Intraoperative Collapse During First-Trimester Abortion: Hyperleukocytosis Crisis, Thrombotic Pulmonary Embolism, or Amniotic Fluid Embolism?

Background: Hyperleukocytosis in patients with hematologic malignancies poses significant perioperative risks, including leukostasis, coagulopathy, tumor lysis syndrome and hyperinflammatory syndrome. Additionally, pregnancy and hyperleukocytosis predispose patients to a hypercoagulable state, increasing the risk of thrombosis. On the other hand, amniotic fluid embolism (AFE) is a rare but serious complication of pregnancy. Although distinct in etiology, thrombotic pulmonary embolism (PE), AFE, and hyperleukocytosis crisis can present with a strikingly similar clinical picture of pulmonary hypertension and respiratory failure, posing a significant diagnostic challenge in the perioperative setting. Case Presentation: An 18-year-old female with chronic phase chronic myeloid leukemia and hyperleukocytosis (WBC >100×10 Conclusion: Anesthesia and surgical interventions in patients with hyperleukocytosis pose a formidable challenge, which could cause life threatening complications and need vigilance care. Given hyperleukocytosis crisis can present with clinical features indistinguishable from thrombotic pulmonary embolism and AFE, recognizing this distinction is critical for guiding appropriate treatment and optimizing perioperative outcomes.