Hemolytic-uremic syndrome laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{HUS}} | {{HUS}} | ||
{{CMG}}; {{AE}} {{AHS}} | {{CMG}}; {{AE}} {{S.G.}}, {{AHS}} | ||
==Overview== | ==Overview== | ||
The classic laboratory findings in HUS include anemia, thrombocytopenia and acute renal | The classic laboratory findings in [[Hemolytic-uremic syndrome|hemolytic uremic syndrome]] ([[Hemolytic-uremic syndrome|HUS]]) include anemia, [[thrombocytopenia]] and [[Acute kidney injury|acute renal injury]]. [[Anemia]] is [[microangiopathic hemolytic anemia]] which low [[hemoglobin]] often < 8g/dl, high [[reticulocyte count]] and [[LDH]], low [[haptoglobin]] level as well as fragmanted [[Red blood cell|RBC]]'s and schistiocytes on [[Peripheral blood smear|peripheral blood smear (PBS)]]. [[Platelets]] are frequently less than 60,000 without active [[bleeding]] usually and renal damage is seen in form of high [[creatinine]], [[BUN]], and [[electrolyte abnormalities]]. | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
Following Lab findings are seen in HUS<ref name="pmid26265890">{{cite journal| author=Canpolat N| title=Hemolytic uremic syndrome. | journal=Turk Pediatri Ars | year= 2015 | volume= 50 | issue= 2 | pages= 73-82 | pmid=26265890 | doi=10.5152/tpa.2015.2297 | pmc=4523989 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26265890 }} </ref><ref>{{Cite journal | Following Lab findings are seen in [[Hemolytic-uremic syndrome|HUS]]:<ref name="pmid26265890">{{cite journal| author=Canpolat N| title=Hemolytic uremic syndrome. | journal=Turk Pediatri Ars | year= 2015 | volume= 50 | issue= 2 | pages= 73-82 | pmid=26265890 | doi=10.5152/tpa.2015.2297 | pmc=4523989 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26265890 }} </ref><ref>{{Cite journal | ||
| author = [[Marina Noris]] & [[Giuseppe Remuzzi]] | | author = [[Marina Noris]] & [[Giuseppe Remuzzi]] | ||
| title = Hemolytic uremic syndrome | | title = Hemolytic uremic syndrome | ||
| Line 19: | Line 19: | ||
| doi = 10.1681/ASN.2004100861 | | doi = 10.1681/ASN.2004100861 | ||
| pmid = 15728781 | | pmid = 15728781 | ||
}}</ref> | }}</ref> | ||
* '''Microangiopathic | * '''Microangiopathic hemolytic anemia''' with features as follows: | ||
** Low | ** Low [[hemoglobin]] level typically < 10g/dl | ||
** High reticulocyte count | ** High [[reticulocyte count]] | ||
** Increased LDH level | ** Increased [[LDH]] level | ||
** Low | ** Low [[haptoglobin]] level | ||
** Negative Coombs test | ** Negative [[Coombs test]] | ||
** Peripheral | ** [[Peripheral blood smear]] shows fragmented [[RBCs|RBC's]] (Schistiocytes, Helmet, and Burr cells) | ||
** PT and | ** [[Prothrombin time|PT]] and a[[Partial thromboplastin time|PTT]] are normal (differentiating feature from [[Disseminated intravascular coagulation|Disseminated Intravascular Coagulation]]) | ||
* '''Thrombocytopenia''' | * '''Thrombocytopenia''' | ||
** Below 150,000 although typically less than 60,000. In spite of low platelet count, active bleeding is rarely seen | ** Below 150,000 although typically less than 60,000. In spite of low [[platelet count]], active [[bleeding]] is rarely seen | ||
* '''Serum | * '''Serum chemistry abnormalities''' | ||
** High BUN | ** High [[BUN]] | ||
** High | ** High [[creatinine]] | ||
** Electrolyte abnormalities may include | ** [[Electrolyte abnormalities]] may include [[hyponatremia]], [[hyperkalemia]], [[hyperphosphatemia]], [[hypocalcemia]], and [[acidosis]] (resulting from [[diarrhea]], [[dehydration]] and [[renal failure]]) | ||
** Increased Bilirubin and aminotransferases | ** Increased [[Bilirubin]] and [[aminotransferases]] | ||
** High uric acid levels | ** High [[uric acid]] levels | ||
* '''Urinalysis'''-may show any of following | * '''Urinalysis'''-may show any of following | ||
** Blood / Red blood cells | ** [[Blood]] / [[Red blood cell|Red blood cells]] | ||
** Protein | ** [[Protein]] | ||
** Bilirubin | ** [[Bilirubin]] | ||
** WBC | ** [[White blood cells|WBC]] | ||
** Casts | ** [[Urinary casts|Casts]] | ||
* '''Stool Testing''' | * '''Stool Testing''' | ||
