Haemolytic uraemic syndrome

Question 1

definition of petechiae and purpura

Answer 1

both do not blanch when pressure is applied
petechiae are pin point spots
purpura are larger non blanching spots

Question 2

history

Answer 2

immunisation status
rapid onset?
medications - prior treatment with antibiotics may mask bacterial infection
high risk groups - immunosupression, previous invasive bacterial infections
history of trauma/injury
association with bleeding, abdominal pain, joint pain, difficulty mobilising
travel
sick contacts

Question 3

examination

Answer 3

abnormal vital signs
cold shock
warm shock
altered conscious state
limb tenderness or difficulty mobilising
hepatomegaly or splenomegaly
lymphadenopthy
swelling or erythema of joints

Question 4

DDx of purpura/petechiae presentations

Answer 4

viral
bacteriaal
mechanical: vomiting or coughing (occurs in the distribution of the vena cava which is above the level of the nipples), local physical pressure, NAI
haematological: ITP, malignancy including acute leukaemia, aplastic anaemia, DIC, haemolytic uraemic syndrome
other: HSP, vasculitis, drug induced

Question 5

purpura >2mm on lower limbs and buttocks +- joint pain/swelling, +-abdominal pain

Answer 5

HSP

Question 6

haemolytic uraemic syndrome is characterised by

Answer 6

microangiopathic haemolytic anaemia (destruction of red blood cells)
acute renal failure
thrombocytopaenia
HUS is among the commonest causes of acute renal failure in children
mortality of 5-10%

Question 7

causes of HUS

Answer 7

infectious and non infectious causes

Question 8

infectious caises of HUS

Answer 8

post darrhoeal illness
strep pneumoniae

Question 9

non infectious causes of HUS

Answer 9

complement defects
familial causes
medications
immune mediated
malignancy
hereditary (inborn error of cobalamin deficiency)
connective tissue disease
other glomerulonephridities

Question 10

Hx of HUS

Answer 10

oliguria
haematuria
anaemia
oedema
renal fialure
hypertension
pneumococcal assoicated HUS usually present with pnuemonia
MI, stroke, pancreatitis, liver necrosis, encephalopathy and seizure have also been described

Question 11

management

Answer 11

admit
manage fluid status, check for altered consciousness, diurese is hypertensive, analgesia for abdominal pain, antibiotics if there is pneumonia
paediatric renal team and general surgeon should be consulted early