Preventing Tumor Lysis Syndrome: Two Case Studies of Unexpected Outcomes

Tumor Lysis Syndrome

BACKGROUND

Tumor lysis syndrome is a life-threatening oncologic emergency in adult and pediatric patients with hematologic cancer. It occurs most often in malignancies with rapid cell turnover and large tumor burden, but its incidence has risen in solid tumors. The subsequent release of tumor cell contents into the bloodstream results in dangerous electrolyte and metabolic disturbances.

OBJECTIVE

To provide acute and critical care nurses with a comprehensive review targeted to critical care nursing practice. Recognition of hallmark signs and symptoms will improve early detection and intervention.

METHODS

A literature review was performed using the following keywords: tumor lysis syndrome, diagnosis, nursing, early detection, and early diagnosis in PubMed and tumor lysis syndrome, diagnosis, early diagnosis, and early detection in CINAHL. Included studies were published in 2014 or later.

RESULTS

Tumor lysis syndrome causes hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia. These laboratory disturbances can lead to potentially destructive complications including renal injury, arrhythmias, seizures, and neuromuscular instability.

DISCUSSION

Acute and critical care nurses can use disease-related risk factors and clinical presentations associated with these laboratory derangements to determine the level of monitoring and intervention necessary for impacted patients.

CONCLUSIONS

Knowledge of risk factors and clinical presentations will enhance the ability of nurses in clinical practice to prevent adverse events and complications that result from tumor lysis syndrome.

Rasburicase induced methemoglobinemia: A systematic review of descriptive studies

PURPOSE

There is an increased number of reports being published on rasburicase-induced methemoglobinemia recently. We aimed to identify and critically evaluate all the descriptive studies that described the rasburicase-induced methemoglobinemia, its treatment approach, and their outcomes.

METHODOLOGY

PubMed, Scopus and grey literature databases were searched from inception to January 2022 using search terms "rasburicase" and "methemoglobinemia" without any language and date restriction. A bibliographic search was also done to find additional studies. Only descriptive studies on Rasburicase-induced methemoglobinemia were included for our review. Two contributors worked independently on study selection, data abstraction, and quality assessment, and any disagreements were resolved by consensus or discussion with a third reviewer.

RESULT

A total of 24 reports including 27 patients (23 male, 3 female patients, and 1 study did not specify the gender of the patient) aged from 5 to 75 years were included in the review. Immediate withdrawal of the drug and administering methylene blue, ascorbic acid, blood transfusion, and supportive oxygen therapy are the cornerstone in the management of rasburicase-induced methemoglobinemia.

CONCLUSION

Rasburicase administration should be followed by careful monitoring of patients for any severe complication and treat it as early as possible appropriately. In a patient who presents with rasburicase-induced haemolysis or methemoglobinemia, it is often important to expect a diagnosis of G6PD deficiency unless otherwise confirmed and to avoid administering methylene blue, even though the patient is from a low-risk ethnicity for G6PDD.

Tumor Lysis Syndrome: Implications for Oncology Nursing Practice

OBJECTIVES

To provide an overview of tumor lysis syndrome, which is one of the metabolic oncologic emergencies.

DATA SOURCES

A review and synthesis of empirical articles.

CONCLUSION

One of the metabolic oncologic emergencies identified by the Oncology Nursing Society is tumor lysis syndrome. This condition is life-threatening and is characterized by metabolic derangements that can lead to acute kidney injury and multiple organ dysfunction. Normal intracellular components (potassium, phosphorus, and nucleic acids) spill into the bloodstream when cancer cells die. If the tumor is large and highly responsive to chemotherapy, the resulting cascade of dead tumor cells may overwhelm normal homeostatic mechanisms. The cells enter the bloodstream faster than they can be cleared by the kidneys. This results in hyperkalemia and hyperphosphatemia. Nucleic acids convert to uric acid in the liver with a resultant hyperuricemia. Excess uric acid in the kidneys can lead to uric acid nephropathy and renal insufficiency. Phosphorus binds with calcium, leading to hypocalcemia from the formation of calcium phosphate precipitate or crystals. These crystals can also lead to renal insufficiency or acute kidney injury, which can lead to a metabolic acidosis and exacerbation of the hyperkalemic state. These metabolic derangements define presence of tumor lysis syndrome.

IMPLICATIONS FOR NURSING PRACTICE

Multidisciplinary collaboration and communication is essential to identifying patients at risk prior to treatment. Meticulous nursing care in terms of prevention and treatment is critical to patient survival.

Stoma formation after lymphoproliferative disorders and immunosuppression therapy

Post-transplant lymphoproliferative disorders (PTLD) are lymphomas that may arise in organ, bone marrow or stem cell transplant recipients who are taking immunosuppressive drugs to prevent rejection of the transplant. The likelihood of developing PTLD depends on the type of transplant. PTLD is a potentially severe complication of post-transplant treatment, with an uncertain prognosis. Lymphoproliferative disorders can also occur in people taking immunosuppressants for inflammatory bowel disease. This article will explore PTLD and discuss the experience of caring for patients who developed lymphoproliferative conditions and required emergency stoma formation. The emotional and physical impact of surgery upon these patients, who have already experienced a protracted treatment journey, will be explored. Implications for practice for the lymphoma team and stoma nurse specialists involved with the care of these patients will also be considered.