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