Presentation: Blast + Pancytopenia ↓

• ALL - peds more likely

AML (vs. ALL based on BM biopsy, flow cytometry, etc.)

• BLAST*
• CBC: Blast (20%+ - Bone marrow / blood)
• Blood film: blast with auger rods (only seen in myeloid) = APML = ATRA

DDX

• MDS (20%- blast) - Dx of exclusion

Tm

• APML -> ATRA
• Others: Chemo

Emergency

• leukostasis (50-100+ WBC) (150-200+ in CML/CLL)
  • Any organ, CNS/Lung ++
  • Tm: IVF, hydroxyurea, TLS prophylaxis
  • Leukapheresis, induction chemo
  • Avoid transfusion
• !DIC
  • Schistocytes,
  • High INR (sensitive)
  • Low Fibrinogen (specific)
  • Treat differently if APML
• !TLS - Tumor lysis syndrome (high K, ,low Ca)
  • Manage electrolyte abnormalities
  • Allopurinol OR Rasburicase (AKI, UA elevated, failed Allo, can induce hemolysis in G6PDD)
  • G6PDD X-resessive, Asia, AF, Middle East, Mediterranean
• APML
  • AML + DIC = APML unless proven otherwise (other genetic subtypes)
• Febrile Neurtropenia