PathWays Case Study for July 21

 Leukocytapheresis collection bag at the end of the 3-hour procedure.
Leukocytapheresis collection bag at the end of the 3-hour procedure.

A 25-year-old woman presents with decreased exercise tolerance over several weeks. Her white blood cell (WBC) count is 185X10 9 /L and the peripheral smear revealed acute leukemia with 98% blasts. Soon after admission, she develops visual blurring.

Leukocytapheresis was performed and 906mL of cell volume was removed during the 3-hour procedure. The patient’s WBC reduced to 34X10 9 /L, her visual blurring improved, and she received hydroxyurea after the procedure.

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Siavash Toosi, M.D.

Siavash Toosi, M.D.
Resident, Anatomic and Clinical Pathology
Mayo Clinic

 

 

 

Dr. Justin Kreuter

Justin Kreuter, M.D.
Consultant, Division of Transfusion Medicine
Mayo Clinic
Instructor in Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine

 

 

Jeffrey Winters, M.D.

Jeffrey Winters, M.D.
Consultant, Division of Transfusion Medicine
Mayo Clinic
Professor of Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine

apriljosselyn

April Josselyn

April Josselyn is a Marketing Associate at Mayo Medical Laboratories. She is the editor of Mayo Clinic PathWays and supports corporate communications strategies and internal communications. She has worked at Mayo Clinic since 2012. Outside of work, April enjoys the outdoors and being "hockey mom" for her two sports-crazed boys.

Responses

I love these cases! Great job.
Thanks

Interesting case. Well done.

Correct.

Thank you for an interesting therapeutic management strategy for leucostasis. May I enquire if leucocytophoresis can be useful in a patient with HIV and TB cerebral endarteritis, leading to basal nuclei, anterior limb and external capsule infarction. Thank you, I look forward to a response from any colleague, available to respond.

impressive and didactic picture

Great case.

Thank you for your question Dr. Vawda! We are unaware of the use of leukocytapheresis in HIV or TB cerebral endarteritis. A Medline search failed to identify any published articles using the following search string: Leukapheresis and (endarteritis, or cerebral endarteritis, or cerebral artery diseases) and (HIV or tuberculosis).
As this indication is not categorized in the American Society for Apheresis guidelines on the use of apheresis, we recommend using the following two references to guide clinical decision making:

1. Shaz BH, Winters JL, Bandarenko N, Szczepiorkowski ZM. How we approach an apheresis request for category III, category IV, or non-categorized indication. Transfusion 2007;47:1963-1971.
2. Winters JL, Chun C. Chapter 4 – Clinical decision making and the American Society for Apheresis guidelines. In: Linz W, Chhibber V, Crookston K, Vrielink H (eds.) Principles of Apheresis Technology: Technical Principles of Apheresis Medicine, 5th edition. Vancouver, Canada: American Society for Apheresis. 2014. pp 51-75.

To summarize, leukapheresis for patients with HIV and TB cerebral endarteritis is not in current guidelines, there appear to be no publications on its use, and we are unable to hypothesize a plausible mechanism for how this procedure could correct this pathophysiology.

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