This section describes diagnosis and initial management. For advice on prevention refer to local haematology department policy.
Tumour lysis syndrome (TLS) is a potentially fatal syndrome characterised by a group of metabolic derangements caused by the release of cellular components into the blood after rapid lysis of malignant cells. This is seen most often at the initial treatment of a number of high grade malignant haematological disorders and results from the instigation of treatment. However, in a small number of cases, patients can present with TLS prior to initiation of any chemotherapy. Patients at highest risk of TLS include those with high cell-count leukaemias, lymphoblastic lymphoma, bulky diffuse large B cell and Burkitt lymphoma, but less commonly, some non-haematological malignancies may present with TLS e.g. germ cell tumours or small cell lung cancer. Patients with TLS often have a high lactate dehydrogenase (LDH) level.
Seek an urgent haemato-oncology review for patients presenting with clinical and/or laboratory features of TLS.
Clinical features of TLS reflect associated metabolic abnormalities
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Laboratory features of TLS
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N.B. Spontaneous TLS prior to the initiation of any chemotherapy is associated with hyperuricaemia but frequently not with hyperphosphataemia. |
First page the on-call haematology registrar urgently. Effective management involves the combination of treating specific electrolyte abnormalities and/or acute renal failure. The haematology registrar will advise on use of a loop diuretic e.g. furosemide, and intravenous fluids (up to 4–6 L/24hours) to attempt to wash out the obstructing uric acid crystals. Rasburicase should also be prescribed. This may only be prescribed by the haematology specialist and is highly effective in causing a rapid reduction in serum urate levels.
Renal support with dialysis or continuous veno-venous haemofiltration can be life saving in these patients. Seek an early renal opinion in all established cases particularly in those with oliguria, persistent hyperphosphataemia and hyperkalaemia.
For treatment of hyperkalaemia and hypocalcaemia (seek specialist advice), refer to Management of hyperkalaemia and Management of hypocalcaemia guidelines.
Uraemia: early renal opinion in all patients