Key Points
- Confirm diagnosis early with highest-yield tests (e.g., MRV for CVST, CTA for mesenteric ischemia).
- Dose-and-route precision for high-risk medications; monitor for adverse effects.
- Explicit ICU criteria and consultation triggers.
Clinical Synopsis & Reasoning
TLS arises after cytotoxic therapy (or spontaneously) in high-burden hematologic malignancy. Prevent with aggressive isotonic fluids, strict monitoring of potassium, phosphate, calcium, uric acid, and renal function, and early uric acid–lowering therapy (rasburicase for high risk).
Treatment Strategy & Disposition
Stabilize airway/breathing/circulation; initiate guideline-concordant first-line therapy; tailor escalation or de-escalation to clinical response and objective metrics; define clear disposition criteria (e.g., ICU triggers, ward acceptability, outpatient safety).
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitating factors
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CBC | Anemia/leukocytosis | Context-specific | Trend with therapy |
| BMP | Electrolytes/renal | Derangements common | Renal dosing |
| Condition-specific imaging | See topic | Diagnostic hallmark | Do not delay when red flags present |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Rasburicase | Recombinant urate oxidase | Hours | Rapidly lowers uric acid in high-risk TLS (typical 0.2 mg/kg IV x1) | Contraindicated in G6PD deficiency |
| Allopurinol | Xanthine oxidase inhibitor | Days | Prophylaxis in intermediate risk (100–300 mg PO daily) | Prevents new uric acid formation; does not reduce existing |
| Normal saline | Crystalloid | Immediate | High-rate hydration to maintain urine output | Adjust for cardiac/renal status |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy
Patient Education / Counseling
- Explain red flags, adherence, and follow-up plan
References
- Authoritative guideline/review; see internal bibliography — Link