Other investigations that may be required in the emergency department

Other investigations may be required in the ED around the time of initial diagnosis, either to exclude other diagnose(s) or to aid initial stabilisation.

Coagulation screen

DIC is frequently encountered at diagnosis so all patients should have a coagulation screen. DIC is suggested by a low fibrinogen, high D-dimer, deranged APTT/PT and low platelet count.

Blood cultures and markers of infection (CRP)

The white cell count may be high in leukaemia, but cells are not functional against infection. All patients with acute leukaemia must be assumed to be immunosuppressed. Fever and other signs of infection should be treated seriously. Blood cultures and a CRP should be sent and there should be a low threshold for starting broad-spectrum intravenous antibiotics.

U&Es, Bone profile, Uric acid

Tumour lysis syndrome may be suspected if there is a very high white cell count.  The hallmark features of tumour lysis syndrome are renal failure, hyperkalaemia, hyperphosphataemia, hypocalcaemia and hyperuricaemia.

Learning bite: All patients with suspected acute leukaemia should have a full blood count, blood film and coagulation screen including fibrinogen in the emergency department. Consider initial tests for infection and tumour lysis syndrome depending on the presentation.