Synopsis
Recognise acute myeloid leukaemia, confirm lineage and defining genetics urgently, stabilise cytopenic and hyperleukocytic emergencies and select biology- and fitness-led treatment with measurable residual disease follow-up.
- Suspect AML with unexplained cytopenias, circulating blasts, recurrent infection, bleeding, bone pain or gingival and skin infiltration; a normal total white-cell count does not exclude it.
- First-line tests are urgent FBC and expert blood film, coagulation and fibrinogen, renal, liver, urate, LDH, calcium, phosphate, cultures and group samples.
- Confirm with bone-marrow aspirate and trephine, flow cytometry, karyotype or FISH and a rapid molecular panel; some defining genetic AML diagnoses do not require 20% blasts.
Key red flags
Fever, rigors, hypotension, hypoxia or confusion with neutropenia is a haematological emergency requiring empiric broad-spectrum antibiotics within the local sepsis pathway.
Hypoxaemia, confusion, headache, focal deficit, priapism or retinal haemorrhage with high blasts suggests leucostasis rather than a harmless laboratory count.
Investigation priorities
Identify blasts, cytopenias and morphology that changes emergency care.
Management branches
Blasts, unexplained cytopenias or an AML emergency is identified.
- Send FBC, film, coagulation, fibrinogen, lysis, infection and group tests and obtain urgent blood or marrow diagnostic material.
- Treat sepsis, bleeding and lysis immediately; start tretinoin on APL suspicion and cytoreduce symptomatic hyperleukocytosis with haematology.
Key medicines
Azacitidine with venetoclaxGive azacitidine 75 mg/m² subcutaneously on days 1–7 of each 28-day cycle and venetoclax orally 100 mg day 1, 200 mg day 2 and 400 mg from day 3 when no interacting inhibitor requires reduction.
HydroxycarbamideFor urgent AML cytoreduction give a specialist protocol dose commonly 50–100 mg/kg/day orally in two or three divided doses, adjusted frequently to count, renal function and definitive-treatment timing.