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Leukostasis is a pathological condition in which excessive amounts cause coalescence and sludgin leading to thrombosis, hemorrhage, respiratory distress, and renal failure. It is imperative that it is treated urgently and efficiently.We report an eleven year old boy presented to our emergency room with low-grade fever for 3 days. Clinical examination showed pallor and hepatosplenomegaly, and blood test showed low hemoglobin, low platelet count, and increased WBC count of 8,86,960 cells/mm³, which were primarily lymphoblasts. Additionally, patient had dyselectrolytemia with hyperkalemia, hypocalcaemia, hyperphosphatemia, and hyperuricemia. He was treated with hydration, Alkalinization, Allopurinol, exchange transfusions, and Rasburicase. Flow cytometry confirmed the diagnosis of acute T-cell lymphoblastic leukemia. This case emphasizes the importance of swift and effective use of exchange transfusion in the management of hyperleukocytosis as it is more readily available and illustrates that it is almost, if not equally, effective as Leukoapheresis.