Extreme Leukocytosis Successfully Managed by Double-Volume Exchange Transfusion in an Infant With T-Cell Leukemia

Extreme leukocytosis at the time of diagnosis of leukemia may lead to potentially fatal complications because of increased cell lysis and hyperviscosity of the blood. Hyperkalemia, hypocalcemia, hyperphosphatemia, and hyperuricemia are some of the abnormalities that may be observed.¹ Intracerebral hemorrhage has also been associated with this condition.^2-4

Leukapheresis has been one mode of therapy for hyperleukocytosis.^5-8 However, with this technique, specialized equipment is required, infants are too small, two separate lines are needed, and metabolic abnormalities are not corrected; infection, hypovolemic shock, and thrombocytopenia may also occur.^6,7 Exchange transfusion has been used in an attempt to circumvent the previously described problems. A 15-year-old patient with an initial WBC count of 457,000/cu mm underwent an exchange transfusion with 7 units of blood via an antecubital vein, and after the exchange transfusion, the WBC count was 200,000/cu mm.⁹ In another instance, a 1-day-old infant received