Tumor lysis syndrome (TLS), Cairo-Bishop laboratory or clinical criteria. Laboratory TLS:...

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

ID	`RF-ONCOLOGIC-EMERGENCY-TLS`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-NCCN-AML-2025` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Tumor lysis syndrome (TLS), Cairo-Bishop laboratory or clinical criteria. Laboratory TLS: ≥2 of uric acid >8 mg/dL (or 25% increase), potassium >6 (or 25%↑), phosphate >4.5 (or 25%↑), calcium <7 (or 25%↓) within 3 days before / 7 days after treatment start. Clinical TLS: laboratory + creatinine ≥1.5× ULN, cardiac arrhythmia, or seizure. Triggers immediate IV hydration, rasburicase 0.2 mg/kg, electrolyte correction, and consideration of dialysis.
Clinical direction	hold
Category	oncologic-emergency

Trigger Logic

{
  "any_of": [
    {
      "finding": "tls_clinical",
      "value": true
    },
    {
      "finding": "tls_laboratory",
      "value": true
    },
    {
      "comparator": ">",
      "finding": "uric_acid_mg_dl",
      "threshold": 8
    },
    {
      "all_of": [
        {
          "comparator": ">",
          "finding": "potassium_mmol_l",
          "threshold": 6
        },
        {
          "comparator": ">",
          "finding": "phosphate_mg_dl",
          "threshold": 4.5
        }
      ]
    }
  ],
  "type": "lab_value"
}

Notes

Cairo & Bishop 2004 criteria, Coiffier et al. 2008 expert panel. Established TLS pre-existing (spontaneous TLS — Burkitt, T-ALL, HGBL, AML with high WBC) requires control before treatment. Treatment-emergent TLS: rasburicase 0.2 mg/kg/day x1-7 (G6PD-deficient contraindicated — use allopurinol); IV NS hydration 3 L/m²/day; avoid alkalinization (calcium phosphate precipitation); RRT for refractory hyperkalemia/hyperphosphatemia/oliguria. Distinct from RF-UNIVERSAL-TLS-RISK (pre-treatment risk stratification, prophylaxis) — this RF is for established TLS where treatment hold and intensive supportive care take priority over the next chemotherapy cycle.

Used By

No reverse references found in the YAML corpus.