Episode 209: Blast Crisis cover art

Episode 209: Blast Crisis

Episode 209: Blast Crisis

Listen for free

View show details

About this listen

 We dive into the recognition and management of blast crisis. Hosts: Sadakat Chowdhury, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Blast_Crisis.mp3 Download 2 Comments Tags: Hematology, Oncology Show Notes Topic Overview Blast crisis is an oncologic emergency, most commonly seen in chronic myeloid leukemia (CML).Defined by: >20% blasts in peripheral blood or bone marrow.May include extramedullary blast proliferation. Without treatment, median survival is only 3–6 months. Pathophysiology & Associated Conditions Usually occurs in CML, but also in: Myeloproliferative neoplasms (MPNs)Myelodysplastic syndromes (MDS) Transition from chronic to blast phase often reflects disease progression or treatment resistance. Risk Factors 10% of CML patients progress to blast crisis.Risk increased in: Patients refractory to tyrosine kinase inhibitors (e.g., imatinib).Those with Philadelphia chromosome abnormalities.WBC >100,000, which increases risk for leukostasis. Clinical Presentation Symptoms often stem from pancytopenia and leukostasis: Anemia: fatigue, malaise.Functional neutropenia: high WBC count, but increased infection/sepsis risk.Thrombocytopenia: bleeding, bruising. Leukostasis/hyperviscosity effects by system: Neurologic: confusion, visual changes, stroke-like symptoms.Cardiopulmonary: ARDS, myocardial injury.Others: priapism, limb ischemia, bowel infarction. Rapid deterioration is common — early recognition is critical. Diagnostic Workup CBC with differential: assess blast % and cytopenias.Peripheral smear and manual diff: confirm immature blasts.CMP: screen for tumor lysis syndrome: Elevated potassium, phosphate, uric acid.Low calcium. LDH & uric acid: markers of high cell turnover.Coagulation studies (PT, PTT): assess for DIC.Definitive tests (done inpatient): bone marrow biopsy, flow cytometry. Emergency Department Management Resuscitation & ABCs: oxygen, IV fluids, vitals monitoring.Avoid aggressive transfusions: Risk of hyperviscosity with PRBCs and platelets. Initiate broad-spectrum antibiotics early: High suspicion for sepsis in functionally neutropenic patients. Consider antifungals for prolonged febrile neutropenia.Cytoreduction strategies: Hydroxyurea to lower WBCs quickly.Tyrosine kinase inhibitors (TKIs).High-dose chemotherapy. Early consultation with hematology/oncology is essential.Mutation testing may guide targeted therapy. Prognosis Without treatment: median survival ~3 months.With treatment: Potential survival >1 year.Best outcomes in patients who enter a second chronic phase and undergo allogeneic stem cell transplant. Ethical & Logistical Considerations Treatment may involve aggressive interventions with serious side effects.Important to assess: Patient goals of care.Capacity for informed consent. Resource limitations: Not all hospitals have oncology services.Patients may require transfer over long distances. Emphasize early, transparent discussions with patients and families. Top 3 Take-Home Points Recognize early: Look for cytopenias, leukostasis, and rapid clinical decline.Resuscitate appropriately: Start antibiotics; be cautious with transfusions.Call for help: Early hematology/oncology involvement is essential for definitive care. Read More
No reviews yet
In the spirit of reconciliation, Audible acknowledges the Traditional Custodians of country throughout Australia and their connections to land, sea and community. We pay our respect to their elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples today.