Hemolytic-uremic syndrome laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anila Hussain, MD [2]

Overview

An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal for patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

Laboratory Findings

Following Lab findings are seen in HUS:

• Microangiopathic Hemolytic Anemia with features as follows:
  • Low Hemoglobin level Often < 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)
• 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
  • Blood / Red blood cells
  • Protein
  • Bilirubin
  • WBC
  • Casts
• 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