Cholesterol emboli syndrome laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Laboratory Findings
Blood and urine
Tests for inflammation (C-reactive protein and the erythrocyte sedimentation rate) are typically elevated, and abnormal liver enzymes may be seen.[1] If the kidneys are involved, tests of renal function (such as urea and creatinine) are elevated. The complete blood count may show particularly high numbers of a type of white blood cell known as eosinophils (more than 0.5 billion per liter); this occurs in only 60-80% of cases, so normal eosinophil counts do not rule out the diagnosis.[2] Examination of the urine may show red blood cells (occasionally in casts as seen under the microscope) and increased levels of protein; in a third of the cases with kidney involvement, eosinophils can also be detected in the urine. If vasculitis is suspected, complement levels may be determined as reduced levels are often encountered in vasculitis; complement is a group of proteins that forms part of the innate immune system. Complement levels are frequently reduced in cholesterol embolism, limiting the use of this test in the distinction between vasculitis and cholesterol embolism.[3]
- Organ specific damage
- Renal failure - rapidly progressive in many cases greenberg
- Myocardial infarction - serum creatine kinase (CPK) and troponin elevation
- Mesenteric ischemia - Bloody (OB+) stool common
- Stroke
- Full septic picture may ensue
- Adult Respiratory Distress Syndrome (ARDS) greenberg
- Microangiopathic hemolysis (disseminated intravascular coagulopathy)
- Hypotension is usually a late finding
Electrolyte and Biomarker Studies
- Peripheral eosinophilia moolenaarneth
- Urinary eosinophilia - usually in patients with cholesterol-renal disease
- May have leukocytosis (even >20K/µL) with left shift
- Hypocomplementemia is common
- Sed rates are nonspecifically elevated
- Thrombocytopenia due to aggregation and complement activation