What special consideration is required before using rasburicase in TLS?

• A. Indicated for high‑risk TLS or significant uric acid elevation; screen for G6PD deficiency prior to use
• B. Rasburicase is not used in TLS and no screening is needed
• C. Rasburicase can be used regardless of uric acid levels
• D. Rasburicase should be used only after hydration fails

Answer: (A)

Rasburicase rapidly lowers uric acid levels, which is crucial in tumor lysis syndrome when there’s a high risk or significant uric acid elevation. A key precaution is screening for G6PD deficiency before giving rasburicase, because the drug can cause oxidative stress leading to acute hemolysis in G6PD-deficient individuals. If G6PD deficiency is present, rasburicase should be avoided and alternative management chosen.

So, the best approach combines using rasburicase for high-risk TLS or significant hyperuricemia with performing G6PD deficiency screening prior to use.