Medical Care
In most cases, treatment for leukocytosis is not necessary.
In extreme instances of hyperleukocytosis syndrome (eg, acute leukemia), leukapheresis, hydration, and urine alkalinization to facilitate uric acid excretion are indicated; however, perform these treatments only in consultation with a hematologist, oncologist, or both. Direct treatment toward the underlying etiology.
Leukemic hyperleukocytosis may cause clinically significant complications when the WBC count exceeds 100,000/μL in acute myelogenous leukemia and 300,000/μL in acute lymphoblastic leukemia. Therefore, in patients with these findings, measures to reduce the WBC count are advisable. However, a decrease in leukocyte count that is too rapid carries a risk of severe tumor lysis syndrome and should be avoided.
Leukapheresis or exchange blood transfusion is a treatment of choice for this purpose, with hydration, urine alkalinization, and administration of allopurinol or rasburicase (uric acid oxydase) to reduce serum uric acid and minimize tumor lysis syndrome. When rasburicase is used, urine alkalinization is not recommended.
A study by Nguyen et al indicated that supportive care and conservative management can discourage early hyperleukocytosis-related morbidity and mortality in children with acute lymphoblastic leukemia, possibly negating the need for leukapheresis. [34] A study by Choi et al, meanwhile, found no evidence that in patients with acute leukemia (myelogenous or lymphoblastic) and hyperleukocytosis, leukapheresis improves early mortality rates or reduces the incidence of either tumor lysis syndrome or disseminated intravascular coagulopathy. [35]
Promptly institute definitive treatment with appropriate chemotherapy. A study by Mamez et al indicated that the administration of oral hydroxyurea before chemotherapy can lower the rate of early death in hyperleukocytic patients with acute myelogenous leukemia. The study, which involved 160 patients, found the hospital mortality rate for patients who received pre-chemotherapy hydroxyurea to be 19%, compared with 34% for those who received no hydroxyurea prior to chemotherapy. However, the two treatment groups did not differ with regard to disease-free survival. [36]
-
WBC counts.
Tables
|
|
Total Leukocytes* |
|
Lymphocytes |
|
Neutrophils† |
|
Monocytes |
|
Eosinophils |
|||||||
Age |
|
Mean |
Range |
|
Mean |
Range |
% |
|
Mean |
Range |
% |
|
Mean |
% |
|
Mean |
% |
Birth |
|
... |
... |
|
4.2 |
2-7.3 |
... |
|
4 |
2-6 |
... |
|
0.6 |
... |
|
0.1 |
... |
12 h |
|
... |
... |
|
4.2 |
2-7.3 |
... |
|
11 |
7.8-14.5 |
... |
|
0.6 |
... |
|
0.1 |
... |
24 h |
|
... |
... |
|
4.2 |
2-7.3 |
... |
|
9 |
7-12 |
... |
|
0.6 |
... |
|
0.1 |
... |
1-4 wk |
|
... |
... |
|
5.6 |
2.9-9.1 |
... |
|
3.6 |
1.8-5.4 |
... |
|
0.7 |
... |
|
0.2 |
... |
6 mo |
|
11.9 |
6-17.5 |
|
7.3 |
4-13.5 |
61 |
|
3.8 |
1-8.5 |
32 |
|
0.6 |
5 |
|
0.3 |
3 |
1 y |
|
11.4 |
6-17.5 |
|
7.0 |
4-10.5 |
61 |
|
3.5 |
1.5-8.5 |
31 |
|
0.6 |
5 |
|
0.3 |
3 |
2 y |
|
10.6 |
6-17 |
|
6.3 |
3-9.5 |
59 |
|
3.5 |
1.5-8.5 |
33 |
|
0.5 |
5 |
|
0.3 |
3 |
4 y |
|
9.1 |
5.5-15.5 |
|
4.5 |
2-8 |
50 |
|
3.8 |
1.5-8.5 |
42 |
|
0.5 |
5 |
|
0.3 |
3 |
6 y |
|
8.5 |
5-14.5 |
|
3.5 |
1.5-7 |
42 |
|
4.3 |
1.5-8 |
51 |
|
0.4 |
5 |
|
0.2 |
3 |
8 y |
|
8.3 |
4.5-13.5 |
|
3.3 |
1.5-6.8 |
39 |
|
4.4 |
1.5-8 |
53 |
|
0.4 |
4 |
|
0.2 |
2 |
10 y |
|
8.1 |
4.5-13.5 |
|
3.1 |
1.5-6.5 |
38 |
|
4.4 |
1.8-8 |
54 |
|
0.4 |
4 |
|
0.2 |
2 |
16 y |
|
7.8 |
4.5-13 |
|
2.8 |
1.2-5.2 |
35 |
|
4.4 |
1.8-8 |
57 |
|
0.4 |
5 |
|
0.2 |
3 |
21 y |
|
7.4 |
4.5-11 |
|
2.5 |
1-4.8 |
34 |
|
4.4 |
1.8-7.7 |
59 |
|
0.3 |
4 |
|
0.2 |
3 |
* 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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