29

CHAPTER 4
DISCUSSION AND SUMMARY

Hyperleukocytosis is defined as peripheral blood leukocyte count exceeding

>100,000/mm3. This extreme leukocyte release is due to defect of leukocyte release
from bone marrow resulting in an increase in leukocyte count circulating in the blood.
According to our case report, HS, 13 year old, came with chief complaint
paleness which became more severe since a month ago. Patient objected having any
bleeding currently and history of bleeding (-). Patient is having menstrual bleeding
for this past 5 days with volume of blood produced is very less. Fever (+) occurred 3
months ago, high type fever that reduced with fever medicines but relapse again.
Vomiting (+) since this past 3 days, preceded by nauseated feeling, 3x/day with
volume aqua cup. The contents of vomit is food that she ate shortly before.
Cough (-), flu (-), spasm (-), decreased appetite (+) and decreased body weight (+)
2 kg in 3 months. History of in contact with peroxide (+). Family members with
similar complaints(-).History of pregnancy, patient is the only child for her parents.
Mother was 24 years old when she was pregnant. During her pregnancy she always
control to midwife. Fever during pregnancy (-). DM (-).Hypertension(-). History of
consuming medicines during pregnancy (-).History of consuming herbs (-). Normal
delivery assisted by midwife with infant birth weight 3700g. Cried as soon as the
baby was born and was declared healthy by the midwife. Urination (+)
normal.Defecation (+) normal.

30

Theory

Patient

Definition: Hyperleukocytosis is defined Patients

leukocyte

count

was

133

as a white blood cell (WBC) count 570/mm

exceeding >100,000/mm3.
Epidemiology: Hyperleukocytosis occurs Patient

is

diagnosed

approximately in 9% until 13% of Hyperleukocytosis

children

with

acute

with
Acute

lymphoblastic lymphoblastic Leukemia

leukemia
Etiology:

Hematological

splenectomy,
leukemia

functional
and

diseases- Patient

has

leukemia;

Acute

asplenia, Lymphoblastic Leukemia

mieloproliferative

disorders, hemolytic anemia, transfusion

reaction

Risk factor : Newly diagnosed or Patient was diagnosed with leukemia 3

recurrent leukemia is a risk factor
Clinical

Manifestation

:-The

months ago
clinical -Patient has weakness, fatigue and

presentation is dominated by progressive paleness secondary to anemia

weakness,

fatigue

and

paleness -Due to ALL patient has experienced

secondary to anemia, infection secondary weight loss, tiredness, fever and loss of
to leukopenia, and bleeding secondary to apetite.
thrombocytopenia.
-Suggestive symptoms such as headache,
vision blurring, exertional dyspnoea to
respiratory

distress,

hypoxia,

mild

confusion and somnolence to stupor and

coma.
-General symptoms of ALL can include

31

weight

loss,

severe

night

sweats,

tiredness, fever, and loss of appetite.

Test and Diagnosis: -All children, once Patients serum electrolytes (sodium,
diagnosed with hyperleukocytosis should potassium, calcium, phosphate) along
be attended for possible complications. with renal functions and uric acid are all
Most importantly, screening for TLS in normal range. However, her blood gas
should

be

done.

Serum analysis revealed acidosis.

electrolytes(sodium, potassium, calcium,

phosphate) along with renal functions and
uric

acid

should

be

requested

immediately.
- Laboratory evalution should include
careful assesement for thrombocytopenia,
coagulopathy, and tumor lysis syndrome.
- A blood gas analysis should be done to
look for acidosis.

Treatment:

Vigorous

hydration

with Patiet was hydrated with 4:1 plus meylon

intravenous fluids, Alkalinization of the 25 mEq.

urine

to

prevent

acute

uric

acid

nephropathy, Recombinant urate oxidase

(rasburicase) is an alternative drug to
prevent

tumor

lysis

and

manage

hyperuricemia in patients who cannot

tolerate allopurinol.

32

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