Quiz — Acute myeloid leukemia (AML)

A 15-year-old presents with fatigue, gingival bleeding, and diffuse ecchymoses. WBC 2,800/µL with 40% promyelocytes containing bundled Auer rods, platelets 18,000/µL, fibrinogen 90 mg/dL, INR 1.8. Cytogenetics are pending. What is the most appropriate immediate action?

• AStart all-trans retinoic acid now and transfuse to support fibrinogen and platelets
• BAwait FISH for t(15;17) before initiating any therapy
• CBegin standard cytarabine and daunorubicin induction
• DStart heparin infusion for disseminated intravascular coagulation