There are no controlled or prospective studies. In ALL, there are conflicting data regarding the usefulness of leukapheresis in the management of metabolic abnormalities. In both ALL and AML, leukapheresis seems to be effective in decreasing symptoms and poor outcome due to leukostasis or hyperviscosity. While arranging for pheresis, the patient can be hydrated, given allopurinol and bicarbonate. Radiation therapy may be needed in the event of a massive mediastinal mass with either airway or vascular compromise.
Vascular access needs to be considered.
Remember that hydration alone will usually bring the count down. In the very small child or person with inadequate venous access, exchange transfusion can be as useful as pheresis. Do not delay chemotherapy. Effect of high concentrations of leukocytes on whole blood viscosity. Rheology of leukocytes, leukocyte suspensions and blood in leukemia.