Tumour Lysis Syndrome

Created on Mon, 06/29/2015 - 02:40
Last updated on Wed, 11/08/2017 - 02:23

Tumour lysis syndrome is a metabolic disorder characterized by the following tetrad of anormalities:

  • Hyperuricemia
  • Hyperphosphatemia
  • Hyperkalemia
  • Hypocalcemia

These abnormalities are brought about by rapid tumor cell turnover. A good NEJM review article is available for the time-rich exam candidate. The current classification system demands at least two of the abovementioned electolyte abnormalities 2-7 days after the commencement of cancer therapy.

The college seems to love tumour lysis, and this topic has come up several times in the SAQs:

The same NEJM article contains within it Table 2, which lists the following risk factors:

  • Large amount of tumour mass
  • Organ infiltration by tumour
  • Bone marrow involvement
  • Pre-existing renal disease
  • High mittic tumour activity
  • The tumour's high sensivity to the cancer therapy
  • High intensity of cancer therapy
  • Dehydration
  • Acidic urine
  • Nephrotoxin exposure
  • Wanton and unchecked potassium and phosphate replacement
  • Barriers to the clearance of uric acid
  • Pre-existing gout

Preventative measures to protect patients against tumour lysis syndrome

  • Adequate hydration
  • Electrolyte monitoring
  • Intelligent electrolyte replacement
  • Allopurinol
  • Rasburicase
  • Alkalinisation of urine

Management strategies for established tumour lysis syndrome:

  • Rasburicase
  • Forced diuresis
  • Electrolyte correction
  • Hemodialysis

 

References

George, James N. "Thrombotic thrombocytopenic purpura." New England Journal of Medicine 354.18 (2006): 1927-1935.

Peyvandi, Flora, et al. "von Willebrand factor cleaving protease (ADAMTS‐13) and ADAMTS‐13 neutralizing autoantibodies in 100 patients with thrombotic thrombocytopenic purpura." British journal of haematology 127.4 (2004): 433-439.

Tsai, Han-Mou. "Advances in the pathogenesis, diagnosis, and treatment of thrombotic thrombocytopenic purpura." Journal of the American Society of Nephrology 14.4 (2003): 1072-1081.

 

Oh's Intensive Care manual:

Chapter 97 (pp. 993)  Therapeutic  plasma  exchange  and  intravenous  immunoglobulin  therapy  by Ian  Kerridge,  David  Collins  and  James  P  Isbister

Kakishita, Eizo. "Pathophysiology and treatment of thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS)."International journal of hematology 71.4 (2000): 320-327.

Tiu, Ramon V., et al. "Tumor lysis syndrome." Seminars in thrombosis and hemostasis. Vol. 33. No. 4. New York: Stratton Intercontinental Medical Book Corporation, c1974-, 2007.

Howard, Scott C., Deborah P. Jones, and Ching-Hon Pui. "The tumor lysis syndrome." New England Journal of Medicine 364.19 (2011): 1844-1854.

Cairo, Mitchell S., and Michael Bishop. "Tumour lysis syndrome: new therapeutic strategies and classification." British journal of haematology 127.1 (2004): 3-11.