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Clinical Case 23
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A 37-year-old man presents to the emergency department with fever, fatigue, and right upper quadrant pain. He was recently treated for an upper respiratory infection with azithromycin (must be that same darned doctor that gave the TMP/SMX to the patient with G6PD deficiency above...). He has no significant past medical history, is in a monogamous relationship, and rarely drinks alcohol. He is not taking any medications except for acetaminophen. His physical examination reveals an ill-appearing, uncomfortable male with a temperature of 39.3°C, pulse 110, blood pressure 153/78, respirations 18. His sclerae are anicteric, his oropharynx reveals a few petechiae, and his gingivae appear hypertrophied. There is no palpable lymphadenopathy. Abdomen is soft, with a liver edge palpable 3 cm below the costal margin. His spleen is not palpable, and the remainder of the exam is unremarkable.

His laboratories reveal a WBC of 80,000/mm3, hemoglobin 8g/dl, and platelet count 40,000/mm3. Creatinine is 1.4 g/dl, and uric acid is 8 mg/dl. The peripheral blood smear reveals 80% blasts. A bone marrow aspirate and biopsy confirm the diagnosis of acute myelogenous leukemia (AML).



1

Which of the following statements is INCORRECT?
A)The patient is at risk for leukostasis and should be considered for leukophoresis.
B)The patient's fever is likely due to the leukemic cells, and antibiotics should be started only if you identify a specific infection.
C)The patient is at risk for consumptive coagulopathy, and coagulation studies should be obtained.
D)The patient is at risk for tumor lysis syndrome and should be started on allopurinol.
E)You should consult a hematologist/oncologist as soon as possible.







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