In the current classification system of Cairo and Bishop, the tumor lysis syndrome can be classified as laboratory or clinical.
Definitions of Laboratory and Clinical Tumor Lysis Syndrome.*
|Metabolic Abnormality||Criteria for Classification of Laboratory Tumor Lysis Syndrome||Criteria for Classification of Clinical Tumor Lysis Syndrome|
|Hyperuricemia||Uric acid >8.0 mg/dl (475.8 umol/liter) in adults or above the upper limit of the normal range for age in children|
|Hyperphosphatemia||Phosphorus >4.5 mg/dl (1.5 mmol/liter) in adults or >6.5 mg/dl (2.1 mmol/liter) in children|
|Hyperkalemia||Potassium >6.0 mmol/liter||Cardiac dysrhythmia or sudden death probably or definitely caused by hyperkalemia|
|Hypocalcemia||Corrected calcium <7.0 mg/dl (1.75 mmol/liter) or ionized calcium <1.12 (0.3 mmol/liter)†|| Cardiac dysrhythmia, sudden death, seizure, neuromuscular irritability (tetany, paresthesias, muscle twitching, carpopedal spasm, Trousseau’s sign, Chvostek’s sign, laryngospasm, or bronchospasm), hypotension, or heart failure probably or definitely|
caused by hypocalcemia
|Acute kidney injury‡||Not applicable||Increase in the serum creatinine level of 0.3 mg/dl (26.5 umol/liter) (or a single value >1.5 times the upper limit of the age-appropriate normal range if no baseline creatinine measurement is available) or the presence of oliguria, defined as an average urine output of <0.5 ml/kg/hr for 6 hr|
† The corrected calcium level in milligrams per deciliter = measured calcium level in milligrams per deciliter + 0.8 × (4 - albumin in grams per deciliter).
‡ Acute kidney injury is defined as an increase in the creatinine level of at least 0.3 mg per deciliter (26.5 umol per liter) or a period of oliguria lasting 6 hours or more. By definition, if acute kidney injury is present, the patient has clinical tumor lysis syndrome.
- Howard SC, Jones DP, Pui C-H. The Tumor Lysis Syndrome. N Engl J Med 2011; 364:1844-1854 [Medline]
- Coiffier B, Altman A, Pui CH, Younes A, Cairo MS. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 2008 Jun 1;26(16):2767-78. [Medline]