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

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dc.contributor.authorOtokiti, O
dc.contributor.authorOgbenna, A.A
dc.contributor.authorBolarinwa, A
dc.contributor.authorOlatinwo, A
dc.date.accessioned2022-09-09T14:01:25Z
dc.date.available2022-09-09T14:01:25Z
dc.date.issued2019
dc.descriptionScholarly articleen_US
dc.description.abstractObjectives: 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.en_US
dc.identifier.citationOtokiti, 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/aqz121en_US
dc.identifier.otherAm J Clin Pathol 2019;152:S104-S116, 10.1093/ajcp/aqz121
dc.identifier.urihttps://ir.unilag.edu.ng/handle/123456789/11395
dc.language.isoenen_US
dc.publisherAmerican Journal of Clinical Pathologyen_US
dc.subjectHyperleukocytosisen_US
dc.subjectMedical emergencyen_US
dc.subjecthematological malignanciesen_US
dc.subjectTumor lysis syndromeen_US
dc.subjectResearch Subject Categories::MEDICINEen_US
dc.titleComparing Efficacy of Low Dose Cytoreduction and Manual Exchange Blood Transfusion in Managing Hyperleukocytosis: A Case Reporten_US
dc.typePresentationen_US
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