Leukemia And Strokes: Understanding The Link And Risks

Leukemia is a cancer of the blood that starts when the bone marrow rapidly produces abnormal white blood cells, which may crowd out normal blood cells and platelets. There are four main types of leukemia: acute lymphocytic leukemia, chronic lymphocytic leukemia, acute myeloid leukemia, and chronic myeloid leukemia. Acute leukemia is incredibly rare and progresses rapidly, with white blood cells growing very quickly over a matter of days to weeks. Extreme fatigue is usually the first symptom, and patients may also develop infections. At the time of diagnosis, patients can have very high white blood cell counts, which can impair blood flow and lead to respiratory failure, stroke, heart attacks, or neurological changes. Chronic leukemia, on the other hand, develops slowly and may go undetected for months or years.

Leukemia patients are at a higher risk of developing cerebral infarction, which can lead to a stroke

Leukemia is a cancer of the blood that begins when the bone marrow starts to rapidly produce abnormal white blood cells. These abnormal cells are called leukemia cells. There are four main types of leukemia: acute lymphocytic leukemia, chronic lymphocytic leukemia, acute myeloid leukemia, and chronic myeloid leukemia.

Acute leukemias are incredibly rare and are the most rapidly progressing form of cancer. The white blood cells in the blood grow very quickly, over a matter of days to weeks. Due to the rapid progression of acute leukemia, patients may experience extreme fatigue as their first symptom, as well as a higher risk of infection.

Additionally, patients with acute leukemia can have very high white blood cell counts, which can impair blood flow and lead to serious complications such as respiratory failure, stroke, heart attacks, or neurological changes. Therefore, it is crucial to quickly remove the abnormal cells from the blood and start chemotherapy to kill the cancer cells as soon as possible.

Chronic leukemia, on the other hand, develops slowly and may take months or years before causing any symptoms. It is often detected during regular check-ups when blood work shows abnormal results. Unlike acute leukemia, chronic leukemia can be controlled or treated similarly to other chronic conditions, and patients may only need monitoring through blood work and physical exams.

Patients with acute myeloid leukemia (AML) are more likely to experience a cerebrovascular accident (CVA) than the general inpatient population

Leukemia, especially acute myeloid leukemia (AML), is associated with an elevated risk of cerebrovascular accidents (CVAs) or strokes. Patients with AML are more likely to experience a CVA than the general inpatient population, with a 50-fold increase in risk compared to all admissions. This heightened risk is due to the increased likelihood of both hemorrhage and thrombosis in AML patients, including in the central nervous system.

A study of nearly 7.3 million admissions, including 10,984 patients with active AML, found that 65 patients (0.59%) had a concurrent CVA, either hemorrhagic or ischemic. This small proportion of AML patients experiencing CVA suggests that while the risk is significantly higher than the general population, CVA is still a relatively rare event in AML patients.

The study also revealed that AML patients who developed a CVA were predominantly female, older, and had a significantly higher inpatient mortality rate of 36.9% compared to 6.7% for all admitted patients with stroke. Furthermore, AML patients with CVA had a five times higher risk of mortality than all CVA patients.

Several factors were identified as significant predictors of stroke in AML patients, including acute renal failure with tubular necrosis, hypernatremia, urinary tract infection, and secondary thrombocytopenia. These factors, along with mechanical ventilation and continuous positive airway pressure ventilation, were more prevalent in AML patients with CVA than in those without.

The occurrence of a CVA in AML patients can have serious medical, financial, and quality-of-life implications, emphasizing the need for better characterization and understanding of stroke risk factors in this vulnerable population.

Leukemia can cause hyperleukocytosis, which can lead to decreased tissue perfusion and ischemia in the brain, resulting in a stroke

Leukemia is a blood cancer that can cause hyperleukocytosis, a condition characterised by an abnormally high white blood cell count. Hyperleukocytosis can lead to a medical emergency known as leukostasis, which is commonly seen in acute myeloid leukemia patients. Leukostasis is caused by an extremely high blast cell count, resulting in decreased tissue perfusion and inadequate oxygen delivery to the body's cells.

The pathophysiology of leukostasis is not yet fully understood, but it is believed to be related to increased blood viscosity and impaired blood flow. The high number of white blood cells circulating in the blood, particularly larger cells with decreased deformability, can lead to blockages in the microvasculature. This results in decreased tissue perfusion, especially in the brain and lungs, which are the most commonly affected organs.

