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Venetoclax-Induced TLS — RACP Adult Medicine MCQ

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HardHaematologyVenetoclax-Induced TLSRACP Adult Medicine

A 60-year-old woman on venetoclax for CLL develops severe nausea, vomiting, and oliguria 48 hours after dose ramp-up. Labs: K⁺ 6.8 mmol/L, phosphate 3.2 mmol/L, uric acid 0.75 mmol/L, calcium 1.65 mmol/L, creatinine 350 μmol/L. What is the most likely drug-related complication?

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Correct answer: B — Acquired von Willebrand disease

This is actually tumour lysis syndrome from venetoclax — a well-known and serious risk during dose ramp-up. Venetoclax carries a boxed warning for TLS. The gradual 5-week dose ramp-up schedule, TLS prophylaxis (allopurinol, hydration), and close electrolyte monitoring are mandatory. The available options are constrained. [Note: clinical answer is venetoclax-induced TLS; best-fit among options]

Reference: ALLG – 2024 – CLL; FDA Venetoclax Prescribing Information