Hematology Question 33 Instructor

A previously healthy 25 year old patient presents with the following bloodwork following diagnosis of Burkitt’s lymphoma:

Hgb 103 g/L
WBC 25.6 x 109/L
Platelets 45 x109/L
Na 138mmol/L
K 6.2mmol/L
Cl 94mmol/L
HCO3 17mmol/L
Cr 390umol/L
Ca 1.4mmol/L
PO4 1.93mmol/L
Uric acid 950umol/L
LDH 1500U/L

What is the major complication with his blood work and how should this be managed?

Tumor Lysis Syndrome: Caused by “dumping” of intracellular metabolites into the circulation.

Hallmarks:

  • Hyperkalemia
  • Hypocalcemia
  • Hyperphosphatemia
  • Hyperuricemia
  • Renal failure

Most frequent in tumors with:

  • High growth fractions
  • Exquisite chemosensitivity

Examples: Lymphomas (esp. high grade), Leukemia, rarely in solid tumors

General treatment of tumor lysis syndrome:

  • Aggressive IV fluid hydration, monitor u/o
  • Allopurinol (300-600 mg/day)
  • Rasburicase in case of contraindication for allopurinol
  • Aggressive management of hyperkalemia
  • Early dialysis and inotropic support as needed

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