Therapeutic leukapheresis

This chapter describes the therapeutic procedure called leukapheresis or leukocytapheresis. This procedure involves the removal of white blood cells (WBCs) from patients with hyperleukocytosis, defined as a circulating WBC or leukemic blast cell count >100,000/μl, which is usually secondary to acute leukemia. Hyperleukocytosis results in hyperviscosity, leading to cerebrovascular insufficiency and pulmonary complications. It can also lead to disseminated intravascular coagulopathy. Leukapheresis is indicated in hyperleukocytosis, which may be symptomatic or phophylactic. Typically, symptomatic leukostasis is observed in acute myeloid leukemia (AML) when the WBC is >100,000/μl, and in acute lymphoblastic leukemia (ALL) when the WBC is >400,000/μl. Leukapheresis should be repeated in persistently symptomatic patients until clinical symptoms resolve typically WBC counts <100,000/μl in patients with AML and <400,000/μl in patients with ALL. Prophylactic leukocytapheresis can be performed prior to symptom onset when increased WBC counts are observed and this treatment can reduce early mortality, but does not improve long-term survival in patients with AML and hyperleukocytosis.

Duke Scholars

Author Beth H. Shaz Pathology