Acute leukemia with extremely high white blood cell count—January 21, 1994

Acute leukemia with extremely high white blood cell count—January 21, 1994

ALL and ANLL with white blood cell counts exceeding 100 × 10^9^/L fall into this category. The characteristic is an acute, severe condition caused by the accumulation of a large number of blast cells. Accumulation in the brain and lungs leads to central nervous system and pulmonary symptoms, while accumulation in peripheral vessels results in DIC. The breakdown of a large number of immature white blood cells releases nucleic acids, potassium, and phosphate ions, causing metabolic disturbances and resulting in hyperuricemia, hyperkalemia, and other conditions. All these manifestations are collectively referred to as hyperleukocytosis syndrome. Due to these reasons, the clinical course of this condition is severe, with a high short-term mortality rate. Treatment should not rush into high-dose chemotherapy; if used, it will inevitably lead to massive necrosis of blood cells, exacerbating accumulation and increasing mortality. For acute lymphoblastic leukemia, the VP regimen can be chosen. For acute non-lymphocytic leukemia, it is advisable to first reduce the chemotherapy dose in the initial cycle and then increase it after the white blood cell count drops. If conditions permit, leukapheresis (LP) can be performed first, using a leukocyte separator to remove a large portion of white blood cells. However, LP alone cannot cure this disease; its therapeutic effect still relies on chemotherapy. Blood transfusion can increase microcirculatory stasis, so it should be avoided. Instead, adequate hydration and alkalinization should be provided, along with oral allopurinol 0.1 g, three times daily, to prevent hyperuricemic nephropathy.