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Patient is Suspected to Have Tumor Lysis Syndrome (TLS)

Patients may present with metabolic derangements along (laboratory TLS) or both laboratory and clinical sequalae.

  • Laboratory TLS (LTLS): Level above or below normal limits for age for 2 or more of the following values (within 3 days prior to and up to 7 days after the initiation of cytotoxic therapy):
    • ↑uric acid (> ULN for age).
    • ↑potassium (≥6mEq/L).
    • ↑phosphorus (≥6.5 mg/dL) ↓calcium (≤ 7.0 mg/dL).
    • Note: LDH is not a diagnostic criterion but a surrogate biomarker for rapid cell turnover and is important in TLS risk assessment.
  • Clinical TLS (CTLS): Defined as the presence of LTLS + 1 or more of the following:
    • Creatinine≥1.5X the upper limit of normal (not directly or probably related to a therapeutic agent).
    • Cardiac arrhythmia.
    • Seizure.
    • Sudden death.

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.

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