Key Points
- Stabilize ABCs; begin targeted evaluation without delaying life-saving therapy.
- Use system-specific risk tools to guide testing and disposition.
- Order high-yield tests first; escalate imaging when indicated.
- Start evidence-based initial therapy and reassess frequently.
Algorithm
- Primary survey and vitals; IV access and monitors.
- Focused history/physical; identify red flags and likely etiologies.
- Order system-appropriate labs and imaging (see Investigations).
- Initiate guideline-based empiric therapy (see Pharmacology).
- Reassess response; arrange consultation and definitive management.
Clinical Synopsis & Reasoning
For Tumor Lysis Syndrome Prevention Management, frame the differential by acuity and pathophysiology, then align diagnostics to the leading hypotheses. Prioritize stabilization while obtaining high‑yield studies such as CBC with diff (Cytopenias/leukocytosis), Coags (Bleeding/clotting), Smear (Morphology). Incorporate bedside imaging and targeted labs to define severity and identify complications; synthesize results with clinical trajectory to refine the working diagnosis and disposition needs.
Treatment Strategy & Disposition
Initiate disease‑directed therapy alongside supportive care, titrating to objective response. Pharmacologic options commonly include Anti-pseudomonal β-lactam. Use validated frameworks (e.g., TLS Risk & Prevention) to guide escalation and site of care. Address precipitating factors, de‑escalate empiric therapies with data, and arrange follow‑up for monitoring and risk‑factor modification; admit patients with instability, high risk of deterioration, or needs for close monitoring.
Management Notes
Avoid xanthine nephropathy with allopurinol by ensuring hydration. Rasburicase contraindicated in G6PD deficiency.
Epidemiology / Risk Factors
- Cytotoxic chemotherapy, neutropenia; lines
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CBC with diff | Cytopenias/leukocytosis | Abnormal counts | |
| Coags | Bleeding/clotting | Abnormalities | |
| Smear | Morphology | Abnormal cells |
TLS Risk & Prevention
| Risk | Approach |
|---|---|
| Low | Hydration ± allopurinol |
| Intermediate | Hydration + allopurinol; consider rasburicase if rising uric acid |
| High/established | Hydration + rasburicase; ICU‑level monitoring |
| Monitoring | Labs q6–12 h; strict I/O |
| Dialysis | For refractory electrolyte/renal failure |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Aggressive IV fluids | Volume expansion | Hours | Prevent AKI | Fluid overload |
| Rasburicase (selected) | Uric acid oxidation | Hours | High-risk or established TLS | G6PD contraindication |
| Allopurinol (prophylaxis) | Xanthine oxidase inhibition | Days | Prevention before chemo | Rash |
Prognosis / Complications
- Tied to depth/duration of neutropenia and comorbidities
Patient Education / Counseling
- Explain red flags and when to seek emergent care.
- Reinforce medication adherence and follow-up plan.
References
- ASCO/ASH TLS Guidance — Link