Symptoms of leukostasis include respiratory distress, such as dyspnea and hypoxia, as well as neurological symptoms like visual changes, headaches, dizziness, confusion, and even coma. Leukostasis carries a high mortality rate, and patients often die from neurological complications. Therefore, prompt treatment is required to reduce white blood cell counts and manage the underlying disorder.

In summary, leukemia can cause hyperleukocytosis, which increases the risk of leukostasis and subsequent decreased tissue perfusion. This can lead to ischemia in the brain and other organs, resulting in a stroke or other life-threatening complications. Early intervention is crucial to improve patient outcomes and reduce the risk of long-term neurological damage.

Cancer treatment options such as chemotherapy, radiotherapy, and surgery can increase the risk of stroke in leukemia patients

Cancer Treatment Options and Risk of Stroke in Leukemia Patients

Chemotherapy

Chemotherapy is a common treatment for leukemia, but it can also increase the risk of stroke. Chemotherapy drugs can have toxic effects on the endothelial cells that line the blood vessels, leading to abnormalities in coagulation and hemostasis factors. This can disrupt the normal functioning of blood vessels and increase the risk of blood clots or bleeding, both of which can lead to stroke. Additionally, chemotherapy can cause immunosuppression, making patients more susceptible to opportunistic infections that may also increase the risk of stroke. Certain chemotherapy drugs, such as methotrexate, 5-fluorouracil, cisplatin, and L-asparaginase, have been specifically associated with an increased risk of stroke.

Radiotherapy

Radiotherapy, or radiation therapy, is another treatment option for leukemia that can increase the risk of stroke. Radiation can damage blood vessels of all sizes, particularly arteries and capillaries. This damage can lead to endothelial cell death, thrombus formation, and hemorrhage. In the brain, radiation can disrupt the blood-brain barrier, causing vasogenic edema and localised hypoxia, which can further increase the risk of stroke. The effects of radiotherapy on the vasculature may be delayed, with the risk of stroke peaking several years after treatment.

Surgery

Surgery for leukemia may also increase the risk of stroke, although this is less commonly reported. Surgical procedures can promote the release of emboli, which are small particles that can travel through the bloodstream and block blood vessels. This can lead to a stroke if the blockage occurs in the brain. Additionally, certain surgical procedures, such as lumbar puncture, intrathecal chemotherapy, and craniotomy, have been specifically linked to an increased risk of subdural hematoma, which is a type of bleeding in the brain.

Overall Considerations

While cancer treatment options can increase the risk of stroke in leukemia patients, it is important to note that the overall risk of stroke in this population is relatively low. The management of stroke in leukemia patients may also differ from that of the general population, and careful consideration of the patient's condition and treatment history is necessary. Additionally, the benefits of these cancer treatments may outweigh the risks in many cases, and discontinuing or avoiding these treatments due to stroke risk may not be advisable.

Leukemia patients with high white blood cell counts are at risk of stroke due to impaired blood flow and the stickiness of tumor cells

Leukemia is a cancer of the blood that begins when the bone marrow starts to rapidly produce abnormal white blood cells. These abnormal cells are called leukemia cells, and they may crowd out normal white blood cells, red blood cells, and platelets, making it hard for the normal cells to do their work.

Acute leukemia is the most rapidly progressing cancer we know of. The white cells in the blood grow very quickly, over a matter of days to weeks. At the time of diagnosis, patients can have very, very high white blood cell counts. Typically, a healthy person has a white blood cell count of about 4,000-11,000. Patients with acute or even chronic leukemia may come in with a white blood cell count up into the 100,000-400,000 range.

When you have that many white cells in your blood vessels, it can impair blood flow, because you have 20 to 40 times the normal number of cells in the blood vessels. And these are not normal cells — they are tumor cells, so they can stick together, and they can also stick to the blood vessels. This stickiness of tumor cells can cause blockages in the blood vessels, which can lead to a stroke.

When patients have very high white blood cell counts, the leukemia cells will usually spill over from the blood vessels into some of the organs. If the lungs are affected, the patient can have respiratory failure. Patients can have strokes because of interrupted blood flow in the brain. They can have heart attacks or neurological changes. So when someone comes in with a very high white blood cell count, we are very concerned about these risks. In those cases, we usually try to quickly remove the abnormal cells from the blood and start chemotherapy to begin killing them off as soon as possible.

Frequently asked questions