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Disorders of Leukocytes01:27

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Leukocyte disorders can lead to either leukopenia, characterized by an abnormally low leukocyte count, or leukocytosis, marked by a very high leukocyte number.
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Common myeloid progenitors (CMPs) are oligopotent cells that can differentiate into granulocytes and macrophages. Granulocytes and macrophages are essential for protecting the body against bacterial, viral, or fungal infections. They migrate from the bone marrow into the circulating blood to reach specific tissue sites where they differentiate and help in immune surveillance. However, they survive only for a few days and must be continuously made available to the organism to maintain a robust...
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Leukocytes are classified into two groups based on the presence or absence of cytoplasmic granules. Granular leukocytes, which contain granules, belong to the myeloid lineage and are divided into three subtypes: neutrophils, eosinophils, and basophils. These cells are roughly spherical and characterized by the granules in their cytoplasm.
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Lipegfilgrastim may cause hyperleukocytosis.

Zekeriya Hannarici1, Ali Yılmaz1, Mehmet Emin Buyukbayram1

  • 1Department of Medical Oncology, 64060Atatürk University Faculty of Medicine, Erzurum, Turkey.

Journal of Oncology Pharmacy Practice : Official Publication of the International Society of Oncology Pharmacy Practitioners
|February 24, 2022
PubMed
Summary

Lipegfilgrastim, a long-acting G-CSF, can cause hyperleukocytosis in breast cancer patients. This case highlights the importance of monitoring white blood cell counts during prophylaxis to prevent serious complications.

Keywords:
Hyperleukocytosislipegfilgrastimneutropenia

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Area of Science:

  • Oncology
  • Hematology

Background:

  • Granulocyte colony-stimulating factors (G-CSF) manage chemotherapy-induced neutropenia.
  • Lipegfilgrastim offers extended G-CSF action but carries potential adverse events.
  • Common side effects include bone pain and fever; rare but serious events involve leukocytosis and organ damage.

Observation:

  • A 45-year-old female with breast cancer developed hyperleukocytosis post-lipegfilgrastim prophylaxis.
  • Symptoms included weakness and loss of appetite, with elevated WBC, LDH, and uric acid.
  • Peripheral smear revealed a left shift, indicating immature white blood cells.

Findings:

  • Treatment with IV saline and allopurinol improved the patient's condition.
  • WBC, LDH, uric acid, and peripheral smear normalized within nine days.
  • Discontinuation of lipegfilgrastim and substitution with filgrastim prevented recurrence of hyperleukocytosis.

Implications:

  • This case suggests lipegfilgrastim may induce hyperleukocytosis, a complication not previously reported.
  • Vigilant monitoring for hyperleukocytosis is crucial when using lipegfilgrastim.
  • Early intervention can prevent severe complications and ensure successful cancer treatment continuation.