title: Anesthesia for children with hyperleukocytosis a retrospective review.
abstract: BACKGROUND
  Hyperleukocytosis (a white cell count in peripheral blood >100 x 10(9) l(-1)) is a well-recognized medical emergency. Rates of morbidity associated with anesthesia in hyperleukocytotic patients have not been previously described. This retrospective study describes the perioperative morbidity and mortality of children who present acutely with hyperleukocytosis.
  
  
  METHODS
  All patients under 17 years of age with leukemia complicated by hyperleukocytosis and who received general anesthesia as part of their acute care at the Children's Hospital in Westmead from July 1999 to June 2008 were included. Data describing perioperative adverse events within 48 h of anesthesia were collected using a systematic chart review.
  
  
  RESULTS
  Over the 8- year period, 60 children were admitted with hyperleukocytosis related to a new diagnosis of leukemia. Fifty-two children had general anesthesia within 48 h of their admission. Eleven children required two separate general anesthetics within this same time frame. Two deaths were recorded within 48 h of anesthesia; one child died from neurological complications of her disease, and the second died from multi-organ failure. Three children had serious respiratory adverse events requiring postanesthesia intensive care. Thirteen children had notable but less serious adverse events. These were typically respiratory in nature and required supplemental oxygen for more than 2 h after anesthesia.
  
  
  CONCLUSIONS
  Children with leukemia-related hyperleukocytosis often require general anesthesia at the time of presentation and are at significant perioperative risk. Respiratory adverse events are very common and mandate close postanesthesia care.
authors.affiliation: Westmead Hospital, Westmead, NSW, Australia.
authors.forename: Clement
authors.initials: C
authors.lastname: Fong
authors.forename: Winnie
authors.initials: W
authors.lastname: Fung
authors.forename: Jane
authors.initials: J
authors.lastname: McDonald
authors.forename: Luce
authors.initials: L
authors.lastname: Dalla-Pozza
authors.forename: Jonathan
authors.initials: J
authors.lastname: De Lima
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000150:complications*; D007964:Leukocytosis / Q000150:complications* / Q000401:mortality; D016528:Postanesthesia Nursing / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D015996:Survival Rate; D016896:Treatment Outcome