It is unlikely that specific management of a leukaemia will be required in the emergency department. Most patients undergoing initial treatment for acute leukaemia will be managed as inpatients, so acute complications of induction chemotherapy are unlikely to present to the emergency department.

However, emergency physicians are best placed to recognise and initiate treatment for the complications of newly presenting or known acute leukaemia, including sepsis, venous thromboembolism, DIC, leukostasis, tumour lysis syndrome and superior vena cava obstruction, whilst liaising with the haematology team.

Learning bite: Patients with acute leukaemia are immunocompromised. Have a low threshold for starting broad-spectrum intravenous antibiotics while awaiting results.

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