CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 71 • NUMBER 8 AUGUST 2004 633
NAVNEET S. MAJHAIL, MD
Department of Hematology, Oncology, and
Transplantation, University of Minnesota,
Minneapolis
ALAN E. LICHTIN, MD
Department of Hematology and Medical
Oncology, The Cleveland Clinic Foundation
â–Ÿ ABSTRACT
From 5% to 30% of adult patients with acute leukemias
present with hyperleukocytosis—very high white blood
cell counts (> 100,000 cells/mm3)—and symptoms of
leukostasis. These conditions are a medical emergency
that needs prompt recognition and initiation of therapy to
prevent respiratory failure or intracranial hemorrhage.
Patients should be referred as soon as possible for
induction chemotherapy and leukapheresis.
â–Ÿ KEY POINTS
Risk factors associated with hyperleukocytosis include
younger age, certain types of leukemia, and cytogenetic
abnormalities.
Symptoms of hyperleukocytosis are primarily due to
leukostasis, a clinicopathologic syndrome caused by the
sludging of circulating leukemic blasts in tissue
microvasculature.
Patients can present with symptoms ranging from
exertional dyspnea to severe respiratory distress.
Neurologic manifestations can range from mild confusion
and somnolence to stupor and coma.
Initial management includes aggressive hydration; use of
allopurinol and hydroxyurea; correction of abnormalities
of metabolism, coagulation, and electrolytes; and
prevention of tumor lysis syndrome.
Definitive treatment consists of leukocytoreduction (via
cytotoxic chemotherapy), hydroxyurea, and, in some cases,
leukapheresis.