Tumour Lysis Syndrome

Tumour Lysis Syndrome is the rapid death of tumour cells by chemotherapy, leading to a massive release of intracellular contents.

This typically presents in an acute leukaemia/lymphoma patient presenting 2 days after receiving high-dose chemotherapy with dysuria/oliguria, abdominal pain, or weakness.

Investigations

• ECG

• U&Es - raised potassium and phosphate

• Uric acid - raised

• Calcium - low (this is due to the high phosphate)

N.B. Raised UPP (uric, potassium, phosphate) + Low calcium

The hallmark of this condition is the Raised Uric acid!

Management

• Correction of electrolyte abnormalities + IVF

• Rasburicase (recombinant form of urate oxidase) for high risk patients to transform uric acid into allantoin, which is more easily excreted by the kidneys - It can be given prophylactically or therapeutically

• Allopurinol has limited therapeutic benefit in established TLS, but can be used prophylactically in the lower risk patients