Tumour lysis syndrome - kithemsireleri.com · Tumor lysis syndrome (TLS) Done by: Salah Saleh . TLS...
Transcript of Tumour lysis syndrome - kithemsireleri.com · Tumor lysis syndrome (TLS) Done by: Salah Saleh . TLS...
Tumor lysis
syndrome
(TLS)
Done by:
Salah Saleh
TLS is an oncology emergency occures when cancer
cells start to break down and die.
While blood cells die they release intracellular
components into the bloodstream, leading to extra
amount of unuseful elements in the body which the
kidneys can not remove the wastes from the body.
Definition
The signs and symptoms of TLS may occur as early
as a few hours after the start of chemotherapy, but
are more common 24 to 48 hours after treatment
begins.
The mortality rate for patients who develop TLS is
about 18%
TLS is a group of abnormal changes in the blood
which are:
1. Potassium (Hyperkalemia)
2. Uric acid (Hyperuricemia)
3. Phosphate (Hyperphosphatemia)
4. Calcium (Hypocalcemia)
HYPERKALEMIA:
* Hyperkalemia is defined as serum K level > 6.0 mEq/L or 25%
increase from baseline
* Causes cardiac arrhythmia
* It is usually seen 6 -72 hours post-chemotherapy
* Neuromuscular and cardiac tissues are most susceptible to
changes in K level
* Neuromuscular symptoms may include: Fatigue, muscle
cramps, anorexia, paresthesias, and irritability
* In the cardiac tissue a variety of electrocardiographic changes
can occur, including peaked T wave (>5 mm)
Hyperuricemia:
* Hyperuricemia is defined as serum uric acid >8.0
mg/d or 25% increase from baseline 3 days before or
7 days after the initiation of chemotherapy
* Usually develops 48 to 72 hours after therapy
* Excretion is through the proximal renal tubule
Allopurinol:
* Inhibits the conversion of hypoxanthine to xanthine and of xanthine to uric acid by inhibiting xanthine oxidase
* Optimally, it’s initiated one to two days before starting chemotherapy
Rasburicase: * Administered intravenously, rasburicase converts uric
acid to Allantoin, which is much more soluble in urine than uric acid
* The drug works quickly (in four hours) to
reduce uric acid levels
Hyperphosphatemia:
Is defined as serum phosphate > 4.5 mg/dL
Hypocalcemia:
is defined as serum calcium level < 7.0 mg/dL How it is happened?
The kidneys try to eliminate the excess phosphorus
As serum phosphate levels increase, phosphate ions (which are
negatively charged) combine with calcium ions (positively
charged), resulting in decreased serum calcium levels
(hypocalcemia).
These calciumphosphate complexes precipitate in soft tissues and
the renal tubules, causing tubular obstruction and acute renal
failure
PREVENTION:
HYDRATION:
* Patients receiving nephrotoxic chemotherapy such as cisplatin should be well hydrated
* IV fluid generally is administered 48 hours prior to chemotherapy
* Hydration also improves the rate of renal blood flow
MEDICATIONS:
The intake of nephrotoxic agents and other medications that may
exacerbate the kidney failure should be discontinued
Examples of nephrotoxic drugs:
1. antimicrobials such as aminoglycosides, amphotericin B
2. nonsteroidal anti-inflammatory drugs
3. Other medications such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers… etc
Patients at high risk for tumor lysis syndrome should have the following levels monitored at least three times daily:
* Blood urea nitrogen (BUN)
* Creatinine
* Uric acid
* Potassium
* Calcium
* Phosphate
* Lactate dehydrogenase (LDH)
Management:
* Identify patients at High-risk:
Burkitt lymphoma, lymphoblastic lymphoma, or B-
cell acute lymphoblastic leukemia
Several chemotherapy agents are associated with TLS
as well including:
cytarabine, cisplatin, etoposide and paclitaxel
Cont
* Hydration and effective urine flow rates remain a
cornerstone of TLS prevention and treatment
* Administration of hypouricemic drugs
* Restriction of dietary phosphorus
* The aim in the management of TLS is to correct
abnormalities in the blood components and to
manage renal failure
Case study
A 45-years-old patient presented with Burkitt
lymphoma with a history of hypertension and
mild renal insufficiency, he is starting treatment
with Hyper-CVAD Regimen.
Based on this clinical situation, what is the patient’s
risk for developing tumor lysis syndrome?
1. High risk
2. Intermediate risk
3. Low risk
4. No risk
1. High risk
2. Intermediate risk
3. Low risk
4. No risk
Which of the following laboratory values are
important in developing a plan for monitoring and
treating TLS?
1. WBC, Lactate dehydrogenase (LDH), serum
potassium, Calcium, Creatinine, Phosphorus, Uric
acid
2. RBCs, albumin, alkaline, total bilirubin
3. CBC, CO2, bicarbonate, serum magnesium
1. WBC, Lactate dehydrogenase (LDH),
serum potassium, Calcium, Phosphorus,
Creatinine, Uric acid
2. RBCs, albumin, alkaline, total bilirubin
3. CBC, CO2, bicarbonate, serum magnesium
Thank you for your attention
References:
• http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/managing-side-effects/tumour-lysis-syndrome/?region=on
• http://emedicine.medscape.com/article/282171-treatment#d10
• http://journals.lww.com/oncology-times/pages/articleviewer.aspx?year=2010&issue=04251&article=00002&type=Fulltext
• https://www.researchgate.net/publication/6306831_Tumor_Lysis_Syndrome