Leucostatic features

• Decreased conscious level.

• Retinal haemorrhages.

• Papilloedema.

• Hypoxia and miliary shadowing on CXR.

• Bleeding and coronary ischaemia.

Should not be performed routinely just because of a high WBC. Leucostatic clinical features are the indication. Conversely, leucostasis may occur in some patients with AML without a very high blast count but these patients should be considered for leucapheresis.

Chemotherapy should be started as soon as possible after leucapheresis as WBC will 'rebound' quickly due to outpouring of cells from marrow. Leucapheresis may need to be repeated daily until chemotherapy has suppressed marrow.

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