<prompt> A child with acute myeloid leukemia presents with hyperleukocytosis. Treatment includes all of the following exceptIV fluidAllopurinolAilcalinizationImmediately start induction chemotherapy  <response>: Hyperleukocytosis and Leukostasis Hyperleukocytosis refers to condition in which patients with acute leukemia present with an extraordinary high leukocyte count usually greater than 100,000 1.Leukostasis Also known as symptomatic hyperleukocytosis is a medical emergency most commonly seen in patients with AML or CML in blast crisis. There is sludging of leukemia blasts in the microcirculation due to extremely elevated blast cells leading to obstruction of small vessels especially in the cerebral and pulmonary circulation.Treatment of hyperleukocytosis includes : -1. Immediate leukoreduction cytoreductionImmediate leukoreduction is required to lower the blast cells.This can be achieved by leukopharesis or by administration of hydroxyurea.2. Induction chemotherapyInduction chemotherapy is initiated early, but only after attempts at leukoreduction not immediately as immediate administration of induction chemotherapy carries a high risk of acute tumor lysis syndrome.So, early induction chemotherapy is advised but not immediately.3. SupportivePrevention of complicationsSupportive therapy is given to preventreduce the metabolic complications of tumor lysis syndrome.It includes IV hydration, allopurinol and alkalinization of urine. 