Leukostasis vs Tumor Lysis Syndrome
 • ...

Leukostasis vs Tumor Lysis Syndrome
 • Pathophysiology: Large, immature blasts and high WBC count cause hyperviscosity syndrome
 • Triggers: Diuretics, PRBC transfusion, Dehydration
 • Symptoms: 
   - Neuro: AMS, dizziness, tinnitus, visual changes, stroke symptoms, coma
   - Pulm: Hypoxia, dyspnea, +/- CXR infiltrates
   - 80% have fever
   - ACS, AKI, acute limb ischemia, bowel infarction or priapism
 • Lab values: WBC >100k, + lab signs of end organ damage
 • Treatment: 
   - If febrile, give abx
   - Aggressive hydration
   - Cytoreduction with hydroxyurea +/- TKIs and/or leukapheresis
   - TLS prophylaxis with allopurinol +/- rasburicase
Tumor Lysis Syndrome:
 • Pathophysiology: Lysis of tumor cells releasing intracellular contents into serum
 • Triggers:
   - Cytotoxic chemotherapy
   - Spontaneous if high proliferation rate or large tumor burden
 • Symptoms: N/V, lethargy, hematuria, cardiac dysrhythmias, seizures, tetany/cramps, syncope, sudden death
 • Lab values: Elevated K, Elevated phos, Elevated uric acid, Elevated Cr, Low calcium
 • Treatment:
   - Aggressive hydration
   - Hyperkalemia treatment (no calcium gluconate unless worrisome EKG features)
   - Non calcium phos binders
   - Rasburicase
   - Avoid calcium repletion unless symptomatic with tetany or cardiac arrhythmis

SCVMC Internal Medicine @SCVMCMed

#Leukostasis #Tumor #Lysis #Syndrome #TLS #diagnosis #management #hematology
Contributed by

Dr. Gerald Diaz
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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