Tumor Lysis Syndrome (Cairo-Bishop Criteria)
Cairo-Bishop definition of laboratory and clinical tumour lysis syndrome (TLS) within 3 days before to 7 days after starting cancer treatment.
Score interpretation
Cairo–Bishop laboratory TLS not met. A creatinine rise, arrhythmia or seizure without laboratory TLS needs another explanation.
→ Oral hydration. Allopurinol prophylaxis if intermediate risk tumour. Monitor electrolytes 12-hourly during first treatment cycle. No rasburicase routinely required.
2 or more laboratory criteria within 3 days before or 7 days after starting treatment (Cairo–Bishop).
→ Aggressive IV hydration (adults: 3 L/m²/day; avoid hypotonic fluids). Rasburicase (adults: 0.2 mg/kg IV daily × 3–7 days; contraindicated in G6PD deficiency — check first). Monitor electrolytes 4–6-hourly. ECG monitoring. Treat hyperkalaemia: calcium gluconate, insulin/dextrose, salbutamol nebuliser, calcium resonium. Nephrology review if AKI. Children: use a children's formulary.
Clinical TLS: laboratory TLS + organ dysfunction (AKI, arrhythmia, seizure). Medical emergency.
→ IMMEDIATE oncology and nephrology. ICU consideration. Rasburicase (if no G6PD deficiency). Continuous cardiac monitoring. Haemodialysis if refractory hyperkalaemia, severe AKI, or symptomatic hypocalcaemia. Hold calcium supplementation if phosphate elevated (risk of calcium-phosphate precipitation). Anti-epileptic cover.
Interpretation bands for the TLS (Cairo-Bishop). Apply clinical judgement and local guidance.
References
- Cairo MS, Bishop M. Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol. 2004;127(1):3–11.
- Howard SC, Jones DP, Pui CH. The tumor lysis syndrome. N Engl J Med. 2011;364(19):1844–1854.
Related
Curated clinical cross-links plus same-class fallbacks.
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.