A child with Acute myeloid Leukemia presents with Hyperleukocytosis. Treatment'includes all of the following, Except:
Answer is D (Immediately sta induction chemotherapy) Immediate treatment of Hyperleukocytosis is leukocytoreduction which is generally achieved by Leukopharesis or administration of Hydroxyurea. Induction chemotherapy is initiated early in treatment after attempts at leukocytoreduction but not immediately. Immediate induction chemotherapy is the single best answer of exclusion. Immediate Administration of induction chemotherapy to a patient with hyperleukocytosis carries a high risk of Acute tumor lysis syndrome and hence induction chemotherapy is often not initiated immediately but generally follows attempts at cytoreduction. IV hydration, Allopurinol and alkalinization of urine are measures to reduce the metabolic complications of tumor lysis syndrome and are indicated as preventive measures in patients with Leukostasis and hyperleukocytosis. Hyperleukocytosis and Leukostasis (Independent poor prognostic factor in acute leukemia) Hyperleucocytosis is a condition in which patients with acute leukemia present with an extraordinary high leukocyte count usually greater than 100,000. The high number of circulating blasts increase the blood viscocity and predispose to the development of Leukostasis. Leukostasis refers to sludging of leukemia blasts in the microcirculation leading to obstruction of small vessels especially in the cerebral and pulmonary circulations. Once identified leukostasis requires immediate and effective treatment to lower the blast count rapidly.
IV fluids
Allopurinol
Alkalinization
Immediately sta induction chemotherapy