Management of Leukocytosis with Lymphocytosis

Initial Diagnostic Approach

• A WBC count of 12.8 × 10⁹/L does not constitute hyperleukocytosis, defined as >100 × 10⁹/L, and does not require emergent cytoreduction, according to the Leukemia society 1
• No immediate risk of leukostasis is present at a WBC level of 12.8 × 10⁹/L, and routine hydration and monitoring are sufficient unless symptomatic, as recommended by the Leukemia society 1

Risk Stratification Based on WBC Count

• If WBC were >100 × 10⁹/L, aggressive IV hydration would be required, as suggested by the Leukemia society 1 and the American Society of Hematology 2
• Hydroxyurea may be used for rapid cytoreduction in cases of hyperleukocytosis, as recommended by the American Society of Hematology 2

Red Flags Requiring Immediate Action

• Invasive procedures should not be performed if concurrent severe thrombocytopenia or coagulopathy is present, as advised by the American Society of Hematology 4