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What is the pathophysiology of uric acid excretion?
a variety of metabolic abnormalities resulting from abrupt release of intracellular components into the bloodstream after the rapid lysis of malignant cells
What is the MOA of Allopurinol?
blocks xanthine oxidase from turning hypoxanthine into xanthine and xanthine into uric acid
What is the MOA of rasburicase?
breaks uric acid down into Allantoin and hydrogen peroxide
What are the common metabolic abnormalities associated with Tumor Lysis Syndrome (TLS)?
What are the risk factors for TLS?
- solid tumors with high proliferative rates and rapid response to tx
- bulky tumors
- elevated LDH
- elevated WBC
- preexisting renal failure
- high baseline uric acid levels
What is the tx for low risk of TLS (WBC < 50,000)?
What is the tx for intermediate risk of TLS (WBC 50,000-10,0000 in ALL or 10,000-50,000 in AML)?
Allopurinol + hydration
What is the tx for high risk of TLS (lymphoma)?
Rasburicase + hydration