How we approach a patient with symptoms of leukostasis requiring emergent leukocytapheresis.
Hyperleukocytosis can induce leukostasis, which can lead to vascular obstructions (usually in the lungs and central nervous system), tumor lysis syndrome, and disseminated intravascular coagulation. Although it has not been conclusively shown to improve long-term outcome, leukocytapheresis may be used as part of the management of hyperleukocytosis with or without leukostasis to rapidly reduce the white blood cell (WBC) burden. Since leukocytapheresis only temporarily decreases the WBC count, early initiation of more definite therapy, such as hydroxyurea and/or chemotherapy, is essential. In this article, clinical assessment of the patient's clinical status to determine the need for leukocytapheresis as well as a general guideline for management of the technical aspects and complications of the procedure are discussed.
Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama.
Huy P
HP
Pham
Department of Pathology and Cell Biology, Columbia University Medical Center and the New York-Presbyterian Hospital, New York, New York.
Joseph
J
Schwartz
D000986:Antisickling Agents / Q000627:therapeutic use; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000209:etiology / Q000628:therapy; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use; D007937:Leukapheresis / Q000379:methods*; D007964:Leukocytosis / Q000097:blood / Q000150:complications / Q000628:therapy; D018921:Leukostasis / Q000097:blood / Q000150:complications / Q000628:therapy*; D015275:Tumor Lysis Syndrome / Q000097:blood / Q000209:etiology / Q000628:therapy
D000986:Antisickling Agents; D006918:Hydroxyurea