This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Neoplastic disorders of WBCs, Subject name: Pediatrics
A child with acute myeloid leukemia presents with hyperleukocytosis. Treatment includes all of the following EXCEPT: 
Select and explain. 
A. IV fluid, B. Allopurinol, C. Alkalinization, D. Immediately sta induction chemotherapy
D: Immediately sta induction chemotherapy
Answer: D: Immediately sta induction chemotherapy 
Explanation: Hyperleukocytosis: - Leukocyte count > 100,000/uL - It is medical emergency most commonly seen with AML or CML in blast crisis - There is sludging of blasts in microcirculation - obstruction of small vessels especially in brain & lungs - Treatment: IV fluids (hydration) Alkalinization Allopurinol (to prevent tumor lysis syndrome) Hydroxyurea (for leukoreduction) - Induction chemotherapy- initiated only after leukoreduction, as it carries a high-risk of acute tumor lysis syndrome