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Leukopheresis for profound hyperleukocytosis.
Seble S Chekol1, Bhavana Bhatnagar, Ivana Gojo
1Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States. schekol@umm.edu
Summary
Leukocytapheresis effectively reduced white blood cell volume in a patient with chronic myelogenous leukemia (CML) and hyperleukocytosis. This procedure, despite initial concerns about percentage reduction, significantly improved symptoms by removing excess leukocytes.
Area of Science:
- Hematology
- Oncology
Background:
- Leukocytapheresis is a recommended treatment for hyperleukocytosis in leukemia, particularly with neurological or respiratory symptoms.
- A single leukocytapheresis session aims to reduce leukocyte count by 30-60% of blood volume.
Observation:
- A 35-year-old male with chronic myelogenous leukemia (CML) presented with hyperleukocytosis (700,000 WBC/μL) and significant visual and auditory impairment.
- Despite the extremely high white cell count, the patient maintained normal organ function and adequate hematocrit and platelet levels.
Findings:
- A 15 L leukocytapheresis procedure removed 1.86 L of fluid, reducing the white blood cell count from 599,000 to 498,500/μL.
- Calculations revealed the patient had 140% blood volume expansion due to leukemia, and the procedure removed approximately 35% of the total white blood cell volume.
Implications:
- This case highlights the importance of considering blood volume expansion in hyperleukocytosis when evaluating the efficacy of leukocytapheresis.
- Accurate assessment of leukocyte volume reduction, beyond simple percentage decrease, is crucial for managing such cases effectively.
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