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Acute promyelocytic leukaemia — SCE Acute Medicine MCQ

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ModerateHaematological EmergenciesAcute promyelocytic leukaemiaSCE Acute Medicine

A 76-year-old man presents with fever, bleeding, thrombosis or severe anaemia. Relevant history includes malignancy, chemotherapy, haemoglobinopathy or anticoagulant exposure. On assessment, blood film and coagulation results are abnormal. Investigations show abnormal promyelocytes with bleeding and low fibrinogen. What is the most important immediate action?

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Correct answer: E — Start ATRA immediately after haematology discussion

The key discriminator is that abnormal promyelocytes with bleeding and low fibrinogen, which makes Start ATRA immediately after haematology discussion the single best answer. Start acetylcysteine without delay is less appropriate because it does not address the dominant acute risk in the vignette; Give hypertonic saline bolus would fit a different presentation or later stage of care. Reverse anticoagulation where appropriate and Give intramuscular adrenaline immediately are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BSH AML/APL guidance