title: Leukopheresis for profound hyperleukocytosis.
abstract: BACKGROUND
  Leukocytoreduction by leukopheresis is recommended for hyperleukocytosis with leukemia, especially when accompanied by neurologic or respiratory symptoms. A single 1-1.5 blood volume leukocytopheresis is expected to reduce the leukocyte count by 30-60%.
  
  
  METHODS
  A 35 year old man presented with a 2 month history of hearing and visual loss and was found to have chronic myelogenous leukemia (CML) in chronic phase with 700,000 WBC/μL. The blast count was 1%. The spleen was markedly enlarged. He was referred for leukocytopheresis and treatment of his leukemia. Despite the extremely high white cell count, he had a hematocrit of 24, platelets of 161,000/μL, and normal lung, liver and renal function.
  
  
  RESULTS
  A 15 L leukocytapheresis was performed with a Cobe Spectra with the removal of 1.86 L of bloody fluid with a hematocrit of 10% and a leukocrit of 28%. The blood white cell count decreased from 599,000 to 498,500/μL, and the patient felt better. He was started on hydroxyuria and 8 days later his WBC was 7000/μL.
  
  
  CONCLUSIONS
  The patient's oncologists were initially concerned by the only 17% reduction in his white cell count. However, calculations based on his hematocrit and leukocrit in blood and waste bag suggested that he was 140% blood volume expanded by his leukemia and that the cytopheresis removed about half of the extra volume along with an additional 250 mL of leukocytes, about 35% of his pre-treatment WBC volume. The case and its implications for similar patients are discussed.
authors.affiliation: Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States. schekol@umm.edu
authors.forename: Seble S
authors.initials: SS
authors.lastname: Chekol
authors.forename: Bhavana
authors.initials: B
authors.lastname: Bhatnagar
authors.forename: Ivana
authors.initials: I
authors.lastname: Gojo
authors.forename: John R
authors.initials: JR
authors.lastname: Hess
mesh_terms: D000328:Adult; D001752:Blast Crisis / Q000097:blood / Q000150:complications / Q000628:therapy*; D006801:Humans; D007937:Leukapheresis; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000097:blood / Q000150:complications / Q000628:therapy*; D007958:Leukocyte Count; D007964:Leukocytosis / Q000097:blood / Q000150:complications / Q000628:therapy*; D008297:Male