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  • Title: Leukopheresis for profound hyperleukocytosis.
    Author: Chekol SS, Bhatnagar B, Gojo I, Hess JR.
    Journal: Transfus Apher Sci; 2012 Feb; 46(1):29-31. PubMed ID: 22082657.
    Abstract:
    BACKGROUND: Leukocytoreduction by leukopheresis is recommended for hyperleukocytosis with leukemia, especially when accompanied by neurologic or respiratory symptoms. A single 1-1.5 blood volume leukocytopheresis is expected to reduce the leukocyte count by 30-60%. CASE REPORT: A 35 year old man presented with a 2 month history of hearing and visual loss and was found to have chronic myelogenous leukemia (CML) in chronic phase with 700,000 WBC/μL. The blast count was 1%. The spleen was markedly enlarged. He was referred for leukocytopheresis and treatment of his leukemia. Despite the extremely high white cell count, he had a hematocrit of 24, platelets of 161,000/μL, and normal lung, liver and renal function. RESULTS: A 15 L leukocytapheresis was performed with a Cobe Spectra with the removal of 1.86 L of bloody fluid with a hematocrit of 10% and a leukocrit of 28%. The blood white cell count decreased from 599,000 to 498,500/μL, and the patient felt better. He was started on hydroxyuria and 8 days later his WBC was 7000/μL. DISCUSSION: The patient's oncologists were initially concerned by the only 17% reduction in his white cell count. However, calculations based on his hematocrit and leukocrit in blood and waste bag suggested that he was 140% blood volume expanded by his leukemia and that the cytopheresis removed about half of the extra volume along with an additional 250 mL of leukocytes, about 35% of his pre-treatment WBC volume. The case and its implications for similar patients are discussed.
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