Tumor lysis syndrome
Definition: group of metabolic abnormalities occurring as a complication of treatment of cancer, caused by destruction of a large number of rapidly proliferating neoplastic cells.
Causes: Bulky, chemosensitive disease, including
- Lymphoma (NHL), Leukemia (AML, ALL, CML)
- Solid time (rarely)
***It can occur spontaneously.
Cellular destruction results in
- Hyperuricemia, Hyperkalaemia.
- Hyperphosphatemia, Hypocalcemia,
- Lactic acidosis
Clinical features:
Due to acute impairment of renal function and the precipitation of uric acid crystals in the renal tubular system and electrolyte imbalance –
- Fatigue, nausea, vomiting,
- Tetany,
- Cardiac arrhythmia, heart failure,
- Syncope, seizures and sudden death.
Investigations:
- S electrolytes, Serum phosphate, Serum calcium
- Serum creatinine, Serum uric acid, Urine analysis
- Serum lactate, LDH
*** Serum biochemistry should be monitored regularly for 48–72 hours after treatment in patients at risk. Elevated serum potassium may be the earliest biochemical marker
Risk patient for TLS :
- Pre-treatment serum lactate dehydrogenase (LDH) correlates with tumor bulk
- Lymphoma → CT scan – bulky disease (> 10 cm lymph node mass)
- Leukemia → high WBC count
Management:
- maintenance of Good hydration and urine output before and during treatment
- by oral and IV fluid
- Preventive drugs (prophylaxis):
- allopurinol and recombinant urate oxidase (rasburicase) to reduce uric acid level
-
- Haemodialysis: may be needed if renal injury occur
- Treatment of specific metabolic abnormality:
- Hypocalcemia, hyperkalemia
*** In high-risk patients, hydration and rasburicase should be commenced 24 hours before the start of treatment.