Tumor lysis syndrome laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]

Overview

Laboratory findings consistent with the diagnosis of tumor lysis syndrome include high serum uric acid, potassium, phosphorus, and low calcium.

Laboratory Findings

Laboratory findings consistent with the diagnosis of tumor lysis syndrome include:

• Blood:

• Hyperuricemia ≥ 476 μmol/l
• Hyperphosphatemia ≥ 2·1 mmol/l (children), x ≥1·45 mmol/l (adults)
• Hyperkalemia ≥ 6·0 mmol/l
• Hypocalcemia ≤ 1·75 mmol/l

• Urinalysis:

• Low urine output
• Uric acid crystals or amorphous urates
• High uric acid-creatinine ratio > 1.0

Cairo-Bishop Definition

• Laboratory tumor lysis syndrome: abnormalitiy in two or more of the following and occurs within 3 days before or 7 days after chemotherapy.
  • uric acid > 8 mg/dL or 25% increase
  • potassium > 6 meq/L or 25% increase
  • phosphate > 4.5 mg/dL or 25% increase
  • calcium < 7 mg/dL or 25% decrease
• Clinical tumor lysis syndrome: laboratory tumor lysis syndrome plus one or more of the following:
  • increase serum creatinine (1.5 times upper limit of normal)
  • cardiac arrhythmia or sudden death
  • seizure

A grading scale (0-5) is used depending on the presence of lab TLS, serum creatinine, arrhythmias, or seizures.