摘要

Rasburicase 主要用於治療及預防腫瘤溶解症候群引起的高尿酸血症。腫瘤溶解症候群是由於腫瘤細胞在化學治療後被快速破壞，導致細胞內電解質和代謝物大量釋放到細胞外，引發嚴重的電解質異常，例如高尿酸血症、高鉀血症、高磷血症和低鈣血症。Rasburicase 透過將尿酸轉化為溶解度較高的尿囊素，降低血液中的尿酸濃度，從而預防高尿酸血症相關的腎臟損傷。本案例報告為一名43 歲女性，因急性白血病住院，使用rasburicase 預防腫瘤溶解症候群，結果出現變性血紅素血症和溶血症狀。進一步檢查確認病人有葡萄糖- 六- 磷酸鹽去氫酶 (glucose-6-phosphate dehydrogenase)缺乏症，為rasburicase 及methylene blue 使用的禁忌症。由於病人的氧氣需求增加，轉入加護病房接受氧氣治療，並使用高劑量維生素C 治療，直到病人的變性血紅素比例恢復正常。最終，病人病情穩定後轉回普通病房繼續治療白血病。

 

ABSTRACT

Rasburicase is primarily used in the prevention and management of tumor lysis syndrome (TLS)-induced hyperuricemia. TLS is a critical metabolic abnormality resulting from the rapid breakdown of tumor cells after chemotherapy, which results in the abrupt release of cellular contents such as electrolytes and metabolites into the extracellular space. TLS can cause severe electrolyte disturbances such as hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. The mechanism of action of rasburicase entails converting uric acid into an inactive and soluble metabolite (allantoin), thereby mitigating hyperuricemia and preventing associated renal injury. This report presents the case of a 43-year-old woman with acute leukemia who developed methemoglobinemia and hemolysis after receiving rasburicase for TLS prophylaxis. The patient was later confirmed to have glucose-6-phosphate dehydrogenase deficiency, a contraindication for rasburicase and methylene blue therapy. Because of her increased oxygen demand, the patient was transferred to the intensive care unit for oxygen therapy and was treated with high-dose ascorbic acid until her methemoglobin levels normalized. Eventually, the patient was stabilized and transferred back to the general ward for continuation of leukemia treatment.

 

 

Submitted for publication: 2024.7.16; Accepted for publication: 2024.10.12