Authors: Deepak Bansal Richa Jain
Publish Date: 2013/06/06
Volume: 81, Issue: 3, Pages: 323-323
Abstract
To the Editor We thank Gupta et al for their comments In a patient with acute leukemia hyperleukocytosis and Hb 7 g/dL hydration is initiated at 2–4 times of normal maintenance Leukoreduction by either leukapheresis or exchange transfusion is considered if the patient has symptoms related to leukostasis If an exchange transfusion is planned recommended volume varies from 70 to 150 mL/kg as mentioned in the article 1 Exchange transfusion can be performed with whole blood or with a mix of packed red blood cells and plasma in a ratio of 2–31 One may prefer a lower concentration of packed red cells say 21 instead of 31 in a child with a higher Hb compared to a very anemic child The decision may be individualizedIt has been rightly pointed that hydroxyurea HDU has been used as a cytoreductive agent typically in chronic myeloid leukemia CML and acute myeloid leukemia AML Its use appears to be less popular in pediatric as compared to the adult hematology services HDU would not need to be considered in a patient with acute lymphoblastic leukemia as rapid cytoreduction can successfully be achieved with steroid monotherapy in the large majority It has been reported that HDU 50–100 mg/kg per day given orally in 3–4 divided doses reduces the WBC count by 50 to 80 within 24–48 h without causing tumor lysis pneumopathy or worsening the disseminated intravascular coagulation 2 According to Porcu et al it should be started immediately in all patients with hyperleukocytic AML and continued until more definitive chemotherapy is initiated 3 HDU has a definitive role in CMLLeukemoid reaction severe enough to cause hyperleukocytosis is very rarely encountered and reported in literature Exchange transfusion has been recommended in the setting of pertussis pneumonia with hyperleukocytosis and pulmonary hypertension 4 In a case report of a premature infant with intrauterine herpes simplex encephalitis and hyperleukocytosis WBC 116700/mm3 a double volume exchange transfusion was performed on concerns of high blood viscosity contributing to the risk of neurological injury 5
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