Acute Liver Failure as the Leading Manifestation of Spontaneous Tumour Lysis Syndrome in a Patient with NonHodgkin Lymphoma: Do Current Diagnostic Criteria of Tumour Lysis Syndrome Need Re-Evaluation?

Table 1

Laboratory blood tests/measuring unit	Reference values	Pre-ICU	ICU DAY 1	ICU DAY 2	ICU DAY 3	ICU DAY 4	ICU DAY 5	ICU DAY 6	ICU DAY 7	ICU DAY 8	ICU DAY 9	ICU DAY 10
Red blood cells (×10^12/L)	3.86–5.08	5.21	4.23	4.19	4.74	4.54	4.17	4.08	3.96	3.91	4.05	3.71
Haemoglobin (g/L)	119–157	149	125	123	135	133	121	120	116	117	120	111
Haematocrit (L/L)	0.356–0.470	0.445	0.367	0.358	0.411	0.395	0.361	0.353	0.343	0.342	0.355	0.327
White blood cells (total) (×10^9/L)	3.4–9.7	10.4	8.3	8.5	10.4	11	10.1	9.5	7	8.4	10.4	10.7
Platelets (×10^9/L)	158–424	85	61	49	31	58	47	34	47	43	44	58
Serum glucose (mmol/L)	4.4–6.4	5.3	9.2	9.9	11.5	10.1	10.6	13.2	12.4	12.7	8.2	7.3
Urea (mmol/L)	2.8–8.3	14.6	20.1	18.1	16	19.2	14.4	16.7	13.1	11	7.9	7.8
Creatinine (umol/L)	49–90	186	112	120	102	121	95	113	73	71	65	90
Sodium (mmol/L)	137–146	137	151	147	141	140	138	142	141	139	135	135
Potassium (mmol/L)	3.9–5.1	4.9	5.8	4	4.4	3.5	3.9	4.4	4.3	4.5	4.6	4.7
Chloride (mmol/L)	97–108	102	109	108	104	104	102	103	99	99	98	99
Calcium (mmol/L)	2.14–2.53	2.04	2	2.14	2.12	2.05	2.16	2.03	1.86	1.96	1.97	1.95
Phosphate (mmol/L)	0.79–1.42		1.44	1.12	1.66	1.41				0.73
Total bilirubin (umol/L)	3–20	102	377	387	405	314	250	278	349	343	506	554
Conjugated bilirubin (umol/L)	<5	74	310	332	333	164	195	228	270	271	394	448
Nonconjugated bilirubin (umol/L)		28	67	55	72	150	55	50	79	72	112	106
Urate (umol/L)	182–403			372		258	245
Aspartate transaminase (AST) (U/L)	11–38	459	141	88	57	48	46	56	71	66	70	77
Alanine aminotransferase (ALT) (U/L)	12–48	428	181	137	117	82	52	48	48	51	56	64
Alkaline phosphatase	50–142	356	228	186	199	188	151			132	139	138
Gamma-glutamyl transferase (GGT) (U/L)	11–55	411	130	101	109	118	108	155	239	336	490	501
Serum amylase (U/L)	40–140	78	60	57	73	74	34			26		12
Lactate dehydrogenase (LDH) (U/L)	<241	786	1109	797	493	441	343			451	468	458
Ammonia (umol/L)	16–60	118.8	62.6				91.1				57.2
Lactate (mmol/L)	0.5–1.6		4.6	2	2.5	1.5	2.4	2.5	2.6	2.3	1.2	1
Procalcitonin (ug/L)	<0.5—low risk of sepsis, >2— high risk of sepsis		8.69	8.89		8.1			2.43	1.79	1.37	1.09
Coagulation tests
Prothrombin time (PT)	0.70–1.40	0.25	0.37	0.4	0.44	0.43	0.5	0.49	0.52	0.59	0.58	0.59
INR		2.38	1.81	1.69	1.54	1.55	1.42	1.43	1.38	1.29	1.31	1.29
APTT (s)	25.00–40.00	45.01	35.7	35.21	36	42.18	37.84	33.31	31.14	30.9	32	32.3
Fibrinogen (g/L)	1.80–4.00	1.38	3.16	2.73	2.69	2.38	2.08	2.03	1.98	2	2.2	2.2