Clinical Pathways are intended to standardize patient care. Our pathways are informed by the systematic review of current pediatric health care literature and includes risk and benefit assessment of alternative care options. When evidence is not available or weak, standards are developed by consensus agreement among subject matter experts.
Clinical Pathways are updated on a revision schedule. Primary files will always be the most current update. Previous revisions are available upon request from Children’s Mercy Library Services.
NOTE:The Clinical Pathways Collection combines and includes work products previously released as Care Process Models and Clinical Practice Guidelines.
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Hyperleukocytosis/Leukapheresis
Children's Mercy Kansas City
Hyperleukocytosis is a life-threatening oncology emergency, defined as a white blood cell (WBC) count ≥ 100,000/µL and can occur in up to 20% of patients with acute myeloid or lymphoid leukemias (Abla et al., 2016). Hyperleukocytosis may lead to leukostasis and subsequent end organ damage, commonly affecting the central nervous system, respiratory and renal systems, and can also cause tumor lysis syndrome (TLS), another oncology emergency, and lead to metabolic derangements and further renal dysfunction (Porcu et al., 2000). Treatment of hyperleukocytosis includes supportive care, early initiation of chemotherapy and/or leukapheresis (Zhang et al., 2021). There are no definitive guidelines on the use or efficacy of leukapheresis in hyperleukocytosis. Within published literature there is a lack of consistency in decision to treat and selection biases (as physician discretion was used as an indication for leukapheresis), variability in treatment (whether or not to administer chemotherapy), and differences in outcome measures (Zhang et al., 2021). According to the American Society of Apheresis Guidelines, the indication for use of leukapheresis as treatment for hyperleukocytosis falls under category III, meaning the quality of published evidence has not established the optimum role of leukapheresis and thus decision making should be based on individual cases (Connelly‐Smith et al., 2023). Development of a clinical pathway for hyperleukocytosis and leukapheresis will allow for standardized management strategies for patients at Children’s Mercy Kansas City (CMKC)
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Multisystem Inflammatory Syndrome in Children (MIS-C): Emergency Department
Children's Mercy Kansas City
