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Board Questions

1. Which of the following patients is at highest risk for tumor lysis syndrome? 

a) 3 yo F with pre-B ALL, WBC of 150K
b) 2 yo M with AML, WBC of 55K
c) 12 yo F with T cell leukemia and WBC of 80K
d) 16 yo M with bulky Burkitt Lymphoma

2. What is a potential complication of alkalinzing fluid therapy for tumor lysis syndrome? 

a) A high urine pH can lead to uric acid crystallization and nephropathy
b) A high urine pH can lead to calcium phosphate crystallization and nephropathy
c) A high serum pH can lead to hyperkalemia
d) A high serum pH interferes with the ability of Rasburicase to function



ANSWERS & EXPLANATIONS

1. D- Patients with Burkitt Lymphoma (bulky or advanced stage) are at highest risk of tumor lysis syndrome. Each of the other answer choices represent patients at high risk for tumor lysis syndrome whether due to tumor burden (ALL WBC 150K) or type of leukemia (T-Cell Leukemia).

2. B- alkalinization of the urine using sodium bicarbonate therapy to target a urine pH>6.5 has been used to prevent urate nephropathy (as uric acid precipitates at low urine pH). However, a high urine pH also favors calcium-phosphate crystallization and nephropathy. Hence, with the increased use of rasburicase to control uric acid levels, urine alkalinzation is less frequently used. 

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