respiratory deterioration.
Main Methods:
- Retrospective analysis of 20 patients admitted to the intensive care unit (ICU) with acute respiratory failure revealing acute monocytic leukemia.
- Review of clinical data, laboratory findings, imaging, bronchoalveolar lavage, and outcomes.
Main Results:
- Patients presented with severe respiratory distress (median PaO2 44.5 mm Hg) and high leukocyte counts (median 98,250/mm3).
- Alveolar hemorrhage was a common finding on bronchoalveolar lavage.
- All patients experienced respiratory function deterioration after chemotherapy initiation, with a high mortality rate (10/15) among mechanically ventilated patients.
Conclusions:
- Leukemic pulmonary infiltration should be considered in cases of acute respiratory failure.
- Intensive management is crucial, anticipating respiratory decline post-chemotherapy.