Haemolytic Uraemic syndrome

Question 1

Define:

Answer 1

Triad of: Thrombocytopenia, microangipathic haemolytic anaemia and acute renal failure

Can be D+ (with diarrhoea prodrome) or D-

Associated with TTP

Question 2

What are the symptoms of TTP:

Answer 2

Fever

CNS signs

Question 3

Risk factors/aetiology:

Answer 3

HUS toxin damages the endothelium leading to platelet activation and VWF recruitment. This leads to small thrombi

Causes:
E.coli O157 (90% of cases in children due to undercooked meat)
Shigella
HIV
COCP
cyclosporin 
5-flurouracil 
Malignancy/ malignant hypertension 
Scleroderma
SLE 
Pregnancy

Question 4

Epidemiology:

Answer 4

Uncommon
D+ in young children
TTP in females

Question 5

Symptoms:

Answer 5

Abdo colic
Water diarrhoea streaked with blood
Maliase
Fatigue 
Nausea
Fever (<38 degrees in D+)
Oliguria
Anuria
Haematuria

Question 6

Signs:

Answer 6

Jaundice 
Hypertension 
Pallor
Bruising 
Generalised oedema
Retinopathy
Abdo tenderness
Weakness*
Reduced vision*
Fits*
Reduced consciousness*
*CNS signs = TTP

Question 7

Investigations:

Answer 7

FBC (normal mcv, high neutrophils, very low platelets)
U+Es ( high urea + creatinine + potassium, low sodium)
Renal biopsy
ABG (low PH,PaCO2, and Bicarbonate)
Blood culture
Stool MC&S
Clotting- normal APTT and fibrinogen
Urine (1+ g protein in 24hrs + haematuria)
LFTS (high unconjuagted bilirubin + high LDH)