Hyperleukocytosis: A report of five cases and review of the literature

Abstract

Hyperleukocytosis (white blood cell count, >100×109/l), an uncommon presentation of leukemia, is associated with an increased risk of early mortality. It may present with a variety of symptoms secondary to leukostasis, a syndrome caused by the sludging of circulating leukemic blasts in the microvasculature. Adequate measures for managing this medical emergency include hydration, cytoreduction, prevention of tumor lysis and, rarely, leukapheresis in cases complicated by leukostasis and hyperviscosity syndrome. The present study reports a case series of five patients with hyperleukocytic leukemia. In addition, a review of the literature with regard to the incidence, pathophysiology, clinical manifestations and management of this laboratory abnormality is included. This study demonstrated that the central nervous system and lungs are the most common sites for leukostasis, and that emergency cases require aggressive treatment.

General Anesthesia for Pediatric Patients with Leukemia

“…It has been reported that minor surgeries, such as dental extraction, can be performed when the platelet count is > 40,000/mm 3 ; the normal platelet count ranges from 150,000 to 400,000/mm 3 [4,5,7,14]. When dental extractions are anticipated, Hb concentrations of ≧ 5.5-8 g/dL are required for effective hemostasis and reduced risk of bacterial infection [5,6,11,21].…”

“…Pediatric cancer is a common cause of disease-related fatality in children [1][2][3]. The common pediatric malignancies are leukemia (30%) and central nervous system (CNS) tumors (22%) [1,4].…”

“…Hyperleukocytosis (a white blood cell count in peripheral blood > 100 × 10 3 /L) is a serious life-threatening complication of pediatric acute leukemia that can cause neurologic injury, pulmonary leukostasis, and metabolic derangements [2,3,10]. It might be associated with 10-25% of childhood white blood cell disorders [2,3,10]. Leukostasis can be triggered by red blood cell transfusion and deteriorating blood viscosity [10].…”

“…The diameter of leukemic blast cells exceeds the internal diameter of capillaries and small vessels, leading to a mechanical obstruction of vessels by leukemic cells. For elevated leukocyte counts, the high fractional volume of leukocytes results in increased blood viscosity [3]. A typical sign for hyperleukocytosis is an alteration in arterial blood gas analysis.…”

Immunophenotypic Profile in Adult Patients with Acute Leukemia Association with Clinical Feature: Fluorescence Cytometry Quantitative Analysis

“…However, certain patients with acute leukemia present with clinical signs of hyperleukocytosis [13].…”