Advanced Practice - Hyperleukocytosis syndrome!

The Bottom Line

  • Consult heme onc on any patient with a hematologic malignancy who presents with very high WBC counts and new neuro/pulm complaints


Hyperleukocytosis syndrome


  • Extremely elevated WBC counts (>50-100K), usually in the setting of AML/CML and less commonly in ALL/CLL


  • Very high concentrations of leukocytes leades to leukostasis


  • Leukostasis results in microvascular occlusion, especially in the brain and lungs



  • Neuro: Confusion, HA, stroke-like symptoms


  • Pulm: Dyspnea, tachypnea, hypoxia



  • WBC count usually >100,000


  • Anemia/thrombocytopenia are common


  • CNS imaging may demonstrate edema, infarction, or hemorrhage


  • Pulmonary imaging may demonstrate alveolar or interstitial infiltrates



  • Emergent leukophoresis in conjunction with hematology/oncology consultation to rapidly lower WBC count


  • IVF may help encourage microvascular blood flow


  • Consider antibiotics for pulmonary manifestations as infections are common in these patients





Emerson G, Kaide CG. Rapid Fire: Acute Blast Crisis/Hyperviscosity Syndrome. Emerg Clin North Am 2018:36; 603-608.