A 60-year-old woman is diagnosed with breast cancer following a routine mammogram. She also has a positive lymph node metastasis for which a treatment with systemic chemotherapy is started. After, Two weeks she comes with 4 days of frequent urination, suprapubic pain, dysuria, and progressive hematuria. She has had no fevers or chills. Temperature is 37.1 C (98.8 F). Suprapubic tenderness is present on abdominal examination. Hemoglobin is 9.8 g/dL. Urinalysis shows numerous red blood cells but no leukocyte esterase or bacteria. Which of the following could have prevented this patient's current condition?

Question

A 60-year-old woman is diagnosed with breast cancer following a routine mammogram. She also has a positive lymph node metastasis for which a treatment with systemic chemotherapy is started. After, Two weeks she comes with 4 days of frequent urination, suprapubic pain, dysuria, and progressive hematuria.  She has had no fevers or chills. Temperature is 37.1 C (98.8 F).  Suprapubic tenderness is present on abdominal examination.  Hemoglobin is 9.8 g/dL.  Urinalysis shows numerous red blood cells but no leukocyte esterase or bacteria.  Which of the following could have prevented this patient's current condition?

Quizplus · Accepted Answer

Eductional Objective: Hemorrhagic cystitis during therapy with cyclophosphamide or ifosfamide is caused by the urinary excretion of the toxic metabolite acrolein.  It can be prevented by aggressive hydration, bladder irrigation, and administration of mesna, a sulfhydryl compound that binds acrolein in the urine.

A 60-Year-Old Woman Is Diagnosed with Breast Cancer Following a Routine