UMEM Educational Pearls

Category: Pediatrics

Title: Hyperleukocytosis / Blast Crisis

Keywords: hyperleukocytosis, leukemia, blast crisis (PubMed Search)

Posted: 1/8/2010 by Adam Friedlander, MD (Updated: 6/16/2019)
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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