Tumor lysis syndrome laboratory findings: Difference between revisions

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{{Tumor lysis syndrome}}
{{Tumor lysis syndrome}}
{{CMG}}
{{CMG}} {{shyam}} {{AE}} {{MJK}}
==Overview==
==Overview==
Laboratory findings consistent with the diagnosis of tumor lysis syndrome include high serum [[uric acid]], [[potassium]], [[phosphorus]], and [[lactate dehydrogenase]]. Another laboratory abnormality is low [[calcium]].<ref name="pmid15384972">{{cite journal| author=Cairo MS, Bishop M| title=Tumour lysis syndrome: new therapeutic strategies and classification. | journal=Br J Haematol | year= 2004 | volume= 127 | issue= 1 | pages= 3-11 | pmid=15384972 | doi=10.1111/j.1365-2141.2004.05094.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15384972  }} </ref>
==Laboratory Findings==
==Laboratory Findings==
TLS should be suspected in patients with large tumor burden who develop acute renal failure along with hyperuricemia (> 15 mg/dL) or hyperphosphatemia (> 8 mg/dL). (Most other acute renal failure occurs with uric acid < 12 mg/dL and phosphate < 6 mg/dL). Acute uric acid nephropathy is associated with little or no urine output. The urinalysis may show uric acid crystals or amorphous urates. The hypersecretion of uric acid can be detected with a high urine uric acid - creatinine ratio > 1.0, compared to a value of 0.6-0.7 for most other causes of acute renal failure.
Laboratory findings consistent with the diagnosis of tumor lysis syndrome include:<ref name="pmid15384972">{{cite journal| author=Cairo MS, Bishop M| title=Tumour lysis syndrome: new therapeutic strategies and classification. | journal=Br J Haematol | year= 2004 | volume= 127 | issue= 1 | pages= 3-11 | pmid=15384972 | doi=10.1111/j.1365-2141.2004.05094.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15384972  }} </ref><ref name="pmid18509186">{{cite journal| author=Coiffier B, Altman A, Pui CH, Younes A, Cairo MS| title=Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. | journal=J Clin Oncol | year= 2008 | volume= 26 | issue= 16 | pages= 2767-78 | pmid=18509186 | doi=10.1200/JCO.2007.15.0177 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18509186  }} </ref>
 
*Blood:
====Cairo-Bishop Definition====
:*[[Hyperuricemia]] ≥ 476 μmol/l
 
:*[[Hyperphosphatemia]] ≥ 2·1 mmol/l (children), x ≥1·45 mmol/l (adults)
* '''Laboratory tumor lysis syndrome''': abnormalitiy in two or more of the following and occurs within 3 days before or 7 days after chemotherapy.
:*[[Hyperkalemia]] ≥ 6·0 mmol/l
** uric acid > 8 mg/dL or 25% increase
:*[[Hypocalcemia]]  ≤ 1·75 mmol/l
** potassium > 6 meq/L or 25% increase
:*[[Creatinine]] ≥1.5 x ULN
** phosphate > 4.5 mg/dL or 25% increase
:*[[Lactate dehydrogenase]] > ULN
** calcium < 7 mg/dL or 25% decrease
:*Metabolic acidosis
* '''Clinical tumor lysis syndrome''': laboratory tumor lysis syndrome plus one or more of the following:
*[[Urinalysis]]:
** increase serum creatinine (1.5 times upper limit of normal)
:*Low urine output
** cardiac arrhythmia or sudden death
:*Uric acid crystals or amorphous urates
** seizure
:*High uric acid-creatinine ratio > 1.0
 
A grading scale (0-5) is used depending on the presence of lab TLS, serum creatinine, arrhythmias, or seizures.


==References==
==References==
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[[Category:Blood]]
[[Category:Blood]]
[[Category:Hematology]]
[[Category:Hematology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]

Latest revision as of 03:19, 21 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [3]

Overview

Laboratory findings consistent with the diagnosis of tumor lysis syndrome include high serum uric acid, potassium, phosphorus, and lactate dehydrogenase. Another laboratory abnormality is low calcium.[1]

Laboratory Findings

Laboratory findings consistent with the diagnosis of tumor lysis syndrome include:[1][2]

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

References

  1. 1.0 1.1 Cairo MS, Bishop M (2004). "Tumour lysis syndrome: new therapeutic strategies and classification". Br J Haematol. 127 (1): 3–11. doi:10.1111/j.1365-2141.2004.05094.x. PMID 15384972.
  2. Coiffier B, Altman A, Pui CH, Younes A, Cairo MS (2008). "Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review". J Clin Oncol. 26 (16): 2767–78. doi:10.1200/JCO.2007.15.0177. PMID 18509186.

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