Manual Exchange Blood Transfusion with Cytoreduction in the Management of Chronic Myelocytic Leukemia with Hyperleukocytosis: A Case Report
Asian Hematology Research Journal,
Chronic Myelocytic Leukaemia (CML) is a haematological malignancy characterized by granulocytic leukocytosis, splenomegaly, and weight loss. Hyperleukocytosis can lead to leukostasis and hyperviscosity syndrome. Leukapheresis is used to manage hyperleukocytosis, but apheresis machines are expensive and unavailable in most health facilities across Nigeria and other resource-limited countries. Manual Exchange blood transfusion (EBT) can be an alternative to leukapheresis in managing hyperleukocytosis and associated metabolic derangement.
We report a case of a 53-year-old woman who presented to the Jos University Teaching Hospital with granulocytic leukocytosis and massive splenomegaly. Full Blood Count and Bone Marrow Aspiration cytology showed features of CML in the accelerated phase. The patient was commenced on cytoreduction with hydroxyurea but defaulted treatment and re-presented one year after with features of CML in blastic transformation and pulmonary leukostasis. Recommencement of Hydroxyurea and Manual EBT achieved cytoreduction and improvement of pulmonary symptom, while the eventual introduction of imatinib mesylate resulted in the attainment of haematological remission.
Our report found that Manual EBT, combined with cytoreduction, is a reliable alternative to automated leukapheresis in managing hyperleukocytosis in resource-limited settings.
- Chronic Myelocytic Leukaemia (CML)
- blood transfusion
How to Cite
Liesveld JL, Lichtman MA. Chronic Myelogenous Leukemia and Related Disorders. In: Kaushanky K, Lichtman MA, Prchal JT, Levi MM, Press OW, Burns LJ, Caligiuri MA (eds). Williams Hematology. 9th edition. New York: Mc Graw Hill. 2016;1437-1490.
Oyekunle AA, Bolarinwa RA, Oyelese AT, Salawu L, Durosinmi MA. Determinants of Overall and Progression-Free Survival of Nigerian Patients with Philadelphia-Positive Chronic Myeloid Leukemia. AdvHematol. 2015;2015:908708.
Hehlmann R. How I treat CML blast crisis. Blood. 2012;120:737-47
Aqui N, O'Doherty U. Leukocytapheresis for the treatment of hyperleukocytosis secondary to acute leukemia. Hematology 2014, the American Society of Hematology Education Program Book. 2014;2014:457-60.
Runco DV, Josephson CD, Raikar SS, Goldsmith KC, Lew G, Pauly M, Fasano RM. Hyperleukocytosis in infant acute leukemia: a role for manual exchange transfusion for leukoreduction. Transfusion. 2018;58:1149-1156.
Suwita BM, Sekarsari D. Pediatric acute lymphoblastic leukemia and leukapheresis: CT evidence of hemorrhagic complication. European Journal of Radiology Open. 2020;7:100269
Pastore F, Pastore A, Wittmann G, Hiddemann W, Spiekermann K. The role of therapeutic leukapheresis in hyperleukocytotic AML. PLoS One. 2014;9:e95062.
Blum W, Porcu P. Therapeutic apheresis in hyperleukocytosis and hyperviscosity syndrome. In: Seminars in thrombosis and hemostasis. Copyright© 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. 2007;33(04):350-354.
Otokiti O, Ogbenna A, Bolarinwa A, Olatinwo A. Comparing Efficacy of Low Dose Cytoreduction and Manual Exchange Blood Transfusion in Managing Hyperleukocytosis: A Case Report. American Journal of Clinical Pathology. 2019;152(Supplement_1):S114-5.
Lin DM, Becker J, Wu Y, Cooling L. How do I perform whole blood exchange? Transfusion. 2020;60:449-53.
Barrett CL, Louw VJ, Webb MJ. Exchange Transfusion as a Life-Saving Intervention in Three Patients With Different Haematological Malignancies With Severe Hyperleukocytosis Where Leukapheresis Was Not Available. Transfusion and apheresis science: official journal of the World Apheresis Association: official journal of the European Society for Haemapheresis. 2013; 49:397-402.
Runco DV, Josephson CD, Raikar SS, Goldsmith KC, Lew G, Pauly M, Fasano RM. Hyperleukocytosis in infant acute leukemia: A role for manual exchange transfusion for leukoreduction. Transfusion. 2018;58:1149-56.
Choi YK, Park KG. Targeting Glutamine Metabolism for Cancer Treatment. Biomol Ther (Seoul). 2018;26:19-28.
Ulrich CM, Potter JD. Folate supplementation: too much of a good thing? Cancer Epidemiology and Prevention Biomarkers. 2006;15:189- 93.
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