REVIEWHyperleukocytosis, leukostasis and leukapheresis: Practice management
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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