Leukostasis vs Tumor Lysis Syndrome Leukostasis: • 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
