Sinusoidal obstruction syndrome diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Diagnostic Criteria

The diagnosis of sinusoidal obstruction syndrome should be considered in any patient who has undergone hematopoietic cell transplant and develops liver dysfunction.

• The two established criteria for the clinical diagnosis of sinusoidal obstruction syndrome are:

LAB	FORMULA/ VARIABLE	NORMAL VALUE	VALUE IN HHS
Plasma glucose (mg/dL)	Direct measurement	< 200 mg/dl	> 600 mg/dl
Arterial pH	Blood pH	7.35-7.45	> 7.30
Anion gap	(Na+) – (Cl– + HCO3–)	7 to 13 (mEq/L)	Variable
Serum osmolality	2(Na + K) + (glucose/18) + (blood urea nitrogen/2.8)	285 to 295 mOsm/kg (285 to 295 mmol/kg) of water	Increased (> 320mOsm/kg)
Plasma ketones	Direct measurement	Negative	Trace or negative
Urine ketones	Direct measurement	Negative	Trace or negative
Serum bicarbonate	Direct measurement	23 - 29 mEq/L	> 18 mEq/L
Blood urea nitrogen (BUN), creatinine levels	N/A	BUN: 7-20 mg/dl Creatinine levels: 0.8-1.2mg/dl	Increased (Dehydration and decreased renal perfusion)