Tumour Lysis Syndrome

Question 1

What are the features of tumour lysis syndrome in the bloods?

Answer 1

1. HyperKalaemia >6
2. HyperPHOSphataemia >1.45
3. HyperURICaemia
4. HypoCALcaemia <1.75

or 25% increase from baseline

Question 1

What are the complications of tumour lysis syndrome? aka the cairo-bishop definition of clinical TLS

Answer 1

1. Renal failure with reduced urine ouput (Cr >1.5x ULN)
2. Cardaic arrhythmias
3. Seizure

Question 2

What are the common malignancies associated with TLS?

Answer 2

1. Burkitt’s
2. ALL
3. AML
4. NHL (bulky disease)
5. CML

Question 3

How is TLS prevented?

Answer 3

High risk: IVF and rasburicase
Medium risk: IVF and allopurinol
Low risk: allopurinol

Question 4

How is TLS treated?

Answer 4

1. Vigorous hydration aiming urine output >100ml/hour
2. Hyperkalaemia treatment
3. Rasburicase 2mg/kg/day every day until uric acid, renal function and electrolytes normalise (STOP allopurinol)
4. ICU/renal input for dialysis
5. Don’t give calcium unless symptoms as can precipitate out/chelate into calcium phosphate crystals if phosphate high