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Q1: Presentation (2 min)
"How does childhood leukaemia present?"
- Bone marrow failure: anaemia (pallor), infection (fever, neutropenia), bleeding (bruising, petechiae)
- Organ infiltration: hepatosplenomegaly, lymphadenopathy, bone pain, CNS signs
- Red flags: pallor + bruising + bone pain + fever in a child = urgent FBC
Q2: Diagnosis (3 min)
"How do you diagnose childhood leukaemia?"
- FBC + blood film: blasts, pancytopenia
- Bone marrow aspirate: morphology, flow cytometry (immunophenotyping), cytogenetics, molecular
- LP: CNS involvement
- Coagulation: DIC screen (especially APL)
Q3: Risk Stratification (3 min)
"What factors affect prognosis in ALL?"
- Good: age 1-10, WCC under 50, ETV6-RUNX1, hyperdiploidy, MRD-negative at day 29
- Poor: under 1 or over 10, WCC over 50, Ph+ t(9;22), hypodiploidy, MLL rearrangement, CNS involvement
- ALL 5-year survival: 90%; AML: 65-70%
Q4: Complications (2 min)
"What is tumour lysis syndrome?"
- Rapid tumour cell breakdown → hyperK, hyperUrate, hyperPhos, hypoCa → AKI
- Highest risk: high WCC, Burkitt, high LDH
- Prevent: rasburicase + aggressive hydration + allopurinol
- Treat hyperK: calcium gluconate, insulin/dextrose, salbutamol
- May need renal replacement therapy