Abstract
Hyperleukocytosis (white blood cell count, >100×109/l), an uncommon presentation of leukemia, is associated with an increased risk of early mortality. It may present with a variety of symptoms secondary to leukostasis, a syndrome caused by the sludging of circulating leukemic blasts in the microvasculature. Adequate measures for managing this medical emergency include hydration, cytoreduction, prevention of tumor lysis and, rarely, leukapheresis in cases complicated by leukostasis and hyperviscosity syndrome. The present study reports a case series of five patients with hyperleukocytic leukemia. In addition, a review of the literature with regard to the incidence, pathophysiology, clinical manifestations and management of this laboratory abnormality is included. This study demonstrated that the central nervous system and lungs are the most common sites for leukostasis, and that emergency cases require aggressive treatment.
Highlights
In patients with acute lymphocytic leukemia (ALL) or acute myeloid leukemia (AML), the clinical presentation is usually non‐specific, including fatigue, fever or bleeding
In March 2012, a 51‐year‐old female was admitted to the Department of Haematology, Chinese People's Liberation Army No 421 Hospital due to a cough lasting for five days, expectoration and two days of gum bleeding
In an additional report [5], a 19-year-old male was diagnosed with ALL (WBC count of 121.0x109/l)
Summary
In patients with acute lymphocytic leukemia (ALL) or acute myeloid leukemia (AML), the clinical presentation is usually non‐specific, including fatigue, fever or bleeding. In September 2012, a 50‐year‐old female was admitted to the Department of Haematology, Chinese People's Liberation Army No 421 Hospital following one month of recurrent oral ulcers and weight loss. In March 2012, a 51‐year‐old female was admitted to the Department of Haematology, Chinese People's Liberation Army No 421 Hospital due to a cough lasting for five days, expectoration and two days of gum bleeding. The patient experienced a severe headache and left arm numbness, with projectile vomiting, Laboratory tests revealed a WBC count of 131.82x109/l, hemoglobin count of 10 g/dl and platelet count of 24x109/l. In January 2009, a 23‐year‐old male was admitted to the Department of Haematology, Chinese People's Liberation Army No 421 Hospital due to multiple abdominal distensions in the past month and low‐grade fever for the past two days. The patient received combination chemotherapy, including vincristine (2 mg intravenous injection on days one, eight, 15 and 22), daunorubicin (40 mg/m2 intravenous infusion on days one to three, and days 15 and 16), cyclophosphamide (mesna rescue; 750 mg/m2 intravenous infusion one days one and 15), L‐asparaginase (6,000 IU/m2 intravenous infusion on days 11, 14, 17, 20, 23 and 26) and predisone (1 mg/kg/day orally on days one to 14, with a decrease to one‐third of the dosage on days 15-28) and acquired complete response after 55 days
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