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September 20, 1976

Blast Cell Crisis in Acute Leukemia

Author Affiliations

Cardinal Glennon Memorial Hospital for Children St Louis, Mo

JAMA. 1976;236(12):1355. doi:10.1001/jama.1976.03270130019018

To the Editor:  We were very interested in the article on the management of blast cell crisis in leukemia by Hoagland and Perry (235:1888-1889, 1976). In pediatrics, some additional problems should be considered in the leukemic infant and child with a very high WBC count.

Hypocalcemia and Tetany.—  Leukemic patients with very high WBC counts have been shown to be more susceptible to hypocalcemia as well as hyperuricemia during the induction therapy.1 However, we also recently encountered an adolescent girl in whom tetany and renal failure developed prior to any chemotherapy for leukemia. The mechanism of hypocalcemia is still not well understood. Some feel that high phosphate load from the lysis of leukemic cells is the cause,1 while others consider renal shutdown responsible.2 Coexistence of hyperuricemia and hypocalcemia may also cause a dilemma in the management of the case. Administration of large amounts of sodium bicarbonate will