Canterbury DHB
Consider therapeutic leucopheresis in patients with life/organ threatening symptoms of leucostasis i.e.:
Consider rapid cytoreduction with hydroxyurea – high doses i.e. 4g bd may be required. Clinicians may choose to initiate cytoreduction whilst awaiting confirmation of the diagnosis, but it is not necessary to cytoreduce patients prior to introducing a TKI.
It is important to prevent and monitor for tumour lysis syndrome.
Avoid RBC transfusion whilst WBC is >100x109/L.
Note that patients with high WBC or platelet counts may have spurious hyperkalaemia. Check potassium levels in ABG tube (venous blood) delivered rapidly to the laboratory.
Topic Code: 532024