Question of the day-4/05/18

Q1. A 10 year old boy with T-ALL was admitted and his blood parameters at admission were:-

  • CBC> Hb= 9 g/dl, Hct =28%, TLC= 102000/microl, PLT= 50000
  • Clinical Chemistry > Creat 1.8, T Bil 1.2, D Bill 0.6, Uric Acid 12.3, K+ 5.8, Phosphate 6.8, Calcium 7.0, LDH 3000, SGOT/PT 65/62

Anti TLS measures including ample hydration, allopurinol and rasburicase, oral phosphate binders and anti hyperkelemia measures were given and his values were repeated after 6 hours which are as given below:-

  • CBC> Hb= 6 g/dl, Hct =18%, TLC= 98000/microl, PLT= 48000
  • Clinical Chemistry> Creat 1.6, T Bil 3.2, D Bill 0.9, Uric Acid 4.3, K+ 5.5, Phosphate 6.2, Calcium 7.8, LDH 13000, SGOT/PT 69/65

How will you explain this scenario ??

Answer:- Features are s/o Hemolysis 

  • Hemolytic anemia is likely to occur in G6PD-deficient patients due to their inability to break down hydrogen peroxide, which results from the oxidation of uric acid to allantoin.
  • It is recommended that G6PD deficiency be ruled out prior to treatment with rasburicase, but this is not always feasible, as TLS is a dangerous condition that often progresses quickly if treatment is delayed.
  • Thus, strict monitoring for signs and symptoms of hemolytic anemia is essential to provide appropriate supportive care if any adverse events occur.
  • Currently the use of rasburicase in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency is contraindicated.

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