Anthrax laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Laboratory abnormalities common in systemic anthrax include: 1) anemia, thrombocytopenia and leukocytosis, particularly in latter stages of the disease; 2) decreased sodium level and increased BUN,;3) elevated transaminase levels and hypoalbuminemia; 4) inflammatory pattern with a low CRP, typical of injection anthrax; 5) identification of the organism, and possibly toxins, in cell cultures from blood, CSF, pleural fluid, among others; 6) and elevated troponin levels. A normal PT/PTT at admission does not exclude coagulopathy nor DIC.

Laboratory Findings

The following tests are used in the diagnosis and monitoring of systemic anthrax:

Laboratory findings

Test	Initial Findings	Serial Monitoring
CBC	Hemoconcentration Possible thrombocytopenia Leukocyte count commonly normal	Anemia Thrombocytopenia Leukocytosis (late in disease)
Electrolyte Renal Panel	Decreased sodium level Increased BUN
Liver Enzymes Serum Albumin	Elevated transaminase levels Hypoalbuminemia
PT PTT D-dimer Fibrinogen	Normal PT/PTT does not exclude DIC or coagulopathy	Low threshold for hypercoagulability workup: Haptoglobin LDH Fibrin split products ADAMTS 13 if hemolytic anemia
C-Reactive Protein	Characterization of inflammatory response Typically low CRP in injection anthrax
Gram stain Cultures Toxic Assays	Blood Serum CSF Pleural fluid Ascites Wound exudate Bronchial exudate	Cultures usually negative after antibiotics Toxins may be detected
Cardiac Enzymes BNP	Troponin leak caused by increased cardiac demand from infection (particularly if atrial fibrillation with rapid ventricular response)