Tumour lysis syndrome developing during an operation

Abstract

Summary We describe an unusual case of tumour lysis syndrome in a child with a high‐grade lymphoma undergoing a staging laparotomy. The patient presented with a refractory ventricular arrhythmia, which required continuous resuscitation in the operating room and continuous venous‐venous haemodialysis in the intensive care unit. This case report suggests that surgery is a possible trigger for developing tumour lysis syndrome, so anaesthetists should be alert to this possibility during surgery in patients with pre‐existing high tumour burdens.

Tumor lysis syndrome developing intraoperatively

“…[10] A similar case report of TLS in a six-year-old child with high-grade lymphoma undergoing laparotomy has been described by Lee et al . [11]…”

Anesthesia Case of the Month

“…10,11 Several clinical factors are associated with an increased risk of acute tumor lysis syndrome in humans, including a large tumor burden, high proliferative fraction, extreme sensitivity to chemotherapeutic drugs, abdominal involvement, and high baseline lactate dehydrogenase and uric acid concentrations. 10,11 Several clinical factors are associated with an increased risk of acute tumor lysis syndrome in humans, including a large tumor burden, high proliferative fraction, extreme sensitivity to chemotherapeutic drugs, abdominal involvement, and high baseline lactate dehydrogenase and uric acid concentrations.…”

Fatal peri‐operative acute tumour lysis syndrome precipitated by dexamethasone

“…This child did not receive steroids during the course of surgery and onset of tumour lysis was thought to be due to lysis precipitated by biopsy of the lesion. A subsequent case report published in early 2007 describes the onset of acute tumour lysis syndrome at the end of staging laparotomy for acute presentation of lymphoma [5]. This report did not comment whether dexamethasone was used but attributed the onset of haemodynamic instability to surgical stress and handling of the lesion.…”