The hyperleukocytic syndrome is the manifestations of several organ-system
dysfunction, mainly of central nervous and cardiopulmonary system, due to the occlusion
of microcirculation resulting from leukostasis in a small proportion of patients with
leukemia who has an extraordinarily high blood leukocyte count. The leukostasis is
resulted from increased blood viscosity in the microcirculations due either to increased
blood bulk viscosity or less deformable blasts and/or immature leukocytes. However,
blood bulk viscosity rarely increased in patients with leukemia because of the
accompanying anemia.
Here presented,a 21-year-old woman with chronic myelocytic leukemia in accelerating
phase who revealed respiratory distress, retinopathy accompanying visual disturbance,
and headache. On admision, peripheral white blood cell count was 588,000/㎣ (blast 4%,
promyelocyte 34%, myelocyte 21%) and nonhypercapnic hypoxemia (pH 7.44, PO₂
32mmHg, PCO₂35mmHg) was noted. Drowsy mental state and aggravation of headache
developed on second day of chemotherapy with hydroxy-urea and Ara-C, and were
managed as brain edema with much benefit despite no discernible change of leukocyte
count. Headache, mental disturbance, and dyspnea completely disappeared on 5th
chemotherapy day with decrease of leukocyte count to 392,000/㎣. During the course,
almost complete recovery of hypoxemia and retinopathy was observed on 15th and 25th
hospital day, respectively with remarkable decrease of leukocyte counts. She discharged
on 49th hospital day without any evidences of hyperleukocytic syndrome with normal
leukocyte count.
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