Когда лейкоцитов много.... ( 1 фото )

A 64-year-old woman presented to the hospital with a 5-month history of fatigue and a 2-week history of fever and cough. Two weeks before presentation, she had fled war-related conflict in her region. Her heart rate was 110 beats per minute, the blood pressure was 90/40 mm Hg, the respiratory rate was 28 breaths per minute, and the oxygen saturation was 88% while the patient was breathing ambient air. On physical examination, there was confusion, generalized nontender lymphadenopathy, and hepatosplenomegaly. A serum sample showed a broad, greenish buffy coat of cells (Panel A). Laboratory studies were notable for a white-cell count of 474,600 per cubic millimeter (reference range, 4000 to 11,000). A peripheral-blood smear showed numerous mature granulocyte forms (Panel B and inset, May–Grünwald–Giemsa stain). Molecular testing was positive for the BCR-ABL1 fusion gene. A diagnosis of chronic myeloid leukemia with hyperleukocytosis was made. Hyperleukocytosis, which is typically seen in hematologic cancers, is defined as a white-cell count of more than 100,000 per cubic millimeter. Treatment with intravenous fluids, empirical antibacterial therapy, and glucocorticoids was initiated. Owing to the war in Sudan, no oncologic medications, such as hydroxyurea and imatinib, were available. Multiorgan failure from an unknown cause developed, and the patient died 5 days after admission.
Author: Bashir A. Bashir, Ph.D.
Published January 1, 2025
N Engl J Med 2025;392:72
VOL. 392 NO. 1

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