allopurinol and Leukocytosis

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. Objective: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines.. These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts.. The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided.

Topics: Algorithms; Allopurinol; Anti-Bacterial Agents; Anticonvulsants; Comorbidity; Consensus; Drug Hypersensitivity Syndrome; Eosinophilia; Expert Testimony; Humans; Leukocytosis; Liver; Risk Factors; Skin; Spain

Hyperleukocytosis secondary to acute leukemia is a medical emergency. Intracranial hemorrhage often leads to death in this setting. Early efforts to prevent this serious complication have included emergent cranial irradiation, with its associated morbidity when used in the young child. Currently, exchange transfusion and/or leukapheresis are employed to acutely lower the peripheral leukocyte count.. We report three infants with acute leukemia and hyperleukocytosis in whom intravenous hydration, alkalinization, and allopurinol therapy alone produced rapid and dramatic decreases in the peripheral leukocyte count.. The maximal decrease in leukocyte count averaged 88% within 70 h of starting conservative management. A fall in leukocyte count to < 100 x 10(9)/L was noted at an average of 15 h following hospitalization. No patient developed complications.. When comparing this approach to exchange transfusion and leukapheresis we find it to be both safe and effective. Children with hyperleukocytosis in association with acute lymphocytic leukemia who present without life-threatening complications of an extremely high leukocyte count can be safely and effectively managed with intravenous hydration, alkalinization, and allopurinol therapy.

Topics: Allopurinol; Bicarbonates; Female; Fluid Therapy; Humans; Infant; Leukemia; Leukocytosis; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Sodium; Sodium Bicarbonate

A small proportion of patients with acute or chronic leukemia has an extraordinarily high blood leukocyte count. These high counts can result in a very high fractional volume of leukocytes (leukocrit), which is also a function of the mean leukocyte volume in different types of leukemia. Despite a high fractional volume of leukocytes, bulk viscosity of blood is usually not increased because a decrement in the fractional volume of erythrocytes accompanies the increase in leukocytes. Nevertheless, the excessive numbers of leukocytes present two major problems: first, they can seriously affect flow in the circulation of the lung, brain, and less often, other organs by obstructing microchannels or by forming aggregates and white thrombi in small veins. Moreover, leukemic blasts may compete for oxygen in the microcirculation and they may be invasive, damaging vessel walls. Second, their rapid destruction in response to cytotoxic drugs causes metabolic disturbances, especially uric acid accumulation, which can lead to obstructive uropathy.

Topics: Adolescent; Allopurinol; Antineoplastic Agents; Blood Flow Velocity; Blood Viscosity; Cerebrovascular Circulation; Child; Child, Preschool; Exchange Transfusion, Whole Blood; Hematocrit; Humans; Hyperkalemia; Leukapheresis; Leukemia; Leukocyte Count; Leukocytosis; Microcirculation; Oxygen Consumption; Pulmonary Circulation; Uric Acid

Childhood leukemic hyperleukocytosis poses a serious threat to life because of its associated metabolic complications. The present prospective trial utilized conservative management of childhood acute lymphoblastic leukemia with hyperleukocytosis (total white cell count equal or > 100 x 10(9)/L) by intravenous hydration, urinary alkalinization, and allopurinol presenting without severe life-threatening complications. The median reduction in WBC count was 81.51% (range: 66-98.8%) within a median period of 36 hours (range: 12-60 hours) following hospitalization. There were no failures or treatment related complications. Thus we conclude that in childhood acute lymphoblastic leukemia, hyperleukocytosis can be managed safely and effectively with intravenous hydration, urinary alkalinization, and allopurinol before starting any specific anti-leukemic chemotherapy avoiding risk-associated cranial irradiation, leukapheresis, and exchange transfusion.

Topics: Adolescent; Allopurinol; Child; Child, Preschool; Citrates; Citric Acid; Female; Fluid Therapy; Humans; Hydrogen-Ion Concentration; Leukocyte Count; Leukocytosis; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prospective Studies

Topics: Aged; Allopurinol; Antimetabolites; Confusion; Febuxostat; Female; Gout Suppressants; Headache; Humans; Leukocytosis; Meningoencephalitis; Recurrence

We present the case of a 44 years man who presented to us with persistent leucocytosis. Following relevant investigations, we diagnosed him to have Chronic Neutrophilic Leukaemia (CNL); a rare haematological disorder. Ten months later, he remains non-responsive to standard line of treatment.

Topics: Adult; Allopurinol; Humans; Hydroxyurea; Leukemia, Neutrophilic, Chronic; Leukocytosis; Male; Prognosis; Vitamins

Topics: Acute Disease; Adult; Allopurinol; Antimetabolites; Antineoplastic Agents; Epistaxis; Fever; Fluid Therapy; Humans; Hydroxyurea; Leukapheresis; Leukemia, Myeloid; Leukocytosis; Male; Vision Disorders

Topics: Allopurinol; Child, Preschool; Fluid Therapy; Humans; Infant; Leukemia, Myeloid, Acute; Leukocyte Count; Leukocytosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Topics: Aged; Allopurinol; Cytarabine; Drug Therapy, Combination; Humans; Hydroxyurea; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukocytosis; Male; Positive-Pressure Respiration; Postoperative Complications; Respiratory Insufficiency

A patient with malignant histiocytosis presented with a number of unusual features including fever, leukemoid reaction, and eosinophilia. Other confusing findings included lymph node biopsies which showed reactive changes, noncaseating granuloma, and atypical Reed-Sternberg cells. These features are compared with cases appearing in the literature. The course was rapidly progressive despite combination chemotherapy.

Topics: Adult; Allopurinol; Autopsy; Bone Marrow Examination; Cyclophosphamide; Eosinophilia; Ethambutol; Female; Granuloma; Humans; Isoniazid; Leukocytosis; Lymph Nodes; Lymphatic Diseases; Male; Prednisone; Streptomycin; Vincristine

Topics: Allopurinol; Amenorrhea; Busulfan; Chlorambucil; Chronic Disease; Drug Eruptions; Female; Hemolysis; Humans; Leukemia, Lymphoid; Leukemia, Myeloid; Leukocytosis; Lymphocytosis; Prednisolone; Pulmonary Fibrosis; Splenectomy; Vincristine

Topics: Acetazolamide; Acute Kidney Injury; Adult; Allopurinol; Anuria; Bicarbonates; Blood Gas Analysis; Blood Urea Nitrogen; Carbon Dioxide; Cystoscopy; Electroencephalography; Eye Manifestations; Female; Humans; Leukemia, Lymphoid; Leukocytosis; Mannitol; Mercaptopurine; Methotrexate; Peritoneal Dialysis; Prednisone; Splenomegaly; Thrombocytopenia; Uric Acid; Urinary Catheterization; Vincristine; Water-Electrolyte Balance