A 3 year old boy is recently diagnosed with Acute lymphoblastic leukemia/lymphoma. His peripheral blood film is shown below. A bone marrow biopsy is performed and reveals > 50 % lymphoblasts. Immunostaining reveals cells positive TdT. He is staed on chemotherapy. Few days later his condition deteriorated. The doctor on duty is suspecting that child may have developed tumor lysis syndrome. Which of the following electrolyte abnormality is not seen in the above condition?
Correct Answer: Hypokalemia
Description: PBF shows lymphoblasts with condensed nuclear chromatin, small nucleoli, and scant agranular cytoplasm s/o Acute lymphoblastic leukemia/lymphoma. Tumor lysis syndrome (TLS) is characterized by : Hyperuricemia hyperkalemia Hyperphosphatemia Hypocalcemia, Etiology: destruction of a large number of rapidly proliferating tumour cells. Acute renal failure may be associated. associated with the treatment of: Burkitt's lymphoma acute lymphoblastic leukemia proliferating lymphomas chronic leukemias solid tumors (rarely) This syndrome has been seen in patients with chronic lymphocytic leukemia after treatment with nucleosides like fludarabine and is increased in frequency in lymphoid neoplasms treated with venetoclax, a bcl-2 antagonist. TLS has been observed with administration of glucocoicoids, hormonal agents such as letrozole and tamoxifen, and monoclonal antibodies such as rituximab and gemtuzumab. TLS usually occurs during or sholy (1-5 days) after chemotherapy. Rarely, spontaneous necrosis of malignancies causes TLS. The standard preventive approach : allopurinol aggressive hydration. Febuxostat Rasburicase Hemodialysis Hemofiltration
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