A Rare Case of Leukemoid Reaction During Mechanical Circulatory Support in a Patient With Severe Heart Failure: An Autopsy Study

TL;DR

This paper reports a rare case of a leukemoid reaction in a patient with severe heart failure undergoing mechanical circulatory support, leading to multiple organ failure and death.

Contribution

This is the first reported case of a leukemoid reaction in a patient with severe heart failure requiring mechanical circulatory support.

Findings

A 36-year-old man with severe heart failure on mechanical circulatory support showed a markedly elevated white blood cell count.

Autopsy findings suggested the possibility of a leukemoid reaction as the cause of leukocytosis.

The patient ultimately died from multiple organ failure, with the cause of heart failure remaining undetermined.

Abstract

The leukemoid reaction (LR) is reported to be caused by severe stress conditions such as infection, malignancies, intoxication, severe hemorrhage, or acute hemolysis; this condition is attributed to a very severe prognosis. Some reports have suggested that the LR was associated with a systemic stress response. A 36-year-old man who required mechanical circulatory support (MCS), including veno-arterial extracorporeal membrane oxygenation and Impella 5.5 due to severe heart failure, was transferred to our hospital. He showed a markedly elevated WBC count and died of multiple organ failure. The autopsy revealed the possibility that leukocytosis might have been due to an LR; however, the cause of the cardiac failure was unknown. To the best of our knowledge, this study is the first to report a rare case of LR in a patient with severe heart failure requiring MCS.

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