64 years old lady presented to emergency department with history of coffee ground vomiting and being unwell. She had emergency resuscitation and appeared to be unwell . her vital signs were all stable apart from
Pyrexia of 38.4 C. Blood pressure : normal
Examinations were all unremarkable apart from bibasal crackles on both lower bases
Her urgent blood test results were
HB 64
WCC 360
PLT 172
CRP 389 high
Uresa : 10, Creatinine : 98 (upper limit of normal)
Full clotting screen : all Normal
She was transferred to a ward and a haematologist on call were contacted
she had emergency blood film as per Laboratory criteria which were looked at by biomedical scientist: suggested Acute myeloid leukaemia with over 90% myeloid blast
initial management:
1,DO NOT TRANSFUSE
2,Patient is at risk of Leuckostasis
3,Exclude APML (Auer rods on film)
4,Full clotting screen (This patient has risk of DIC)
Emergency transfer to the tertiary facility where emergency leukopheresis can be done
Phone haematology consultant is the most important point of this patient care and should take emergency steps