The clinical course of acute myeloid leukemia (AML) is complex, and the care of patients with AML should be entrusted to clinicians with sufficient knowledge and experience. Symptoms associated with anemia, infection, and bleeding occur almost universally as a consequence of the treatment and the disease itself. Other complications, such as leukostasis, metabolic abnormalities, and involvement of the central nervous system (CNS) may also be life-threatening, and must be rapidly diagnosed and treated, lest they interfere with appropriate treatment of the leukemia, either before chemotherapy can be given, or during the recovery period.
This topic will provide an overview of the complications of AML. The clinical features, diagnosis, classification, treatment, and overall prognosis of AML are discussed separately. (See "Clinical manifestations, pathologic features, and diagnosis of acute myeloid leukemia" and "Induction therapy for acute myeloid leukemia in younger adults" and "Treatment of acute myeloid leukemia in older adults".)
Patients with AML typically present with a normocytic, normochromic anemia that can vary in severity. This anemia worsens with induction chemotherapy and is managed primarily with blood transfusions. There is no role for the use of erythropoietic stimulating agents during induction therapy of AML. (See "Hematologic consequences of malignancy: Anemia and bleeding".)
The threshold for transfusion of packed red blood cells varies with patient age, symptoms, and the presence of medical comorbidities. In general, most centers recommend transfusion to asymptomatic patients with a hemoglobin ≤8 g/dL (5 mmol/liter). Blood products should be leukocyte depleted to reduce the risk of alloimmunization and transmission of cytomegalovirus (CMV) [1,2]. Although graft versus host disease is very unusual in patients with leukemia receiving conventional chemotherapy, many centers routinely irradiate blood products for such patients. (See "Induction therapy for acute myeloid leukemia in younger adults", section on 'Transfusions'.)
Of importance, red cell transfusions may increase the whole blood viscosity of patients with hyperleukocytosis resulting in symptoms of leukostasis. As such, red blood cell transfusions should be administered very slowly, or, if possible, withheld until the blast count is reduced in such patients. (See "Hyperleukocytosis and leukostasis", section on 'Supportive care'.)