B-ALL with hyperleukocytosis (WBC ≥100 K/µL — Ph+ B-ALL especially), tumor lysis syndrome...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-B-ALL-EMERGENCY-TLS-LEUKOSTASIS`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-B-ALL`
Sources	`SRC-BLAST-GOKBUGET-2018` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	B-ALL with hyperleukocytosis (WBC ≥100 K/µL — Ph+ B-ALL especially), tumor lysis syndrome (LDH >2× ULN, uric acid >7.5 mg/dL, hyperkalemia, hyperphosphatemia, hypocalcemia) or symptomatic leukostasis at diagnosis
Clinical direction	hold
Category	organ-dysfunction
Shifts algorithm	ALGO-B-ALL-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "wbc_k_ul",
      "threshold": 100
    },
    {
      "comparator": ">",
      "finding": "ldh_ulnratio",
      "threshold": 2
    },
    {
      "comparator": ">",
      "finding": "uric_acid_mg_dl",
      "threshold": 7.5
    },
    {
      "finding": "leukostasis_symptoms",
      "value": true
    },
    {
      "finding": "tls_active",
      "value": true
    },
    {
      "comparator": ">",
      "finding": "potassium_mmol_l",
      "threshold": 5.5
    }
  ],
  "type": "composite"
}

Notes

Per NCCN ALL/LBL Burkitt/B-ALL section: rasburicase 0.2 mg/kg IV pre-cycle for high-risk TLS; IV hydration 3 L/m²/day. Hyperleukocytosis in B-ALL is less common than AML/T-ALL but Ph+ B-ALL can present with very high WBC. Direction HOLD until stabilization; priority 10. STUB — requires clinical co-lead signoff.

Used By

No reverse references found in the YAML corpus.