Haem: Tumour Lysis Syndrome: Free MSRA Podcast

🎧Deep Dive: TumourLysis Syndrome (TLS) – MSRA Emergency FocusWelcome to your rapid-fire revision on Tumour Lysis Syndrome (TLS) – a life-threateningoncological emergency you absolutely need to master for the MSRA and real-world clinical practice.⚠️What is Tumour LysisSyndrome (TLS)?TLS occurs when alarge number of cancer cells lyse (break down) rapidly – typically afterstarting treatment – flooding the bloodstream with intracellular contents andtriggering metabolic chaos.🧪Core BiochemicalHallmarks – Think PUKH• Phosphate ↑• Uric acid ↑• K (Potassium) ↑• Hypocalcaemia (Calcium ↓)🧠Mnemonic: PUKH – phosphate, urate, potassium high, hypocalcaemia 🔬Causes & RiskFactorsTLS is most common in haematological cancers like:• Acute leukaemias• Burkitt lymphoma• High-gradenon-Hodgkin lymphoma💣Triggers• Chemotherapy• Radiotherapy• Steroids(sometimes)🚩High-Risk Patients• High tumour burden• High proliferationrate• Pre-existing renalimpairment• Dehydration• Elevated baselineuric acid• Children (morevulnerable) 🧬Pathophysiology in 3StepsLysis of tumour cellsRelease of potassium, phosphate, urateKidney overwhelmed → metabolic derangement & AKI🎯Key Effects• Hyperkalaemia → arrhythmias• Hyperphosphataemia + hypocalcaemia → tetany,seizures• Hyperuricaemia → uric acid nephropathy• Metabolic acidosis → worsens organ function 📊Cairo-Bishop CriteriaLaboratory TLS – Based on abnormal blood valuesClinical TLS – Lab abnormalities + clinical signs (AKI, seizures, arrhythmias) 🔍Symptoms to Watch For• Fatigue, nausea,vomiting• Muscle cramps,tetany• ↓ Urine output(AKI)• Confusion orseizures• Cardiacarrhythmias 🧪Key Investigations• U&Es, calcium,phosphate, urate, LDH• Creatinine &eGFR• ECG (arrhythmiarisk)• Strict fluidbalance• Imaging (renalultrasound or CT if AKI unclear) 🛡️Management – Think inPhases🔹 Prevention is Key:→ Assess risk before chemotherapy• Low risk – Monitor• Intermediate risk – IV fluids + oral allopurinol• High risk – IV fluids + IV rasburicase (not allopurinol)💡 Mnemonic: ALLOral / RAS-IV→ Allopurinol = oral, Rasburicase = IV🔹 Treatment of Established TLS:• Aggressive IV fluids (no potassium!)• Rasburicase daily• IV calcium gluconate – for symptomatichypocalcaemia only• Correct electrolytes (avoid worsening CaPO₄deposits)• Dialysis – if AKI/severe derangement• Continuous cardiac monitoring📵Do not use urinaryalkalinisation – no longer recommended 📉Prognosis• Excellent ifrecognised early and managed aggressively• Poor if diagnosisis delayed or complications develop• Mortality oftendue to AKI or arrhythmias 💣Complications• Acute kidneyinjury (may require dialysis)• Life-threatening hyperkalaemia• Hypocalcaemia →seizures/tetany• Calcium-phosphatedeposits• Metabolic acidosis• Multi-organfailure 🧠Key TakeawayTLS =a biochemical time bomb 💣 in cancer patients.PUKH + Prevention = Survival.Identify high-riskpatients, initiate prophylaxis early, and act fast at the first sign oftrouble. 📚Tumour Lysis Syndrome– MSRA Study Resources📝Revision Notes⁠https://www.passthemsra.com/topic/tumour-lysis-syndrome-revision-notes/⁠🧠Flashcards⁠https://www.passthemsra.com/topic/tumour-lysis-syndrome-flashcards/⁠❓Accordion Q&ANotes⁠https://www.passthemsra.com/topic/tumour-lysis-syndrome-accordion-qa-notes/⁠🔥Rapid Quiz⁠https://www.passthemsra.com/topic/tumour-lysis-syndrome-rapid-quiz/⁠🧪Quiz Bank⁠https://www.passthemsra.com/quizzes/tumour-lysis-syndrome/⁠ 🎓 Stay sharp, stay ready. For more high-yieldhaematology and acute med revision, check out passthemsra.comand freemsra.com.#MSRA #MSRARevision#TumourLysisSyndrome #TLS #Haematology #AKI #OncologyEmergency #MSRAFlashcards#MSRAQuiz #MSRAQANotes #Rasburicase #Allopurinol #PasstheMSRA #FreeMSRA