Elsevier

Blood Reviews

Volume 26, Issue 3, May 2012, Pages 117-122
Blood Reviews

REVIEW
Hyperleukocytosis, leukostasis and leukapheresis: Practice management

https://doi.org/10.1016/j.blre.2012.01.003Get rights and content

Abstract

Hyperleukocytosis, arbitrarily defined in acute leukemia as a white blood cell count greater than 100,000/mL, often is associated with increased morbidity and mortality in patients with leukemic processes. It can induce leukostasis, tumor lysis syndrome and disseminated intravascular coagulopathy and has significant prognostic implications with or without one of these clinical complications. The main sites that tend to be injured from the obstructions are the central nerve system and lungs. Despite characteristic clinical presentations, the diagnosis of leukostasis is rarely made with high confidence. The main goal of the management of hyperleukocytosis and/or leukostasis is to reduce the white blood cell count before starting induction chemotherapy. The cytoreduction can be achieved by either leukapheresis and/or hyroxyurea. The technical aspects, complications and efficacy of leukapheresis are discussed in the current article.

Introduction

Hypeleukocytosis is of prognostic importance in several types of leukemias. In a few situations the presence of hyperleukocytosis can even be life threatening, with or without the development of leukostasis. Leukapheresis is considered one of the common treatments for these emergent states.

The definitions, clinical manifestations, pathophysiology and therapeutic options will be reviewed. The indications, technical aspects and efficacy of leukapheresis will also be considered as well as its role in the prophylaxis and management of these emergent situations.

Section snippets

Hyperleukocytosis

Hyperleukocytosis, defined as a white blood cell (WBC) count greater than 100,000/μL, often is associated with increased morbidity and mortality in patients with leukemic processes. The number 100,000/μL is arbitrary and in every kind of leukemia the critical WBC count is different. While in patients with AML a leukocyte count of 50,000/μL can cause severe symptoms, patients with CLL can remain asymptomatic even with WBC counts greater than 500,000/μL.

In several leukemias there is an

Leukostasis

Leukostasis is one of the predominant manifestations of hyperleukocytosis. The high leukocyte level leads to vascular obstruction which induces tissue hypoxia.

Definition

Apheresis stems from the Greek to take away or remove. The procedure refers to the withdrawal of whole blood from the body, separation and retention of one or more components, with the return of the remaining components to the patient. During leukapheresis, the WBCs are concentrated and removed from the blood and the other constituents are infused back into the patient.

Goals

The goal of leukapheresis is to reduce the peripheral WBC count. This maneuver can decrease the acute symptoms of leukostasis,

Conflict of interest statement

No conflicts of interest to declare.

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