title: [Extreme leucocytosis can lead to an erroneous diagnosis of severe hypoxaemia. Description of a case].
abstract: The diagnosis and treatment of respiratory failure is a part of the anaesthesist's daily practice, as well as the hypoxaemia that is one of its physiological and analytical consequences. Patients with an extreme leucocytosis secondary to leukaemia can suffer an incorrect diagnosis of hypoxemia, called "pseudohypoxaemia". This is basically due to the rapid in vitro oxygen consumption, and is characterized by a low partial pressure of oxygen in arterial blood (PaO2) despite a normal oxygen saturation (SpO2) measured by pulse oximetry. Pseudohypoxaemia appears in patients with thrombocytosis or hyper-leucocytosis occurring during blastic crisis of a leukaemia. It must be suspected in patients with a discrepancy between the SpO2 measured by oximetry and the PaO2. In this context, pulse oximetry is the most accurate way to establish the diagnosis and to avoid unnecessary actions. We report the case of a patient with chronic myeloid leukaemia and extreme leucocytosis requiring emergency surgery, and diagnosed with pseudohypoxaemia during the perioperative period that led to a delay in the extubation of the patient.
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
authors.forename: C
authors.initials: C
authors.lastname: Rodríguez
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital del Mar, Parc de Salut Mar, Barcelona, España. Electronic address: 94397@parcdesalutmar.cat.
authors.forename: S
authors.initials: S
authors.lastname: Pacreu
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
authors.forename: N
authors.initials: N
authors.lastname: Baldomà
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
authors.forename: S
authors.initials: S
authors.lastname: Sánchez
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
authors.forename: E
authors.initials: E
authors.lastname: Vilà
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Mases
mesh_terms: D000368:Aged; D060666:Airway Extubation; D016913:Blood Component Transfusion; D003951:Diagnostic Errors; D004630:Emergencies; D006465:Hemoperitoneum / Q000209:etiology / Q000628:therapy; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000097:blood* / Q000150:complications; D007964:Leukocytosis / Q000097:blood / Q000175:diagnosis*; D008297:Male; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D012422:Rupture, Spontaneous; D013156:Splenectomy; D013161:Splenic Rupture / Q000097:blood / Q000209:etiology / Q000601:surgery
chemical_list: D010100:Oxygen