From the Guidelines
Leukocyte larceny, also known as hyperleukocytosis, is a condition where the white blood cell count is extremely high, and immediate medical treatment is necessary to prevent complications such as leukostasis, tumor lysis syndrome, and infections. The management of hyperleukocytosis involves reducing the white blood cell count, and according to the most recent guidelines, hydroxyurea is the recommended therapy to lower WBC, given at dosages up to 50 to 60 mg/kg per day, until WBCs are less than 10-20 10^9/L 1. Some key points to consider in the management of hyperleukocytosis include:
- Leukapheresis is an option for the initial management of hyperleukocytosis, but it has no impact on long-term outcome 1
- Prevention of tumor lysis syndrome is crucial, and this can be achieved through hydration, control of uric acid production using allopurinol or rasburicase, and control of urine pH 1
- The diagnosis of leukostasis is based on the presence of unexplained hypoxia, neurological symptoms, renal failure, cardiac ischemia, priapism, or severe retinopathy 1
- The management of symptomatic leukostasis requires immediate medical attention, and the goal is to rapidly reduce the white blood cell count to prevent further complications 1 It's worth noting that the evidence provided is mostly related to the management of acute myeloid leukemia (AML) and hyperleukocytosis, and the guidelines recommend a multidisciplinary approach to the management of these conditions, including the use of chemotherapy, supportive care, and other therapies as needed 1. In terms of specific treatments, the guidelines recommend the use of hydroxyurea to reduce the white blood cell count, as well as other therapies such as apheresis and chemotherapy, depending on the underlying condition and the patient's overall health status 1. Overall, the management of leukocyte larceny requires a comprehensive approach that takes into account the underlying condition, the patient's overall health status, and the potential risks and benefits of different therapies.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Leukocyte Larceny Overview
- Leukocyte larceny, also known as "spurious hypoxemia" or "oxygen steal," refers to the phenomenon where high white blood cell (WBC) counts consume oxygen in arterial blood gas (ABG) samples, resulting in falsely low oxygen tension readings 2, 3.
- This condition is typically seen in patients with hematological malignancies and extremely high WBC counts, often exceeding 500,000 3.
- The consumption of oxygen by active cellular elements in the arterial blood sample during ABG analysis is thought to be the underlying cause of this phenomenon 2.
Diagnosis and Confirmation
- Leukocyte larceny is suspected when there is no other obvious explanation for hypoxemia on ABG, especially in the setting of normal oxygen saturations by pulse oximetry 2.
- Pulse oximetry can be used to confirm higher hemoglobin oxygen saturation and establish the diagnosis of leukocyte larceny 3.
- Medical professionals should be aware of this condition to avoid unnecessary hospitalization and escalation of care 2.
Related Studies
- A study published in 1990 reported a case of leukemic patient with a white blood count in excess of 500,000, where multiple ABGs documented hypoxemia out of proportion to his clinical picture, and pulse oximetry was used to confirm higher hemoglobin oxygen saturation 3.
- Another study published in 2015 investigated the safety of growth factor administration for leukapheresis in patients with WBC counts greater than 60,000/µl and found no serious adverse events reported, except for common side effects associated with growth factor administration 4.
- A study published in 2010 demonstrated the efficiency of gravity sedimentation with hydroxyethyl starch in removing red blood cells and retaining neutrophils in granulocytapheresis concentrates, which may be relevant to the management of patients with high WBC counts 5.