Leukocytosis Medication

  • Author: Susumu Inoue, MD; Chief Editor: Robert J Arceci, MD, PhD   more...
 
Updated: May 10, 2010
 

Medication Summary

Hyperleukocytosis in leukemia is often complicated by a tumor lysis syndrome, which includes a high serum uric acid and uric acid nephropathy. Prompt measures to reduce serum uric acid and prevent uric acid nephropathy are required.

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Uric acid inhibitors

Class Summary

These drugs are used to prevent acute uric acid nephropathy associated with leukocytosis in myeloproliferative disease and leukemia.

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Allopurinol (Aloprim, Zyloprim)

 

Inhibits xanthine oxidase, the enzyme that synthesizes uric acid from hypoxanthine. Reduces synthesis of uric acid without disrupting biosynthesis of vital purines. Reduces plasma concentration and urine excretion of uric acid; simultaneously increases plasma concentration and urine excretion of more soluble oxypurine precursors.

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Rasburicase (Elitek)

 

Recombinant form of urate oxidase (derived from Saccharomyces cerevisiae -synthesized Aspergillus flavus), which oxidizes uric acid to allantoin (soluble and inactive). Indicated for treatment and prophylaxis of severe hyperuricemia associated with treatment of malignancy. Hyperuricemia causes precipitant in kidneys, leading to acute renal failure. Unlike uric acid, allantoin soluble and easily excreted by kidneys. Elimination half-life is 18 h.

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Contributor Information and Disclosures
Author

Susumu Inoue, MD  Professor of Pediatrics and Human Development, Michigan State University College of Human Medicine; Clinical Professor of Pediatrics, Wayne State University School of Medicine; Director of Pediatric Hematology/Oncology, Associate Director of Pediatric Education, Department of Pediatrics, Hurley Medical Center

Susumu Inoue, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Clinical Oncology, American Society of Hematology, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Gary R Jones, MD  Associate Medical Director, Clinical Development, Berlex Laboratories

Gary R Jones, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Pediatric Hematology/Oncology, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Gary D Crouch, MD  Associate Professor, Program Director of Pediatric Hematology-Oncology Fellowship, Department of Pediatrics, Uniformed Services University of the Health Sciences

Gary D Crouch, MD is a member of the following medical societies: American Academy of Pediatrics and American Society of Hematology

Disclosure: Nothing to disclose.

Helen SL Chan, MBBS, FRCP(C), FAAP  Senior Scientist, Research Institute; Professor, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Canada

Helen SL Chan, MBBS, FRCP(C), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Society of Hematology, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

Robert J Arceci, MD, PhD  King Fahd Professor of Pediatric Oncology, Professor of Pediatrics, Oncology and the Cellular and Molecular Medicine Graduate Program, Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine

Robert J Arceci, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Pediatric Society, American Society of Hematology, and American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

References

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WBC counts.
Table. Normal Leukocyte Counts
Total Leukocytes*LymphocytesNeutrophils†MonocytesEosinophils
AgeMeanRangeMeanRange%MeanRange%Mean%Mean%
Birth......4.22-7.3...42-6...0.6...0.1...
12 h......4.22-7.3...117.8-14.5...0.6...0.1...
24 h......4.22-7.3...97-12...0.6...0.1...
1-4 wk......5.62.9-9.1...3.61.8-5.4...0.7...0.2...
6 mo11.96-17.57.34-13.5613.81-8.5320.650.33
1 y11.46-17.57.04-10.5613.51.5-8.5310.650.33
2 y10.66-176.33-9.5593.51.5-8.5330.550.33
4 y9.15.5-15.54.52-8503.81.5-8.5420.550.33
6 y8.55-14.53.51.5-7424.31.5-8510.450.23
8 y8.34.5-13.53.31.5-6.8394.41.5-8530.440.22
10 y8.14.5-13.53.11.5-6.5384.41.8-8540.440.22
16 y7.84.5-132.81.2-5.2354.41.8-8570.450.23
21 y7.44.5-112.51-4.8344.41.8-7.7590.340.23
* Numbers of leukocytes are in X 109 \L or thousands per μ L; ranges are estimates of 95% confidence limits; and percentages refer to differential counts.



† Neutrophils include band cells at all ages and a small number of metamyelocytes and myelocytes in the first few days of life.



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