Pseudohyperkalemia with concurrent tumor lysis syndrome in extreme leukocytosis: Diagnostic and management pitfalls

Abstract

Introduction: Pseudohyperkalemia is a well-described phenomenon in extreme leukocytosis and thrombocytosis. Clinical recognition can be challenging, especially in the setting of coexisting disorders known to cause true hyperkalemia. We present a case of pseudohyperkalemia occurring in tandem with tumor lysis syndrome and progressive kidney injury. Case description: A 74-year-old gentleman was diagnosed with chronic myeloid leukemia complicated by blast crisis. Investigations demonstrated an elevated potassium result which was initially attributed to tumor lysis syndrome and acute kidney injury. Further investigations revealed underlying pseudohyperkalemia, supported by the absence of classical electrocardiographic changes of hyperkalemia. Patient was subsequently initiated on kidney replacement therapy due to progressive kidney injury with anuria. Diagnosis and management of this phenomenon is discussed. Conclusion: Due to the potential for harm with erroneous treatment, physicians should develop an increased appreciation for the diagnostic and management pitfalls associated with pseudohyperkalemia in hematological conditions.