Haem/Onc

Question 1

How do you prevent haemorrhagic cystitis when on cyclophosphamide

Answer 1

Mesna.

Cyclophosphamide can convert to urotoxic metabolites such as acrolein. Mesna binds to these through sulfhydryl-moieties.

Question 2

Features of CLL

Answer 2

Often none
Constitutional - anorexia, weight loss
Bleeding, infections
Lymphadenopathy

Question 3

Investigations for CLL

Answer 3

FBC - lymphocytosis, anaemia, thrombocytopenia

Blood film - smudge cells

Immunophenotyping is key investigation

Question 4

What causes CLL

Answer 4

Monoclonal proliferation of well-differentiated lymphocytes which are almost always B cells

Question 5

Features of AML

Answer 5

Anaemia - pallor, lethargy, weakness
Neutropenia
Thrombocytopenia - bleeding
Splenomegaly
Bone pain

Question 6

Poor prognostic features of AML

Answer 6

> 60 years
20% blasts after first course of chemo
Cytogenetic - deletion of cr 5 or 7

Question 7

Features of acute promyelocytic leukaemia M3

Answer 7

Associated with translocation 15:17
Fusion of PML and RAR-alpha genes
Presents younger (average 25yr)
Auer rods
DIC or thrombocytopenia
Good prognosis

Question 8

Classification of AML (French American British)

Answer 8

M0 - undifferentiated
M1 - without maturation
M2 - with granulocytic maturation
M3 - acute promyelocytic
M4 - granulocytic and monocytic maturation
M5 - monocytic
M6 - erythroleukaemia
M7 - megakaryoblastic