AMCmiddle twist
A 35-year-old woman presents with bruising, gum bleeding and increasing lethargy. Her haemoglobin is 84 g/L (115–155), platelet count 18 × 10^9/L (150–400), white cell count 12 × 10^9/L (4–11), prothrombin time and activated partial thromboplastin time are prolonged, and fibrinogen is 0.8 g/L (2.0–4.0). The blood film shows abnormal promyelocytes containing multiple fine azurophilic inclusions. What is the most appropriate disease-directed treatment to commence before molecular confirmation?