TY - JOUR
T1 - Leukopheresis for profound hyperleukocytosis
AU - Chekol, Seble S.
AU - Bhatnagar, Bhavana
AU - Gojo, Ivana
AU - Hess, John R.
N1 - Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2012/2
Y1 - 2012/2
N2 - 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%. Case Report: 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. Discussion: 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.
AB - 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%. Case Report: 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. Discussion: 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.
KW - Blood cell removal
KW - Blood viscosity
KW - CML
KW - Leukostasis
KW - White cell apheresis
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U2 - 10.1016/j.transci.2011.10.022
DO - 10.1016/j.transci.2011.10.022
M3 - Article
C2 - 22082657
AN - SCOPUS:84857452526
SN - 1473-0502
VL - 46
SP - 29
EP - 31
JO - Transfusion and Apheresis Science
JF - Transfusion and Apheresis Science
IS - 1
ER -