Management of Hyperleukocytosis

Antonio Ruggiero, Daniela Rizzo, Maria Amato, Riccardo Riccardi

Risultato della ricerca: Contributo in rivistaArticolo in rivistapeer review

14 Citazioni (Scopus)

Abstract

Hyperleukocytosis has a high morbidity index. The involvement of the respiratory or central nervous system and the metabolic derangements accompanying tumor lysis are responsible for early mortality. Standard care for acute hyperleukocytosis must include cytoreduction, proper supportive care, and prevention of tumor lysis. Hydration, alkalization, allopurinol, or urate oxidase should be started immediately. In patients with low platelet count of less than 20,000/mm3, platelet transfusions should be given to prevent cerebral hemorrhage, as platelets do not add substantially to blood viscosity. Packed red blood cells must be given with caution as they can significantly increase blood viscosity. If the patient is hemodynamically stable, packed red transfusions should be planned when the hemoglobin level is less than 7–8 g/dl, avoiding post-transfusional levels above 10 g/dl. Coagulation abnormalities should be corrected. Leukapheresis has been advocated to correct metabolic abnormalities and to decrease viscosity by reducing the peripheral white blood count. However, leukapheresis may fail to decrease the leukocyte count substantially or may achieve only a transient tumor bulk reduction. The procedure is generally well tolerated but can involve problems such as the need for anticoagulation or difficulty of access, and limited availability in many institutions. Specific antileukemic therapy must be initiated as soon as life-threatening complications have been corrected as it remains the first-line treatment of hyperleukocytosis.
Lingua originaleEnglish
pagine (da-a)1-10
Numero di pagine10
RivistaCurrent Treatment Options in Oncology
Volume17
DOI
Stato di pubblicazionePubblicato - 2016

Keywords

  • Acute leukemia
  • Alkalization
  • Allopurinol
  • Blood Coagulation Disorders
  • Fluid Therapy
  • Humans
  • Hydration
  • Hyperleukocytosis
  • Leukapheresis
  • Leukemia
  • Leukocyte Count
  • Leukocytosis
  • Oncology
  • Pharmacology (medical)
  • Prognosis
  • Rasburicase
  • Tumor Lysis Syndrome

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