Hyperkalaemia with ECG changes — MCCQE Part 1 MCQ

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ModerateWeaknessHyperkalaemia with ECG changesMCCQE Part 1

A patient with newly diagnosed acute myeloid leukemia has leukocytes 280 × 10⁹/L, confusion, retinal hemorrhages, dyspnea and hypoxemia without infection. What is the best immediate management?

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Correct answer: C — Begin urgent cytoreduction with hematology support

Neurologic and pulmonary dysfunction with extreme leukocytosis in AML indicates leukostasis, a time-critical emergency. Admit to a monitored setting, begin urgent cytoreduction—commonly hydroxyurea while definitive leukemia therapy is organized—and provide hydration, tumor-lysis prophylaxis or treatment and careful transfusion support. Leukapheresis may be considered in selected symptomatic patients, but it must not delay effective chemotherapy and its outcome benefit is uncertain. Unnecessary rapid red-cell transfusion can increase viscosity. Cytogenetic studies guide definitive therapy but cannot postpone stabilization and cytoreduction in an actively symptomatic patient.

Reference: Hyperleukocytosis and Leukostasis Review: https://pmc.ncbi.nlm.nih.gov/articles/PMC8375818/