Oncologic Emergencies: Tumor Lysis Syndrome

@Inkling777 3 years ago

Thanks for an excellent explanation! I'll add a suggestion based on my experience with this syndrome. In the early 1980s I was working nights on a pediatric Hem-Onc unit. A boy of about eight was admitted having leukemia (ALL) with an exceptional high blast count and a low platelet count (70,000). We moved even quicker than usual. As his chemo was wrapping up, he developed a nose bleed. Every other remedy failed, so the resident decided to pack his nose with cotton. As he did so, I became worried. A half hour before the boy had been obviously miserable as his nose bleed triggered vomiting. Now and without being given anything to reduce the pain, he was oblivious to what had to be a painful procedure. Something is wrong, I thought. There was already an order for a CBC to monitor those low platelets. I persuaded the resident to add a blood chemistry. The latter came back with all alarms ringing and the boy went (briefly) to our ICU. Now for the clincher. Because of that incident, a few days later the national protocol for treating childhood leukemia was altered to prevent that from happening again. My suggestion? Our brains are sensitive to changes in our blood. Watch patients who're getting chemotherapy. If they seem to be losing an awareness of their surroundings, get a blood chemistry run pronto.

@WhiteboardMedicine 4 years ago

Awesome video! One of those syndromes where the findings and treatment fit the pathology perfectly! Cheers.

@bardacha100 5 months ago

Very insightful ! Many thx for sharing knowledge :)

@SuperCoolguy124 8 years ago

You are an awesome teacher!

@mdjk89 11 years ago

Thank you this was way helpful!!!! im a nursing student and this makes way more sense then the textbook!

@dusayzayrplayne9178 4 years ago

Thank you for the "easy to understand" explanation

@MikeBirkhead 9 years ago

Andrew Wolf, Thanks for the video. I just wanted to let you know that with Chronic Myeloid Leukemia (I haven't confirmed AML, yet) the uric acid increases well before chemotherapy ever begins. The increased uric acid levels are attributed to high turn-over rate of cells. -Source: Fundamentals of Pathology: Pathoma. 2011. - I have also seen a case of CML that presented, at least initially, with only hyperuricemia and none of the other TLS's. I am not sure if that is typical or not, and I'm wondering your take on that.