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Dr. David
Dr. David, Board Certified Physician
Category: Medical
Satisfied Customers: 46959
Experience:  Experienced Physician trained in New York City. I'm ready to help.
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My father is 82 and was diagnosed with CMML years ago. He

Customer Question

My father is 82 and was diagnosed with CMML years ago. He had been treated with Vidaza, and most recently with hydroxyurea. Over the past week, his left hand has progressively become severely edematous, with severe pain, and now he has compartment syndrome. We were told a week ago the cause was gout. He is currently hospitalized, and the ultrasound confirmed there is NO clot.
I am an RN and have been researching the cause of this issue. I am concerned my dad has non-traumatic osteonecrosis, as the causes include osteoarthritis, cancer, gout (he has a hx of increased uric acid levels), blood-clotting disorders (is anemic, received transfusions, and has been thrombocytopenic), chemotherapy, and steroid...all of which fit his history and current clinical picture.
What are your thoughts on the diagnosis of osteonecrosis or osteomyelitis? Current WBC 104k.
Of note, this same condition occurred a month ago to his right shoulder, and we were told it was an "leukemic event" (?) that caused the sxs. At that time, his right shoulder caused extreme pain upon movement, and the entire extremity became edematous, but not to the degree of the left hand/arm now.
He is being followed by his PCP and his hematologist at this time.
Any thoughts would be greatly appreciated.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. David replied 1 year ago.

This is Dr. David

this situation is unusual of severe edema and pain and compartment syndrome in just his left hand.

did he have an IV into that hand that infiltrated possibly?

was he getting Vidaza or hydroxyurea into that hand or arm? chemo infiltration into the soft tissue can cause chemical soft tissue edema and swelling and compartment syndrome?

does he have an infusor port where he was getting his chemo?

he could also have DIC which can cause abnormal clotting and bleeding in the body as well if he has clotting disorder

WBC count of 104k can cause increased viscosity of the blood and this can cause slugging of his blood and edema and swelling in the distal capillaries with the high WBC counts causing clots

I think that is more likely than osteonecrosis of the bone.

CML is a tough cancer to fight and can be quite aggressive.

it is hard to fight the bone marrow when it wants to make way too many white blood cells which don't work properly at all.

I am sorry about your dad

let me know if you have questions.