Home : Department of Pediatrics : Academic Divisions : Emergency Medicine : Resident Manual : Hematology & Oncology : Hyperleukocytosis


Hyperleukocytosis is defined as a wbc > 100,000/mL3. It is seen in 5-20 percent of children diagnosed with leukemia at their initial presentation. It is most commonly seen with ALL, but also AML. The morbidity and mortality of hyperleukocytosis is from high numbers of circulating leukemic blast cells that lead to leukostasis and high viscosity in pulmonary and cerebral vasculature. Symptoms can range from mental status changes, headache, seizures to dyspnea, hypoxemia or no symptoms at all.


  • Hydration 2-4x maintenance without potassium
  • Alkalinization (50-100 mEq NaHCO3/L)
  • Allopurinol (see dose on next page)
  • Monitor lytes and renal function closely
  • Correct coagulopathies (more prominent with AML)
  • Keep hbg < 10mg/dL as PRBC's will increase viscosity

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