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
Laboratory features of TLS
|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.
Uraemia: early renal opinion in all patients