** Stool culture on Sorbitol MacConkey's agar or | ** [[Stool culture]] on Sorbitol MacConkey's [[agar]] or detection of [[Shiga toxin]] with [[serological testing]] | ||
* '''Genetic Testing''' | * '''Genetic Testing''' | ||
** Done if suspicion of genetic or complement-mediated HUS/ recurrent HUS. However, results take weeks-month thus have no role in the acute management of disease and treatment should not be delayed while awaiting results | ** Done if suspicion of [[genetic]] or [[complement]]-mediated [[Hemolytic-uremic syndrome|HUS]]/ recurrent [[Hemolytic-uremic syndrome|HUS]]. However, results take weeks-month thus have no role in the [[Acute (medicine)|acute]] management of [[disease]] and treatment should not be delayed while awaiting results | ||
** Low C3 and C4 may indicate complement mediated HUS | ** Low [[C3 (complement)|C3]] and C4 may indicate [[complement]] mediated [[HUS]] | ||
** Genetic testing/screening for cobalamine metabolic defects in neonates presenting with HUS | ** [[Genetic testing]]/[[Screening (medicine)|screening]] for cobalamine [[metabolic]] defects in [[neonates]] presenting with [[Hemolytic-uremic syndrome|HUS]] | ||
* '''Cultures''' | * '''Cultures''' | ||
** Blood, spinal, organ/tissue cultures may be needed in case of suspicion of other sources of HUS for example | ** [[Blood]], spinal, organ/tissue cultures may be needed in case of suspicion of other sources of [[Hemolytic-uremic syndrome|HUS]] for example pnemococcal [[infection]]. | ||
==References== | ==References== | ||
Latest revision as of 03:57, 20 September 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2], Anila Hussain, MD [3]
Overview
The classic laboratory findings in hemolytic uremic syndrome (HUS) include anemia, thrombocytopenia and acute renal injury. Anemia is microangiopathic hemolytic anemia which low hemoglobin often < 8g/dl, high reticulocyte count and LDH, low haptoglobin level as well as fragmanted RBC's and schistiocytes on peripheral blood smear (PBS). Platelets are frequently less than 60,000 without active bleeding usually and renal damage is seen in form of high creatinine, BUN, and electrolyte abnormalities.
Laboratory Findings
Following Lab findings are seen in HUS:[1][2]
- Microangiopathic hemolytic anemia with features as follows:
- Low hemoglobin level typically < 10g/dl
- High reticulocyte count
- Increased LDH level
- Low haptoglobin level
- Negative Coombs test
- Peripheral blood smear shows fragmented RBC's (Schistiocytes, Helmet, and Burr cells)
- PT and aPTT are normal (differentiating feature from Disseminated Intravascular Coagulation)
- Thrombocytopenia
- Below 150,000 although typically less than 60,000. In spite of low platelet count, active bleeding is rarely seen
- Serum chemistry abnormalities
- High BUN
- High creatinine
- Electrolyte abnormalities may include hyponatremia, hyperkalemia, hyperphosphatemia, hypocalcemia, and acidosis (resulting from diarrhea, dehydration and renal failure)
- Increased Bilirubin and aminotransferases
- High uric acid levels
- Urinalysis-may show any of following
- Stool Testing
- Stool culture on Sorbitol MacConkey's agar or detection of Shiga toxin with serological testing
- Genetic Testing
- Done if suspicion of genetic or complement-mediated HUS/ recurrent HUS. However, results take weeks-month thus have no role in the acute management of disease and treatment should not be delayed while awaiting results
- Low C3 and C4 may indicate complement mediated HUS
- Genetic testing/screening for cobalamine metabolic defects in neonates presenting with HUS
- Cultures
References
- ↑ Canpolat N (2015). "Hemolytic uremic syndrome". Turk Pediatri Ars. 50 (2): 73–82. doi:10.5152/tpa.2015.2297. PMC 4523989. PMID 26265890.
- ↑ Marina Noris & Giuseppe Remuzzi (2005). "Hemolytic uremic syndrome". Journal of the American Society of Nephrology : JASN. 16 (4): 1035–1050. doi:10.1681/ASN.2004100861. PMID 15728781. Unknown parameter
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