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Acute leukaemia with leukostasis — SCE Acute Medicine MCQ

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HardHaematological EmergenciesAcute leukaemia with leukostasisSCE Acute Medicine

A patient with acute leukaemia has white cells 220 × 10^9/L, hypoxaemia, confusion and diffuse pulmonary infiltrates without infection. What is the emergency?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: BBegin urgent cytoreduction for symptomatic leukostasis

The best answer is “Begin urgent cytoreduction for symptomatic leukostasis”. This is correct because respiratory and neurological dysfunction with extreme blast counts reflects microvascular obstruction and is immediately life-threatening. Haematology coordinates hydration, tumour-lysis prophylaxis and rapid cytoreduction, with leukapheresis selected case by case. Unnecessary red-cell transfusion can increase viscosity, and treatment must not await additional end-organ signs.

Reference: British Society for Haematology acute-myeloid-leukaemia diagnostic good-practice paper: https://b-s-h.org.uk/guidelines/guidelines/recommendations-for-laboratory-testing-of-uk-patients-with-acute-myeloid-leukaemia-a-british-society-for-haematology-good-practice-paper