A 46-year-old man with newly diagnosed AML presents with WBC 145,000/μL, dyspnoea, oxygen saturation 88%, confusion, and blurred vision; fundoscopy shows retinal haemorrhages and leukemic infiltrates. Which immediate intervention takes priority alongside prompt initiation of induction chemotherapy?

• A Immediate packed red cell transfusion to raise hemoglobin above 10 g/dL
• B Therapeutic lumbar puncture with intrathecal methotrexate
• C Broad spectrum antibiotics alone and reassessment after 24 hours
• D Hydroxyurea with or without leukapheresis for rapid cytoreduction ✓

Explanation

Symptomatic hyperleukocytosis with leukostasis (dyspnoea, hypoxia, neurologic signs, retinal changes at WBC far above 100,000/μL) is an emergency requiring rapid cytoreduction with hydroxyurea and sometimes leukapheresis, together with urgent induction. Red cell transfusion is avoided initially because it raises whole blood viscosity and worsens stasis. Antibiotics address infection but not mechanical vascular occlusion, and intrathecal therapy treats CNS relapse, not leukostasis.

Reference: Williams Hematology, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.