Treatment of Hyperviscosity Syndrome with Leukemia Blast / WBC Count Above 100,000 Cells per Microliter
When the leukemia cell (blast) or white blood cell (WBC) count rises above 100,000 per microliter, patients may develop signs and symptoms of impaired tissue perfusion — a clinical threshold that in itself indicates intervention, without the need for whole-blood viscosity measurement.
Scenario: Leukemia cell (blast) / white blood cell count above 100,000 cells per microliter. Impaired tissue perfusion related to hyperviscosity is the presenting concern, and the blast/WBC count threshold is sufficient to confirm the indication for management.
The treatment objective is meaningful reduction of the circulating white blood cell count. Management involves an exchange procedure targeting the white cell layer — the full regimen, including procedural parameters and transfusion guidance, is in the protocol.
Complete regimen, procedural details, and quantitative targets available via the link below.
References
DOI: 10.1182/blood-2018-06-846816
- When the WBC count exceeds 100 000 cells per microliter, patients may experience signs and symptoms related to impaired tissue perfusion.
- It is generally agreed that whole-blood viscosity measurements are not required and that if the leukemia cell (blast) count is above 100 000, exchange with removal of the white cell layer is indicated.
- In these situations, red cell transfusions are recommended to be withheld until the WBC count is lowered.
- American Society for Apheresis guidelines recommend processing 1.5 to 2 total blood volumes for each leukocytapheresis procedure to remove 30% to 60% of the WBCs.