Approach to hyperleukocytosis and leukostasis-inpatient management strategies
Maun R Baral1, Sambhawana Bhandari2
1Division of Hospital Medicine, Department of Medicine, Washington University in Saint Louis, St. Louis, Missouri, USA.
Abstract:
Hyperleukocytosis is defined as a white blood cell count exceeding 100,000/µL and is a critical manifestation of acute and chronic leukemia. It can lead to life-threatening complications such as leukostasis, disseminated intravascular coagulation, and tumor lysis syndrome. Leukostasis results from microvascular obstruction by leukemic blasts, causing multisystemic manifestations. Leukostasis is primarily a clinical diagnosis requiring prompt recognition and intervention. Supportive care includes intravenous hydration, uric acid-lowering agents, and cautious blood transfusions to prevent worsening hyperviscosity. Hydroxyurea and cytarabine are used as cytoreductive agents until a definitive diagnosis and management are started. The role of leukapheresis is controversial, and practice patterns differ between clinicians and institutions.
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