When should I consider referring a patient with Tumour Lysis Syndrome to secondary care for further management?

Consider referring a patient with Tumour Lysis Syndrome (TLS) to secondary care urgently if they present with any signs of severe metabolic disturbances or complications that require specialist management. This includes evidence of acute kidney injury, severe electrolyte imbalances (such as hyperkalemia, hyperphosphatemia, hypocalcemia), or clinical features like arrhythmias, seizures, or significant fluid overload that cannot be managed safely in primary care.

Referral should also be considered if the patient has underlying malignancy requiring specialist oncology input or if the diagnosis is uncertain and requires further investigation.

While the provided UK guidelines do not explicitly detail TLS referral criteria, the principles of urgent referral for suspected cancer and management of complications apply. For example, patients with suspected haematological malignancies presenting with systemic symptoms (fever, night sweats, weight loss) or abnormal blood counts should be referred urgently for specialist assessment within 48 hours ¹.

Given TLS is a potentially life-threatening oncological emergency, early secondary care involvement is critical for monitoring and managing metabolic abnormalities and initiating treatments such as intravenous fluids, electrolyte correction, and renal support if needed.