2: Haematology - Overview Management of malignancy Flashcards
What is tumour lysis syndrome
Potentially deadly condition related to management of leukaemia and lymphoma with induction of chemotherapy. Rapid lysis of cells releases electrolytes that can damage the kidneys
What scoring system is used for tumour lysis syndrome
Cario-Bishop
Define tumour lysis syndrome
Two or more of the following within 3-days or after 7-days of chemotherapy:
- High Phosphate
- High Uric Acid
- High Potassium
- Low Calcium
What is a mnemonic to remember electrolytes that are raised in TLS
PUP
What is clinical TLS described as
Laboratory TLS with one of the following:
- Creatinine raised 1.5 times baseline (renal failure)
- Arrhythmias or sudden-death
- Seizure
What usually causes TLS
Induction phase of chemotherapy for leukaemia of lymphoma
What are 4-symptoms of hyperkalaemia
- Muscle weakness
- Arrhythmias
- Diarrhoea
- N+V
What is a symptom of hyperphosphataemia
AKI
What does high uric acid cause
AKI
What does low calcium cause
- Peri-oral tingling
- Chovstek
- Trosseaus
- Seizures
- Muscle spasms
- Arrhythmias
- Abdo cramps
In which patients should TLS be suspected
Any patient on chemo with AKI
Explain consequences of high phosphate in TLS
Phosphate is released from cells and binds to calcium forming calcium pyrophosphate crystals that obstruct renal tubules resulting in AKI. By phosphate binding calcium, it also causes hypocalcaemia
Explain prevention of TLS
Hydration
Allopurinol
What is second-line for prevention of TLS
Rasburicase
What is rasburicase
Xanthine oxidase Recombinante -converts uric acid to allantoin which is more easily processed by kidneys
