How can I effectively prevent Tumour Lysis Syndrome in high-risk patients receiving treatment for hematological malignancies?

Effective prevention of Tumour Lysis Syndrome (TLS) in high-risk patients with hematological malignancies involves early risk stratification, aggressive hydration, and pharmacological interventions to manage metabolic abnormalities before and during treatment initiation. First, identify patients at high risk based on tumour burden, type of malignancy (e.g., acute leukaemias, high-grade lymphomas), baseline renal function, and pre-existing metabolic derangements NICE NG47 McBride & Westervelt 2012. Initiate vigorous intravenous hydration with isotonic saline to maintain high urine output, which facilitates renal clearance of uric acid and electrolytes NICE NG47 McBride & Westervelt 2012. Allopurinol is recommended as a prophylactic agent to inhibit xanthine oxidase and reduce uric acid production, particularly in moderate-risk patients NICE NG47. However, in high-risk patients, rasburicase, a recombinant urate oxidase enzyme, is preferred as it rapidly degrades existing uric acid, preventing crystal formation and renal injury McBride & Westervelt 2012. Close monitoring of electrolytes, renal function, and fluid balance is essential to detect early signs of TLS and adjust treatment accordingly NICE NG47. Correction of electrolyte abnormalities, such as hyperkalemia and hyperphosphatemia, should be prompt and guided by clinical protocols NICE NG47. Coordination with oncology and nephrology teams is critical for managing complications and considering renal replacement therapy if needed McBride & Westervelt 2012. This integrated approach combining UK guideline recommendations with contemporary literature ensures optimal prevention of TLS in high-risk hematological malignancy patients.