A 7 year old unwell child presents with a diarrhoeal illness. Her FBC and UEC show anaemia, thrombocytopaenia and renal failure. There is evidence of infection ( elevated WCC). These results are classic of
Haemolytic Uraemic syndrome
Other DDX include:
Inflammatory Bowel disease
HSP
Intussusception
Sepis
TTP
Vasculitis
Investigations:
Blood film – Schistocytes (fragmented RBC)
urine – Protein, blood
Blood Cultures, stool cultures
Haemolysis (MAHA) – elevated LDH, low haptoglobin, elevated plasma free Haemoglobin (this mops up the haptoglobin), elevated unconjugated bilirubin.
Coombs test -ve => non immune cause
Coagulation Profile – normal PT, PTT (excludes DIC)
HUS – commonest cause of acute renal failure in childhood
Cause:
Infection – E Coli 0157:H7 (also O104:H4); Shigella, Campylobacter, pneumococcal, viruses
Agent – Shiga toxin or shiga like toxin is thought to be the main agent involved
Source – contaminated water or foodborne
Treatment – supportive, dialysis, plasmapheresis
Prognosis – high mortality during acute phase (up to 25%), up to 50% may develop CRF