Hemolytic Uremic Syndrome

Loose Bowels 2

Step 1: View clinicals

A 3 year old boy presents with vomiting and bloody diarrhea for 5 days. His urine output has been markedly reduced since last night. No other symptoms were present, and he has no comorbidities. His birth history is unremarkable and all immunizations are up to date.


Step 2: Order all relevant investigations

Complete Blood Count

WBC/DC: 7,200/mm3 (5,500-15,500) N: 70% (23-56) L: 30% (35-65) Hb: 11 g/dL (11.5-15.5) Hct: 34% (34-40) Platelets: 50,000/mm3 (150,000-450,000) The blood film reveals mild anemia with 1+ schistocytes, abundant reticulocytes, and marked thrombocytopenia.

Urinalysis + Renal Functions

Urinalysis: Red Blood Cells: 20/hpf Pus cells: Occasional/hpf Protein: + No cell casts Renal Functions: Na+: 134 mEq/l (135-145) K+: 4.5 mEq/l (3.5-5.0) Cl-: 97 mEq/l (95-105) Blood Urea: 41 mg/dl (0-50) Serum Creatinine: 2.4 mg/dl (< 1.5)

Coagulation Profile

INR: 1.0 (0.9-1.1) PT: 12 sec (11-13.5) APTT: 35 sec (30-50) TT: 10 sec (10-15) Fibrinogen: 300 mg/dL (150-400)

Stool Shiga Toxin Test

Rapid Assay Results: Negative for Shiga Toxin 1 (stx1) Positive for Shiga Toxin 2 (stx2)


Step 3: Select appropriate management

IV Fluids
Antibiotics
Plasma Exchange
Eculizumab


Score: ★★☆