Abstract
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Background / Context
Recurrent hyperleukocytosis in acute myeloid leukemia (AML) presents evolving risks requiring timely escalation and adaptive nursing surveillance. Cytoreduction may be followed by profound cytopenias, while substantial leukemic burden raises concern for leukostasis and tumor lysis syndrome (TLS).
Objective
To demonstrate the nursing contribution to critical-result communication, interdisciplinary coordination, and continuous risk surveillance during recurrent hyperleukocytosis in relapsed/refractory AML.
Methods
This descriptive nursing case report examined the clinical course, serial laboratory findings, treatment chronology, and nursing documentation of a 33-year-old woman diagnosed with AML in 2025. Analysis focused on escalation, implementation of prescribed interventions, neurological surveillance, fluid-balance monitoring, and patient outcomes.
Key Findings
WBC reached 242.9 × 10⁹/L on August 13, 2026, declined to 5.5 × 10⁹/L by August 25, and subsequently increased to 102.7 × 10⁹/L on August 31 and 126 × 10⁹/L on September 23. During cytarabine-based cytoreduction and hydroxyurea adjustment, WBC decreased to 0.4 × 10⁹/L on September 8. Nurses communicated CBC results to the assigned hematologist within 30–60 minutes of electronic medical record posting and implemented prescribed interventions, including intravenous hydration at 120 mL/hour, hydroxyurea adjustment, and cytarabine infusion for cytoreduction. Strict intake and output monitoring and surveillance for bleeding and neurological deterioration were documented. No signs or symptoms of hyperleukocytosis or CNS deterioration were documented. No clinical TLS was reported, and the patient was discharged in good condition.
Conclusions / Implications
This case highlights nursing surveillance as an active, adaptive process throughout cytoreduction. Timely result communication, implementation of clinical orders, focused neurological and pulmonary assessment, fluid-balance monitoring, and reassessment for cytopenic complications support coordinated, safety-oriented hematology care. Written patient consent and applicable institutional authorization requirements were fulfilled, as confirmed by the author.
Speaker
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