SPURIOUS HYPOXEMIA IN A CRITICALLY ILL PATIENT WITH CHRONIC LYMPHOCYTIC LEUKEMIA

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Critically ill patients who require intubation and mechanical ventilation are routinely monitored with arterial blood gas (ABG) analysis to measure oxygen tension (PaO2) as an indicator of adequate exchange. The partial pressure in ABG sample can be impacted by many factors including metabolically active cells such white or platelets leading a false measurement hypoxemia. We report case spurious hypoxemia critically patient due chronic lymphocytic leukemia. CASE PRESENTATION: 67 year-old male, no reported past medical history, presented complaints acute onset fever, diarrhea dyspnea. His physical exam was notable for cachexia, tachycardia tachypnea. On arrival he hemodynamically unstable hypoxic respiratory failure, requiring ventilation. Lab results showed anemia, thrombocytopenia leukocyte count 104,000/mm3. Peripheral smear large lymphocytes, smudge presence prolymphocytes. Chest imaging left lower lobe pneumonia emphysematous changes. He started on broad spectrum antibiotics. Post PaO2 59 but patient's SpO2 95%. Repeat same results. vent settings were adjusted increasing PEEP. pulse oximetry remained >92% however persistent Patient's improved after leukopharesis. However succumbed his clinical condition family opted comfort care. DISCUSSION: Spurious occurs when leukocytosis thrombocytosis have low concurrent normal saturation. It first described 1979 "leukocyte larceny" (1). pathophysiology is believed related the high number which increase consumption dissolved samples (2, 3). ability differentiate between true important especially managing thrombocytosis. High suspicion should considered cell counts >50,0000/mm3, severe thrombocytosis, saturations very analysis. Some methods that been used prevent include immediate cooling rapid samples, where both theoretically slow metabolic rate reduce consumption. CONCLUSIONS: Early recognition leukemia could unnecessary testing ruled out appropriate setting. REFERENCE #1: Hess CE, Nichols AB, Hunt WB, Suratt PM. Pseudohypoxemia secondary N Engl J Med. 1979;301(7):361–363. #2: Fox MJ, Brody JS, Weintraub LR. Leukocyte larceny: cause Am Med 1979;67(5):742–746. #3: Lele A, Mirski M, Stevens R. Crit 2005;33(8):1854–1856. DISCLOSURES: No relevant relationships Louis Gerolemou, source=Web Response Wael Kalaji, Aneeta Kumari, Nabil Mesiha, Kunal Nangrani, Viswanath Vasudevan,