LACTIC ACIDOSIS AND HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS: A REVIEW OF THE LITERATURE

Abstract

Lactic acidosis is the most common cause of anion gap metabolic acidosis and is associated with high morbidity and mortality in hospitalized patients. The association between Hemophagocytic Lymphohistiocytosis (HLH) and lactic acidosis is still unclear. HLH causes cytokine overproduction which in turn induces lactic acidosis. There have been only few reports of type B lactic acidosis in HLH patients. There have been no studies addressing the outcome of cytokine removal for patients with HLH induced lactic acidosis. We reviewed literatures on HLH, focusing on its association with lactic acidosis and treatment options. This review demonstrates thatlactic acidosis in patients with HLH is under-recognized. Physicians should increase awareness of this association. In the setting of cytokine storm with multiorgan failure, cytokine removal with high blood flow, ultrafiltration rate and frequent membrane changes is a potential treatment option. More studies are urgently required to confirm this finding due to high morbidity and mortality of HLH.