Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel

Management of leukemic hyperleukocytosis with hydration, urinary alkalinization, and allopurinol. Are cranial irradiation and invasive cytoreduction necessary?

Publication ,  Journal Article
Nelson, SC; Bruggers, CS; Kurtzberg, J; Friedman, HS
Published in: Am J Pediatr Hematol Oncol
August 1993

PURPOSE: Hyperleukocytosis secondary to acute leukemia is a medical emergency. Intracranial hemorrhage often leads to death in this setting. Early efforts to prevent this serious complication have included emergent cranial irradiation, with its associated morbidity when used in the young child. Currently, exchange transfusion and/or leukapheresis are employed to acutely lower the peripheral leukocyte count. PATIENTS AND METHODS: We report three infants with acute leukemia and hyperleukocytosis in whom intravenous hydration, alkalinization, and allopurinol therapy alone produced rapid and dramatic decreases in the peripheral leukocyte count. RESULTS: The maximal decrease in leukocyte count averaged 88% within 70 h of starting conservative management. A fall in leukocyte count to < 100 x 10(9)/L was noted at an average of 15 h following hospitalization. No patient developed complications. CONCLUSIONS: When comparing this approach to exchange transfusion and leukapheresis we find it to be both safe and effective. Children with hyperleukocytosis in association with acute lymphocytic leukemia who present without life-threatening complications of an extremely high leukocyte count can be safely and effectively managed with intravenous hydration, alkalinization, and allopurinol therapy.

Duke Scholars

Published In

Am J Pediatr Hematol Oncol

ISSN

0192-8562

Publication Date

August 1993

Volume

15

Issue

3

Start / End Page

351 / 355

Location

United States

Related Subject Headings

  • Sodium Bicarbonate
  • Sodium
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Male
  • Leukocytosis
  • Leukemia
  • Infant
  • Humans
  • Fluid Therapy
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Nelson, S. C., Bruggers, C. S., Kurtzberg, J., & Friedman, H. S. (1993). Management of leukemic hyperleukocytosis with hydration, urinary alkalinization, and allopurinol. Are cranial irradiation and invasive cytoreduction necessary? Am J Pediatr Hematol Oncol, 15(3), 351–355.
Nelson, S. C., C. S. Bruggers, J. Kurtzberg, and H. S. Friedman. “Management of leukemic hyperleukocytosis with hydration, urinary alkalinization, and allopurinol. Are cranial irradiation and invasive cytoreduction necessary?Am J Pediatr Hematol Oncol 15, no. 3 (August 1993): 351–55.

Published In

Am J Pediatr Hematol Oncol

ISSN

0192-8562

Publication Date

August 1993

Volume

15

Issue

3

Start / End Page

351 / 355

Location

United States

Related Subject Headings

  • Sodium Bicarbonate
  • Sodium
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Male
  • Leukocytosis
  • Leukemia
  • Infant
  • Humans
  • Fluid Therapy
  • Female