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
