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