Comparing Efficacy of Low Dose Cytoreduction and Manual Exchange Blood Transfusion in Managing Hyperleukocytosis: A Case Report

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Date
2019
Authors
Otokiti, O
Ogbenna, A.A
Bolarinwa, A
Olatinwo, A
Journal Title
Journal ISSN
Volume Title
Publisher
American Journal of Clinical Pathology
Abstract
Objectives: Hyperleukocytosis is defined as white cell count greater than 100,000 cells/mm3. Symptomatic hyperleukocytosis (leukostasis) is a medical emergency and can complicate hematological malignancies. It is commoner in myeloid leukemia but can occur in extremely high-count lymphoid leukemia causing tumor lysis syndrome and death. Immediate management is hydration, cytoreduction, and leukapheresis. In a developing country without leukapheresis, how effective is manual exchange blood transfusion compared to low-dose cytoreduction? We present a case of chronic lymphocytic leukemia with severe hyperleukocytosis, comparing response to different treatment modalities in the absence of leukapheresis. Case Summary: A 57-year-old woman with complaints of a vaginal protrusion and an incidental finding of a splenomegaly with moderate anemia. Hemogram showed a white cell count of 301,000 cells/mm3, and blood film revealed a chronic lymphocytic leukemia. She had two cycles of cyclophosphamide, vincristine, and prednisolone and presented 8 months later with worsening leukocytosis of 697,000 cells/mm3, severe anemia, dizziness, headaches, fatigue, and hyperkalemia. Two manual exchange blood transfusions insignificantly decreased count by 40,000 cells/mm3 with slight reduction of hyperkalemia. She had low-dose cytoreduction with weekly vincristine and prednisolone. White cell count reduced from 653,000 cells/mm3 to 467,000 cells/mm3 with normal electrolytes. She was then commenced on cyclophosphamide, mini-hydroxorubicin, vincristine, and prednisolone. There was a steady decline in counts with improvement in hematological parameters and overall well-being. Conclusion: Due to nonavailability of leukapheresis, we attempted a manual exchange without a significant decrease in white cell count. However, with low-dose cytoreduction, there was a considerable decrease in white blood cell count and improvement of electrolyte with no tumor lysis syndrome, and it was more affordable. Therefore, in a resource-poor setting, using lowdose cytoreduction might be cheaper, safer, and more effective than exchange blood transfusion in managing hyperleukocytosis.
Description
Scholarly article
Keywords
Hyperleukocytosis , Medical emergency , hematological malignancies , Tumor lysis syndrome , Research Subject Categories::MEDICINE
Citation
Otokiti, O., Ogbenna, A. A., Bolarinwa, A. and Olatinwo, A. (2019). Comparing Efficacy of Low Dose Cytoreduction and Manual Exchange Blood Transfusion in Managing Hyperleukocytosis: A Case Report. American Journal of Clinical Pathology, 152. S114-S115. 10.1093/ajcp/aqz121