Home

Search

Pathway AI

Account ⋅ Sign Out

Table of contents

Tumor lysis syndrome

Key sources
The following summarized guidelines for the evaluation and management of tumor lysis syndrome are prepared by our editorial team based on guidelines from the British Society for Haematology (BSH 2015) and the Clinical Pharmacogenetics Implementation Consortium (CPIC 2014).
1
3

Guidelines

1.Classification and risk stratification

Risk stratification: evaluate the risk of risk of TLS in all patients who are due to receive chemotherapy for a hematological malignancy.
B
Create free account

2.Medical management

Intravenous fluids
Administer balanced or isotonic crystalloid solutions to maintain urine output > 100 mL/m²/hour (target > 4 mL/kg/hour for infants).
B
Avoid adding potassium to the hydration fluid.
D

More topics in this section

  • Urine alkalinization

  • Rasburicase

  • Allopurinol

  • Management of hypocalcemia

3.Inpatient care

Cardiac monitoring: provide cardiac monitoring for patients with potassium levels ≥ 6 mmol/L or a ≥ 25% increase from baseline.
B

4.Therapeutic procedures

Dialysis: initiate RRT in patients with intractable fluid overload, hyperkalemia, hyperuricemia, hyperphosphatemia, or hypocalcemia.
A
Show 2 more

5.Specific circumstances

Patients with G6PD deficiency: avoid withholding rasburicase based on G6PD status in patients with a normal G6PD phenotype with low or reduced risk of hemolytic anemia.
D
Show 4 more

6.Preventative measures

Urinary alkalinization: avoid performing urinary alkalinization as a prophylactic measure for TLS.
D

More topics in this section

  • Primary prophylaxis (low-risk patients)

  • Primary prophylaxis (intermediate-risk patients)

  • Primary prevention (high-risk patients)

7.Follow-up and surveillance

Multidisciplinary management
Manage patients with established TLS in a multidisciplinary setting including a team of hematologists, nephrologists and intensive care physicians.
B
Transfer patients to an intensive care/high-dependency unit, if local facilities are not available for intensive management and monitoring.
B