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首页> 外文期刊>The Internet Journal of Academic Physician Assistants >Acute Leukemias
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Acute Leukemias

机译：急性白血病

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The initial diagnosis of acute leukemia should be considered a medical emergency if the patient presents with a white count above 50,000/ul or acute promyelocytic leukemia. These patients require immediate treatment. However, any patient with acute leukemia is at increased risk of infection, bleeding, and problems related to severe anemia, such as high output cardiac failure. If treatment is not available at time of diagnosis, the patient should be transfused with blood products as necessary and then referred to a major cancer center. Chemotherapy will have a greater chance of success if the patient is in a stable condition prior to initiation.1However, if stabilization proves impossible within a few days, therapy should begin anyway, even in patients with lower white blood counts (WBC) and without acute promyelocytic leukemia. If AML is left untreated, the median survival is approximately 2 months. When the peripheral blast count exceeds 50-100,000/ul, leukostasis can cause altered mental status, retinal hemorrhages, cerebrovascular accidents, priapism, local perivascular tissue infiltration, and organ failure, especially of pulmonary and renal systems. Emergent therapy for leukostasis includes hydration, effective anti-leukemic therapy and/or leukopheresis. 2 Tumor lysis syndrome may occur with rapid destruction of large numbers of leukemic cells by chemotherapy and can cause life-threatening acute metabolic derangements such as hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, acidosis, and renal failure. This syndrome can be avoided by vigorous hydration, alkalinization, the use of allopurinol, close observation, and early initiation of hemodialysis when necessary.
机译：如果患者的白细胞计数高于50,000 / ul或急性早幼粒细胞白血病，则应将急性白血病的初步诊断视为医疗急症。这些患者需要立即治疗。但是，任何患有急性白血病的患者感染，出血和与严重贫血有关的问题（例如高输出心力衰竭）的风险均增加。如果在诊断时无法进行治疗，则应根据需要向患者输血，然后转诊至主要癌症中心。如果患者在开始治疗之前处于稳定状态，化学疗法将有更大的成功机会。1但是，如果在几天之内证明无法实现稳定，则无论如何应开始治疗，即使是白细胞计数较低且没有急性发作的患者早幼粒细胞白血病。如果不治疗AML，中位生存期约为2个月。当周围胚泡计数超过50-100,000 / ul时，白细胞停滞会导致精神状态改变，视网膜出血，脑血管意外，阴茎异常勃起，局部血管周围组织浸润和器官衰竭，特别是肺和肾系统衰竭。白血球的紧急治疗包括水合作用，有效的抗白血病治疗和/或白细胞去除术。 2肿瘤溶解综合征可能会因化学疗法迅速破坏大量白血病细胞而发生，并可能导致危及生命的急性代谢紊乱，例如高尿酸血症，高钾血症，高磷酸盐血症，低钙血症，酸中毒和肾衰竭。可以通过剧烈的水合作用，碱化，使用别嘌呤醇，仔细观察并在必要时尽早开始血液透析来避免这种综合征。

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