Manual Exchange Blood Transfusion with Cytoreduction in the Management of Chronic Myelocytic Leukemia with Hyperleukocytosis: A Case Report

Abstract

Chronic Myelocytic Leukaemia (CML) is a haematological malignancy characterized by granulocytic leukocytosis, splenomegaly, and weight loss. Hyperleukocytosis can lead to leukostasis and hyperviscosity syndrome. Leukapheresis is used to manage hyperleukocytosis, but apheresis machines are expensive and unavailable in most health facilities across Nigeria and other resource-limited countries. Manual Exchange blood transfusion (EBT) can be an alternative to leukapheresis in managing hyperleukocytosis and associated metabolic derangement. We report a case of a 53-year-old woman who presented to the Jos University Teaching Hospital with granulocytic leukocytosis and massive splenomegaly. Full Blood Count and Bone Marrow Aspiration cytology showed features of CML in the accelerated phase. The patient was commenced on cytoreduction with hydroxyurea but defaulted treatment and re-presented one year after with features of CML in blastic transformation and pulmonary leukostasis. Recommencement of Hydroxyurea and Manual EBT achieved cytoreduction and improvement of pulmonary symptom, while the eventual introduction of imatinib mesylate resulted in the attainment of haematological remission. Our report found that Manual EBT, combined with cytoreduction, is a reliable alternative to automated leukapheresis in managing hyperleukocytosis in resource-limited settings.