急性骨髓性白血病患者的呼吸照護經驗

The experience of respiratory care in patient with acute myeloid leukemia

柯雅云(Ya-Yun Ko) ； 沈威廷(Wei-Ting Shen) ； 譚美珠(Mei-Chu Tan)

《呼吸治療》 19卷1期 (2020/07) Pp. 65-79

https://doi.org/10.6269/JRT.202007_19(1).0007

摘要

急性骨髓性白血病（acute myeloid leukemia, AML）患者約有10～30%屬於高白血球症（hyperleukocytosis; white blood cell count (WBC)＞100 ×10^3/uL），由於過多的未成熟白血球，易使動脈血檢體發生嚴重的白血球細胞的盜竊（leukocyte larceny）現象，而導致動脈血液氣體分析（arterial blood gas, ABG）的（partial pressure of arterial oxygen, PaO_2）假性偏低。本個案此次入院確診為AML合併高白血球症，並且因呼吸衰竭而插管使用呼吸器，在照護此病人期間，臨床發現動脈血液氣體分析結果與病人脈動式血氧飽和度（oxyhemoglobin saturation by pulseoximetry, SpO_2）不一致，動脈血氣體分析及判讀是呼吸治療師照護重點之一，因此想藉由本文分享與探討此一特殊臨床現象。

關鍵字

高白血球症 ； 假性低血氧現象 ； 白血球細胞的盜竊

並列摘要

About 10~30% of patients with acute myeloid leukemia (AML) belong to hyperleukocytosis (WBC count ＞100 X10^3/Ul). Due to excessive immature white blood cells, arterial blood samples are severely affected. The phenomenon of leukocyte larceny, which leads to a pseudo-lower PaO_2 for gas analysis. This case was diagnosed as AML with high white blood cell disease, and was intubated with mechanical ventilation due to respiratory failure. During the care of this patient, we found that the results of arterial blood gas (ABG) were not consistent with saturation of peripheral oxygen (SpO_2)of this patient clinically. Arterial blood gas analysis and interpretation is one of the focuses of respiratory therapists. Therefore, we would like to share and discuss this special clinical phenomenon through this case report.

並列關鍵字

hyperleukocytosis ； spurious hypoxemia ； leukocyte larceny