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Hyperleukocytosis is often seen in acute presentations childhood leukemias, and is defined as a WBC count of greater than 30-50K. Complications usually arise at counts greater than 300, however, keep in mind that automated cell counters may underestimate very high white counts.
Complications include:
- Hyperviscosity Syndrome / Leukostasis
- Risk of CVA, PE, Mesenteric Ischemia, etc.
- Tumor Lysis Syndrome (TLS)
- Risk of fatal arrhythmia, may monitor with K, LDH, Uric Acid
- Disseminated Intravascular Coagultion (DIC)
Treatment:
- EMERGENT LEUKOREDUCTION APHERESIS, aka Leukopheresis
- This is a true emergency - if you are at a facility without leukopheresis capability, the fastest transport mode possible is indicated - fly, don't drive
- Temporizing measures include fluids, fluids, and fluids
- Allopurinol / Rasburicase may be considered, but not if this will delay transport, especially if there is no evidence of TLS - this decision may be made in consultation with the pediatric heme/onc specialist who is helping to arrange for leukopheresis