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Tumour lysis haematological emergency — SCE Acute Medicine MCQ

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ModerateHaematological EmergenciesTumour lysis haematological emergencySCE Acute Medicine

A 29-year-old man presents with fever, bleeding, thrombosis or severe anaemia. Relevant history includes malignancy, chemotherapy, haemoglobinopathy or anticoagulant exposure. On assessment, blood film and coagulation results are abnormal. Investigations show hyperkalaemia, high urate, high phosphate and low calcium after induction chemotherapy. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Treat hyperkalaemia immediately and give rasburicase with aggressive hydration

The key discriminator is that hyperkalaemia, high urate, high phosphate and low calcium after induction chemotherapy, which makes Treat hyperkalaemia immediately and give rasburicase with aggressive hydration the single best answer. Give controlled oxygen and senior review is less appropriate because it does not address the dominant acute risk in the vignette; Arrange routine outpatient follow-up would fit a different presentation or later stage of care. Optimise chronic medication and discharge and Provide supportive care and close monitoring are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BCSH tumour lysis guideline