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TLS Treatment — RACP Adult Medicine MCQ

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ModerateHaematologyTLS TreatmentRACP Adult Medicine

A 55-year-old man with newly diagnosed acute lymphoblastic leukaemia (WCC 150 × 10⁹/L) develops tumour lysis syndrome 24 hours after commencing induction chemotherapy. Labs: K⁺ 7.2 mmol/L, phosphate 3.5 mmol/L, uric acid 0.85 mmol/L, calcium 1.75 mmol/L, creatinine 350 μmol/L. What is the most appropriate specific treatment?

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Correct answer: D — Rasburicase (recombinant urate oxidase)

Established TLS with markedly elevated uric acid and AKI requires rasburicase (recombinant urate oxidase), which rapidly converts uric acid to allantoin (water-soluble). It reduces uric acid within 4 hours. Rasburicase is contraindicated in G6PD deficiency (causes methaemoglobinaemia). Allopurinol prevents uric acid formation but does not reduce existing levels. Aggressive IV hydration and electrolyte management are essential.

Reference: ALLG – 2024 – TLS Guidelines; ASCO 2024