Background

When chronic leukemia progresses to an acute leukemia, therapeutic leukapheresis might be necessary: if the patient shows signs of leukostasis and if the required chemotherapy does not lead to a satisfactory and fast improvement, therapeutic leukapheresis can lower the leukocyte count fast, by collecting (and subsequently discarding) as many leukocytes as possible.

Methods

Our patient presented with acute leukostasis, after starting chemotherapy for chronic lymphatic leukemia. An acute kidney failure, due to the leukostasis, led to an emergency hemodialysis and to the request for a leukocyte reduction apheresis.

Results

During apheresis, the patient showed signs of circulatory collapse, which could initially be treated sufficiently. After 100 minutes of apheresis, the patient went into shock, requiring emergency intubation. The apheresis was discontinued right away. After extensive intensive care and within 24 hours, the patient had completely recovered. At that time, the chemotherapy had become effective, leading to a falling leukocyte count, so no further apheresis was necessary.

Conclusion

The patient had been taking Ramipril for high blood pressure. The last application had taken place only a few hours prior to apheresis. Adverse reactions after Ramipril-intake and lipid-lowering apheresis have been documented. To our knowledge, we present the first case of ramipril-induced shock during leukocyte apheresis.

Offenlegung Interessenkonflikt:

No conflicts of interest to declare.