What are the complications of leukocytosis?

Updated: May 19, 2020
  • Author: Susumu Inoue, MD; Chief Editor: Jennifer Reikes Willert, MD  more...
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Clinically significant morbidity and mortality are frequently observed in patients with leukemic hyperleukocytosis. Hyperleukocytosis may result in tumor lysis syndrome and disseminated intravascular coagulopathy. In addition to well-known complications (eg, acute respiratory failure, pulmonary hemorrhage, CNS infarction, hemorrhage), splenic infarction, myocardial ischemia, renal failure due to renal vessel leukostasis, and priapism have been reported.

A study by Tien et al indicated that hyperleukocytosis is an independent risk factor for poor prognosis in acute myelogenous leukemia, its impact being unassociated with a patient’s cytogenetic or mutational status. However, the detrimental effects of hyperleukocytosis were apparently reduced in study patients who underwent allogeneic hematopoietic stem cell transplantation in first complete remission, with overall and disease-free survival being significantly extended in these individuals. [2]

Spurious hyperkalemia may result from hyperleukocytosis. Claver-Belver et al described a case of T-cell acute lymphoblastic leukemia with a WBC count of 468.11 X 109/L. A biochemistry analyzer determined the patient's serum potassium level to be 7.3 mmol/L, but a blood gas analyzer determined the whole blood potassium value to be only 4.0 mmol/L. According to the investigators, the spuriously high serum potassium value was attributable to a centrifugation process for serum separation. Thus, it is important to recognize that such false findings may occur in the presence of a very high WBC count. [3]

In certain situations, leukocytosis may have a prognostic value. In a study performed mostly with adult patients, cardiac preoperative leukocytosis (defined by WBC >11,000) was found to be a strong predictor of postoperative medical complications. [4]

A study by Izhakian et al indicated that following lung transplantation, delayed leukocytosis is significantly linked to a higher mortality rate (hazard ratio = 1.52). The highest associated mortality was found when the delay was attributed to acute graft rejection. [5]

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