1.TY is a 38-year-old obese woman who presents with right subconjunctival hemorrhage, multiple ecchymoses on the abdominal wall diplopia within 1 week of onset. Examination otherwise is unremarkable. CBC showed hemoglobin 9.3 g/dL, leukocyte 1,250/μL, and platelet 35,000/μL; INR 1.6, PTT normal, fibrinogen 95 mg/dL. Peripheral blood smear shows hypergranular cells with multiple Auer rods. CT scan of head suggests small intracranial hemorrhage in the thalamic area. Diagnosis of acute promyelocytic leukemia (APL) is highly suggested but it is not confirmed by bone marrow examination and cytogenetics. What is the best next step?

A. Continue supporting care until the diagnosis is confirmed by bone marrow biopsy

B. Start all-trans retinoic acid (ATRA) without confirmed diagnosis

C. Hold transfusion of all blood products

D. Discuss end-of-life/hospice care with the patient and family