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TLS Prevention — RACP Paediatrics MCQ

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HardHaematology & OncologyTLS PreventionRACP Paediatrics

A 10-year-old with newly diagnosed ALL develops tumour lysis syndrome 24 hours after starting chemotherapy. His uric acid is 850 umol/L, potassium is 6.8 mmol/L, phosphate is markedly elevated, and calcium is low. What is the most important preventive measure that should have been commenced before chemotherapy?

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Correct answer: D — IV hyperhydration (3 L/m2/day) and rasburicase (for high-risk patients)

TLS prevention: aggressive IV hyperhydration (2-3 L/m2/day) is the cornerstone. Rasburicase (recombinant urate oxidase) rapidly reduces uric acid and is preferred over allopurinol for high-risk patients (high tumour burden, high WCC, bulky disease). Monitoring of K+, PO4, Ca2+, urate, creatinine, and urine output is essential.

Reference: ANZCHOG – 2024 – Treatment Guidelines: Tumour Lysis Syndrome