Tumor lysis syndrome resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Twinkle Singh, M.B.B.S. [2]
Definition
Tumor lysis syndrome (TLS) is a group of metabolic abnormalities resulting from rapid lysis of malignant cells and massive release of cell breakdown products into blood. It is a life threatening condition and an oncologic emergency. Metabolic complications include hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia and hyperuricosuria.
Causes
Life Threatening Causes
Tumor lysis syndrome resulting from any cause is a life threatening condition and needs immediate management.
Common Causes
Commonly tumor lysis syndrome is precipitated by chemotherapy in patients with hematologic malignancies.
- Burkitt's lymphoma
- Acute myeloid leukemia
- Acute lymphoblastic leukemia
- Chronic lymphocytic leukemia
- Chronic myeloid leukemia
- Non-Hodgkin's lymphoma
- Multiple myeloma
Classification
Cairo and Bishop classified and graded TLS as laboratory tumor lysis syndrome (LTLS) and clinical tumor lysis syndrome (CTLS). Laboratory tumor lysis syndrome
| Element | Value | Change from baseline |
| Uric acid | ≥476 μmol/L or 8 mg/dL | 25 % increase |
| Potassium | ≥6 mmol/L or 6mg/L | 25 % increase |
| Phosphorus | ≥2.1 mmol/L for children ≥1.45 mmol/L for adults |
25 % increase |
| Calcium | ≤1.75 mmol/L | 25% decrease |
Management
Shown below is an algorithm summarizing the approach to [[disease name]].