Leukostasis is a high morbidity and mortality condition. Leukocytapheresis is often used as a bridge to definitive chemotherapy to quickly decrease the white blood cell count and alleviate, or prevent, clinical symptoms of leukostasis. Given the evolving evidence in the literature may suggest its limitation in providing clinical benefits, the role of leukocytapheresis may be reconsidered. Furthermore, leukocytapheresis for leukostasis is an emergent procedure. These patients may be hemodynamic unstable and/or having multiple laboratory abnormalities and thus, making the procedure challenging. Therefore, this session will provide the knowledge needed to evaluate the necessity of a leukocytapheresis consult as well as its alternatives, and if indicated, to perform a safe and effective procedure. Pediatric considerations, such as whole blood exchange, especially in infants weighing <5 kg will also be reviewed.
Update the evidence and limitations of therapeutic leukocytapheresis in patients with hyperleukocytosis.
Review the technical specifications and procedural considerations of therapeutic leukocytapheresis.
Discuss step-by-step instructions to overcome technical/procedural challenges in leukocytapheresis in pediatric population and review different alternatives to automated leukocytapheresis.
MD, MPH, MSc,
Department of Laboratory Medicine, UCSF School of Medicine