Kawasaki disease laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
Kawasaki disease is diagnosed | Kawasaki disease is diagnosed by clinical presentation, although the laboratory findings are non-specific for the diagnosis of Kawasaki disease - normocytic [[anemia]], [[thrombocytosis]], with [[Platelet|platelets]] ≥ 450×10<sup>3</sup>/μL (after first week of acute disease), [[Leukocytosis|leucocytosis]] with [[white blood cell count]] ≥ 15,000/μL, elevated [[erythrocyte sedimentation rate]], elevated [[liver enzyme]] levels, [[hypoalbuminemia]] with ≥ 3.0g/dL, elevated [[c-reactive protein]], [[hyponatremia]] and sterile [[pyuria]] can be noted on laboratory investigations. | ||
== Laboratory Findings == | == Laboratory Findings == | ||
Although non specific for diagnosis | Although non-specific for diagnosis, the following laboratory findings are helpful in the diagnosis of Kawasaki disease:<ref name="McCrindleRowley2017">{{cite journal|last1=McCrindle|first1=Brian W.|last2=Rowley|first2=Anne H.|last3=Newburger|first3=Jane W.|last4=Burns|first4=Jane C.|last5=Bolger|first5=Anne F.|last6=Gewitz|first6=Michael|last7=Baker|first7=Annette L.|last8=Jackson|first8=Mary Anne|last9=Takahashi|first9=Masato|last10=Shah|first10=Pinak B.|last11=Kobayashi|first11=Tohru|last12=Wu|first12=Mei-Hwan|last13=Saji|first13=Tsutomu T.|last14=Pahl|first14=Elfriede|title=Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association|journal=Circulation|volume=135|issue=17|year=2017|pages=e927–e999|issn=0009-7322|doi=10.1161/CIR.0000000000000484}}</ref><ref name="pmid15574639">{{cite journal |vauthors=Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, Wilson WR, Baddour LM, Levison ME, Pallasch TJ, Falace DA, Taubert KA |title=Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association |journal=Pediatrics |volume=114 |issue=6 |pages=1708–33 |date=December 2004 |pmid=15574639 |doi=10.1542/peds.2004-2182 |url=}}</ref><ref name="pmid15505111">{{cite journal |vauthors=Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, Wilson WR, Baddour LM, Levison ME, Pallasch TJ, Falace DA, Taubert KA |title=Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association |journal=Circulation |volume=110 |issue=17 |pages=2747–71 |date=October 2004 |pmid=15505111 |doi=10.1161/01.CIR.0000145143.19711.78 |url=}}</ref><ref name="pmid26714775">{{cite journal |vauthors=Chen X, Zhao ZW, Li L, Chen XJ, Xu H, Lou JT, Li LJ, Du LZ, Xie CH |title=Hypercoagulation and elevation of blood triglycerides are characteristics of Kawasaki disease |journal=Lipids Health Dis |volume=14 |issue= |pages=166 |date=December 2015 |pmid=26714775 |pmc=4696131 |doi=10.1186/s12944-015-0167-2 |url=}}</ref> | ||
*[[Complete blood count]] (CBC) may reveal: | *[[Complete blood count]] (CBC) may reveal: | ||
**[[Normocytic | **[[Normocytic normochromic anemia]] | ||
**[[Thrombocytosis]] | **[[Thrombocytosis]] | ||
***[[Platelet|Platelets]] ≥ 450×10<sup>3</sup>/μL (450 × 10<sup>9</sup>/L) after first week | ***[[Platelet|Platelets]] ≥ 450×10<sup>3</sup>/μL (450 × 10<sup>9</sup>/L) after the first week and peaking to a mean of ≈700,000 per mm<sup>3</sup> and normalizing after 4-6 weeks of onset of acute episode of Kawasaki disease | ||
**[[Leukocytosis|Leucocytosis]] | **[[Leukocytosis|Leucocytosis]] | ||
***[[White blood cell count]] ≥ 15,000/μL (15.0 × 10<sup>9</sup>/L) | ***[[White blood cell count]] ≥ 15,000/μL (15.0 × 10<sup>9</sup>/L) | ||
*Elevated [[ | *[[Lipid profile]] | ||
*Elevated [[ | **May demonstrate [[hypertriglyceridemia]] | ||
*Elevated [[erythrocyte sedimentation rate]] | |||
*Elevated [[c-reactive protein]] | |||
*Hypercoagulation profile | |||
**May or may not demonstrate evidence of hypercoagulability | |||
**Panel should include [[thrombomodulin]], [[tissue factor]], [[tissue factor pathway inhibitor]], [[Von Willebrand factor]], coagulation [[factor VII]], activated [[factor VII]], [[prothrombin]] fragment 1 + 2, and [[D-dimer]]. | |||
*[[Liver function tests]] may reveal: | *[[Liver function tests]] may reveal: | ||
