A 73 year old male is brought to the ER via ambulance. He was found speaking incoherently in the local grocery store. He was taking Hydroxyurea for CML  but has not been to his doctor in a long time. His neurological examination is normal except for confusion. His relatives say that he was fine about 3 days ago.
Labs show the following results:

WBC 145,000/cu mm, Hb 10.2gm/dl, Platelet count, MCV 92, Hematocrit 31, RDW 15,

Sodium-140 , Potassium- 3.9, Chloride- 104, Bicarbonate 25, BUN 16, Creatinine 1.1, Glucose 98mg%.

Which of the following maneuvers are important to the survival of this patient?

1. Urgent chemotherapy
2. High dose corticosteroids given IV
3. Leukapheresis
4. Allopurinol therapy
5. Dialysis

This is hyperviscosity syndrome. The patient should be urgently moved to a center that can perform the leukapheresis but meanwhile, one can just conduct a phlebotomy and concurrent infusion of plasma or saline. This maneuver can effectively reduce the viscosity of fluid and prevent potential catastrophes such as strokes or priapism.