Is leukocytosis (elevated white blood cell count) common in priapism after treatment with phenylephrine and blood aspiration?

Leukocytosis in Priapism After Phenylephrine and Blood Aspiration

Leukocytosis is not typically associated with priapism treatment using phenylephrine and blood aspiration, and its presence should prompt investigation for other causes such as infection. 1

Understanding Priapism and Inflammatory Response

Priapism is a urologic emergency characterized by a persistent, painful erection lasting more than 4 hours without sexual stimulation. According to clinical guidelines, the presence of Systemic Inflammatory Response Syndrome (SIRS) features, including leukocytosis, in a patient with priapism is not typical and should trigger a search for other underlying causes 1.

Key points regarding leukocytosis in priapism:

• The American College of Critical Care Medicine indicates that SIRS in priapism is not expected and should prompt evaluation for other etiologies, particularly infection 1
• When leukocytosis is present after standard priapism treatment, clinicians should consider:
  • Underlying hematologic disorders (particularly leukemia)
  • Deep-seated infections that may not be immediately apparent
  • Other systemic inflammatory conditions

Relationship Between Leukemia and Priapism

Interestingly, the literature shows a bidirectional relationship between leukocytosis and priapism:

• Hyperviscosity from leukemia can cause priapism 2, 3
• In cases of priapism secondary to chronic myeloid leukemia (CML), marked leukocytosis is often present 3, 4

However, standard treatment of priapism with phenylephrine and aspiration itself has not been documented to cause leukocytosis in the available evidence.

Treatment Considerations

When treating priapism with phenylephrine and aspiration:

1. First-line treatment involves intracavernosal phenylephrine (100-500 μg/mL), administered in 1 mL injections every 3-5 minutes for up to 1 hour 1
2. If unsuccessful, aspiration with or without irrigation should follow 1
3. Blood pressure and heart rate monitoring is essential during treatment with sympathomimetics 1

The success rate of phenylephrine treatment ranges from 43-81%, while aspiration with or without irrigation has a resolution rate of approximately 30% 1. High-dose phenylephrine has demonstrated success rates of up to 94% in some studies 5.

Clinical Implications and Recommendations

If leukocytosis is observed after priapism treatment:

• Complete blood count should be examined in any case of ischemic priapism of unknown etiology 3
• Consider hematologic consultation if marked leukocytosis is present
• Evaluate for possible infection, as the combination of SIRS and priapism raises suspicion for infection 1
• In cases where leukemia is diagnosed, targeted chemotherapy along with standard priapism management is recommended 3

Common Pitfalls to Avoid

• Failing to investigate leukocytosis after priapism treatment, assuming it's a normal response
• Missing underlying hematologic disorders that may have caused the priapism
• Delaying treatment of priapism in patients with sickle cell disease while waiting for disease-specific interventions 1
• Not monitoring for cardiovascular side effects during phenylephrine administration, especially in patients with cardiovascular risk factors 1

Remember that time is critical in ischemic priapism, with treatment efficacy decreasing after 48 hours and significant risk of erectile dysfunction after 18 hours 1.