Tumour Lysis Syndrome

Diagnostic Use

Tumour Lysis Syndrome (TLS) is a potentially life-threatening oncological emergency caused by rapid breakdown of tumour cells (spontaneous or following initiation of therapy), releasing intracellular potassium, phosphate, and nucleic acids that overwhelm homeostatic mechanisms. This results in hyperuricaemia, hyperkalaemia, hyperphosphataemia and secondary hypocalcaemia, which can culminate in acute kidney injury, arrhythmias, seizures or death.

Tumour lysis syndrome is observed most commonly in patients with bulky, chemosensitive haematologic cancers (e.g., highly proliferative lymphomas and acute leukaemias) who are undergoing intensive induction therapy, when the ability of the body to maintain electrolyte-uric acid homeostasis is overwhelmed.

In patients with a high risk of Tumour Lysis Syndrome may be treated with Rasburicase - a uric acid lowering drug as prophylaxis to reduce the risk of complications

Department

Core Biochemistry

Delphic Registration Code

TLS

Laboratory Handling

Phlebotomy

NB: If rasburicase has been administered use Li-heparinised tubes on ice for uric acid monitoring. Spurious hyperkalaemia can result from sending tubes through Lamson systems (can check on blood gas analyser or walk tubes to lab)

Constituent Tests

• Potassium, Plasma
• Urate, Plasma
• Calcium (corrected), Plasma
• Calcium, Plasma
• Albumin, Plasma
• Phosphate, Plasma
• Creatinine, Plasma
• est GFR using Plasma Crn and CKD-EPI equation, Plasma

Turnaround Time

2 hours

Test Code

1040

Specimen Type

• Serum
• Plasma

Specimen Requirements

Tube/Container Type:

Preferred

• Lithium Heparin - Non-gel (Green Cap)

Acceptable

• Serum (Red Cap)
• SST II (Gold Cap)
• Lithium Heparin - Gel (Light Green Cap)

Preferred Sample Volume (ml)

4.5

No of Samples Required

1

Interferences

Spurious hyperkalaemia can result from sending tubes through Lamson systems (can check on blood gas analyser or walk tubes to lab)

Aliquot Instructions

Interpretation

Diagnosis is based on both clinical and laboratory findings. Clinicians should watch for changes in laboratory values from baseline, particularly hyperuricemia, hyperkalaemia, hyperphosphatemia, hypocalcemia and an increase in creatinine.

A laboratory diagnosis of TLS is made with 2 or more of the following:

• • • elevated uric acid (≥ 476 μmol/L or 25% increase from baseline),
    • elevated potassium (≥ 6.0 mmol/L or 25% increase),
    • elevated phosphate (≥ 1.45 mmol/L [adults] or 25% increase) and
    • lowered calcium (≤ 1.75 mmol/L or 25% decrease).

A clinical diagnosis requires a laboratory diagnosis of TLS with either elevated creatinine (≥ 1.5 times the upper limit of normal), seizure or arrhythmia. Both laboratory and clinical TLS should be treated.

Reference Intervals

See individual constituent tests

Test Method

See individual constituent tests

Contact Canterbury Health Laboratories on +64 3 364 0484 or email LabInfo@cdhb.health.nz

Cairo MS, Bishop M. Tumor lysis syndrome: new therapeutic strategies and classification. Br J Haematol 2004;127:3-11.
Durani U, Hogan WJ. Emergencies in haematology: tumor lysis syndrome. Br J Haematol 2020;188:494-500.
Grewal K, Herrity E, Pasic I. Tumour lysis syndrome. CMAJ 2023 April 11;195:E515. doi: 10.1503/cmaj.221433

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