Tumour lysis syndrome

The tumour lysis syndrome occurs after lysis of large numbers of circulating tumour cells, typically leukemic blasts. It an oncological emergencies. This massive breakdown is most often caused by cytostatics or antibody therapy of the malignancy. The cytoplasm of the cells leaks into the circulation. Most of the time, it is leukocytes that release biologically active substances - interleukins, which cause metabolic disruption. To remove these metabolites, the filtration capacity of the kidney is exceeded, creatinine and urea rise. The cells release potassium and hyperkalemia develops.

Etiology[edit | edit source]

often begins after the initiation of cytotoxic therapy in patients with hemato-oncological disease (ALL, AML or NHL)

Diagnosis[edit | edit source]

LAB: ↑ Creatinine (AKI), ↑ K⁺, ↓ Ca²⁺

BC: ↑ LEU (50-100x10^9/l), can be ↓Hb and ↓Tro
Urine: urate crystals
ECG: arrhythmia
Markers of cell lysis: ↑ LDH, ↑ uric acid, ↑ PO₄^3-

Clinical picture[edit | edit source]

renal failure - AKI: oedema, oliguria, lethargy
hyperkalemia: cardiac arrhythmias, nausea, diarrhea
hypocalcemia: spasms

Therapy[edit | edit source]

fluid management
- Low risk: p.o. / i.v. hydration, fluid balance monitoring
- High risk: aggressive IV therapy, hyperhydration F1/1,
- monitor urine output → possibly initiate forced diuresis (furosemide);

prevention and treatment of urate nephropathy
- Alopurinol/Milurite, Rasburicase
correction of electrolyte balance
- hyperkalemia: ECG motorization, glucose with insulin
- hyperphosphatemia: Sevelamer (phosphate binders)
- hypocalcemia: 10% Calcium gluconicum

Links[edit | edit source]

Literature used[edit | edit source]

KLENER, Pavel. Vnitřní lékařství. 3. vydání. Praha : Galén, 2006. ISBN 80-7262-430-X.

Kategorie:Vnitřní lékařství Kategorie:Hematologie Kategorie:Onkologie