**Elevated [[liver enzyme]] levels | **Elevated [[liver enzyme]] levels | ||
**[[Hypoalbuminemia]] ≥ 3.0g/dL (30g/L) | **[[Hypoalbuminemia]] ≥ 3.0g/dL (30g/L) | ||
*[[ | *Electrolyte study may reveal [[hyponatremia]] | ||
* | *Urine analysis may demonstrate sterile [[pyuria]] | ||
==References== | ==References== | ||
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[[Category: | [[Category:Pediatrics]] | ||
[[Category:Cardiovascular diseases]] | |||
[[Category:Angiology]] | |||
[[Category:Cardiology]] | |||
[[Category:Rheumatology]] | |||
[[Category:Dermatology]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Up-To-Date]] | |||
Latest revision as of 21:48, 16 April 2018
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Kawasaki disease Microchapters |
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American Roentgen Ray Society Images of Kawasaki disease laboratory findings |
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Risk calculators and risk factors for Kawasaki disease laboratory findings |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]
Overview
Kawasaki disease is diagnosed by clinical presentation, although the laboratory findings are non-specific for the diagnosis of Kawasaki disease - normocytic anemia, thrombocytosis, with platelets ≥ 450×103/μL (after first week of acute disease), leucocytosis with white blood cell count ≥ 15,000/μL, elevated erythrocyte sedimentation rate, elevated liver enzyme levels, hypoalbuminemia with ≥ 3.0g/dL, elevated c-reactive protein, hyponatremia and sterile pyuria can be noted on laboratory investigations.
Laboratory Findings
Although non-specific for diagnosis, the following laboratory findings are helpful in the diagnosis of Kawasaki disease:[1][2][3][4]
- Complete blood count (CBC) may reveal:
- Normocytic normochromic anemia
- Thrombocytosis
- Platelets ≥ 450×103/μL (450 × 109/L) after the first week and peaking to a mean of ≈700,000 per mm3 and normalizing after 4-6 weeks of onset of acute episode of Kawasaki disease
- Leucocytosis
- White blood cell count ≥ 15,000/μL (15.0 × 109/L)
- Lipid profile
- May demonstrate hypertriglyceridemia
- Elevated erythrocyte sedimentation rate
- Elevated c-reactive protein
- Hypercoagulation profile
- May or may not demonstrate evidence of hypercoagulability
- Panel should include thrombomodulin, tissue factor, tissue factor pathway inhibitor, Von Willebrand factor, coagulation factor VII, activated factor VII, prothrombin fragment 1 + 2, and D-dimer.
- Liver function tests may reveal:
- Elevated liver enzyme levels
- Hypoalbuminemia ≥ 3.0g/dL (30g/L)
- Electrolyte study may reveal hyponatremia
- Urine analysis may demonstrate sterile pyuria
References
- ↑ McCrindle, Brian W.; Rowley, Anne H.; Newburger, Jane W.; Burns, Jane C.; Bolger, Anne F.; Gewitz, Michael; Baker, Annette L.; Jackson, Mary Anne; Takahashi, Masato; Shah, Pinak B.; Kobayashi, Tohru; Wu, Mei-Hwan; Saji, Tsutomu T.; Pahl, Elfriede (2017). "Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association". Circulation. 135 (17): e927–e999. doi:10.1161/CIR.0000000000000484. ISSN 0009-7322.
- ↑ Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, Wilson WR, Baddour LM, Levison ME, Pallasch TJ, Falace DA, Taubert KA (December 2004). "Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association". Pediatrics. 114 (6): 1708–33. doi:10.1542/peds.2004-2182. PMID 15574639.
- ↑ Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, Wilson WR, Baddour LM, Levison ME, Pallasch TJ, Falace DA, Taubert KA (October 2004). "Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association". Circulation. 110 (17): 2747–71. doi:10.1161/01.CIR.0000145143.19711.78. PMID 15505111.
- ↑ Chen X, Zhao ZW, Li L, Chen XJ, Xu H, Lou JT, Li LJ, Du LZ, Xie CH (December 2015). "Hypercoagulation and elevation of blood triglycerides are characteristics of Kawasaki disease". Lipids Health Dis. 14: 166. doi:10.1186/s12944-015-0167-2. PMC 4696131. PMID 26714775.