Increased cerebral blood flow after leukapheresis for acute myelogenous leukemia

Leukapheresis is often considered in the management of acute myelogenous leukemia (AML) with hyperleukocytosis and its sequelae, including myocardial infarction, pulmonary complications, and stroke. It is utilized on the assumption that leukapheresis improves blood rheology. We present a woman with AML and a history of meningioma encasing her left internal carotid artery. She presented with hyperleukocytosis and symptoms of ischemia. As her white blood cell continued to rise despite initiation of hydroxyurea therapy, she underwent leukapheresis emergently. Transcranial Doppler ultrasound demonstrated increased flow velocities in the left internal carotid and the right middle cerebral arteries, which normalized after leukapheresis. This is the first documentation that leukapheresis, in combination with hydroxyurea, improves cerebral hemodynamics in a patient with AML.