Introduction <p>Hyperleukocytosis is defined as a white blood cell (WBC) count ≥ 100,000/mm³ and frequently observed in pediatric acute leukemia patients. It has prognostic significance due to an increased risk of early mortality. This study aimed to evaluate the potential role of leukapheresis in the management of hyperleukocytosis-related complications, including tumor lysis syndrome (TLS), in pediatric acute leukemia patients. </p> Material and methods <p>This retrospective study included 40 pediatric patients (&lt; 18&#xa0;years) with acute leukemia and hyperleukocytosis at presentation. Patients were monitored for TLS development, and groups that received and did not receive leukapheresis were compared. Statistical analyses were performed using IBM SPSS 22.</p> Results <p>Of 40 patients, 32.5% (<i>n</i> = 13) underwent leukapheresis. TLS occurred in 47.5% (<i>n</i> = 19) of patients, with no statistically significant difference between groups (<i>p</i> = 0.44). No leukapheresis patients required hemodialysis, while four non-leukapheresis patients did. Time from presentation to chemotherapy initiation was not significantly different between groups (<i>p</i> = 0.10).</p> Conclusion <p>While leukapheresis did not significantly affect the incidence of TLS, clinical improvements were observed in some patients, particularly in hyperleukocytosis-related symptoms, such as respiratory distress and neurological manifestations. These findings suggest that leukapheresis may play a supportive role in managing leukostasis-associated complications in pediatric acute leukemia patients presenting with hyperleukocytosis.</p>