People with leukemia may have high levels of uric acid. If large numbers of cancer cells die rapidly, they release significant amounts of uric acid into the bloodstream, which the kidneys are unable to eliminate quickly enough.
Treatment for leukemia, such as chemotherapy, or certain leukemias with tumors that have a rapid rate of dividing cells may lead to rapid death of cancer cells and high levels of uric acid in the body.
The medical term for high levels of uric acid in the blood is hyperuricemia. Without treatment, hyperuricemia may lead to complications.
This article looks at the link between uric acid and leukemia, normal and high levels of uric acid, and methods of lowering its levels.
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Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
People with leukemia
According to the Canadian Cancer Society (CCS), if cancer cells break down too rapidly in a short period of time, they release high levels of chemicals into the bloodstream. One of these is uric acid.
The kidneys are unable to respond to the rising levels of uric acid quickly enough, causing levels to increase rapidly in the blood.
Higher levels of uric acid can lead to a condition that health experts call tumor lysis syndrome (TLS).
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Dehydration and existing kidney problems also increase the risk of TLS.
Moreover, TLS may result from chemotherapy and other treatments, such as:
- hormonal therapy
- targeted therapy
- radiation therapy
Individuals who have a higher white blood cell count before they start treatment for leukemia may also have a greater risk of developing TLS.
According to 2021 research, normal uric acid levels in the blood range from 2.4 to 6.0 milligrams per deciliter (mg/dl) in females and from 3.4 to 7.0 mg/dl in males.
High levels of uric acid are those above 6.8 mg/dl. People may have hyperuricemia if uric acid blood levels are higher than 6.0 mg/dl in females and over 7.0 mg/dl in males.
The researchers behind a 2016 study note that levels or uric acid are higher in those with acute myeloid leukemia (AML). They found that the average level of uric acid in individuals with AML was 4.8 mg/dl.
High levels of uric acid may cause gout, and people may experience swelling and inflammation in the joints.
The Leukemia & Lymphoma Society notes that if people have TLS, very high levels of uric acid can damage the heart and kidneys.
If TLS remains untreated, people may be at risk of:
- arrhythmia, or irregular heartbeat
- loss of muscle control
- kidney failure
Certain drugs, such as allopurinol and rasburicase, can help prevent or reduce the risk of TLS complications.
According to a 2016 article, there is a link between higher levels of uric acid and poorer outcomes in people with AML.
People with leukemia and high uric acid levels may receive intravenous (IV) fluids, meaning into a vein and directly into the bloodstream, to ensure the body has enough fluid to flush out excess uric acid.
The CCS notes that people may receive extra fluids 24–48 hours before cancer therapy and for the days following treatment.
Doctors will monitor uric acid levels, as well as how much urine a person is producing. To decrease the risk of TLS, an individual needs to produce 150–200 milliliters of urine per hour.
Doctors may give a person a diuretic if they are not producing enough urine or to maintain enough urine production.
Doctors may also combine sodium bicarbonate or acetazolamide with IV fluids to prevent uric acid from crystalizing, which helps the kidneys remove uric acid from the body.
Other drugs also help lower uric acid levels. Allopurinol prevents the body from making uric acid, and rasburicase breaks down uric acid so the body can flush it out more easily.
Doctors may also use these methods to treat TLS and will carefully monitor uric acid levels during treatment.
There is conflicting evidence as to whether high uric acid levels increase the risk of cancer.
According to a 2018 study, high uric acid levels are a marker of chronic inflammation and may increase the risk of cancer. However, uric acid also has antioxidant properties, which may help protect against cancer.
The authors of the study conclude that there is an association between increased uric acid levels and a modest increase in cancer risk, although the risk is not statistically significant.
A 2021 study found no clear evidence to suggest a link between high uric acid levels and cancer risk, but a potential risk of malignant cells. This, however, requires further research.
Risk factors for increased uric acid levels include:
- a diet high in purines, which are present in alcohol and foods such as seafood and organ meats
- alcohol consumption
- high blood pressure
People with leukemia may have high levels of uric acid. This can happen when a large number of cancer cells die rapidly in a short period of time. When the cancer cells die, they release uric acid into the bloodstream.
As a result, the kidneys are unable to eliminate the uric acid quickly enough, leading to high uric acid levels in the body.
Without treatment, high levels of uric acid can cause complications and may damage internal organs.
People may require medications that lower uric acid levels, diuretics, or IV fluids to help the body flush out excess uric acid.