Rasburicase G6PD — SCE Medical Oncology MCQ

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EasyOncological EmergenciesRasburicase G6PDSCE Medical Oncology

A 55-year-old man with AML develops tumour lysis syndrome after starting induction chemotherapy. Rasburicase is being considered. What is the specific contraindication to rasburicase?

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Correct answer: C — G6PD deficiency — rasburicase causes oxidative haemolysis in G6PD-deficient patients due to hydrogen peroxide generation during uric acid metabolism

Rasburicase (recombinant urate oxidase) rapidly converts uric acid to allantoin but generates hydrogen peroxide as a by-product. In patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, impaired antioxidant defences lead to severe oxidative haemolytic anaemia. G6PD testing should ideally be performed before rasburicase administration. In G6PD-deficient patients, allopurinol ± aggressive hydration is the alternative for TLS uric acid management. Rasburicase also falsely lowers uric acid levels in samples stored at room temperature.

Reference: BNF Rasburicase; ESMO Oncological Emergencies; Cairo et al Br J Haematol 2010