haemolytic uraemic syndrome

Question 1

Define haemolytic uraemic syndrome (HUS)

Answer 1

HUS is characterised by microangiopathic haemolytic anaemia, thrombocytopenia and acute kidney injury
90% results from shiga toxin producing E.COli
atypical HUS-mainly in children
abnormalities in completent pathway

Question 2

Aetiology and risk factors of haemolytic uraemic syndrome (HUS)

Answer 2

Most of the time caused by shiga producing E.coli-esp if epidemic
streptococcus can also cause HUS
Familal HUS is a thing
can also result from drug exposure, pregnancy

shiga toxin causes It by exposing basement membrane resulting in abnormal immune response-thrombosis, fragmentation of RBC, thrombocytopenia

Risk factors
E.coli-children under 5
community outbreak of ecoli
bone marrow transplant, ciclosproin

Question 3

Epidiemology of haemolytic uraemic syndrome (HUS)

Answer 3

HUS most common in children under 5
Lower incidence as get older
2-3 per 100 000
15% of children with STEC get HUS-5-10 days after
was endemic in 2017, esp in uk -550 cases, 5% got HUS

other forms are even rarer

Question 4

Signs and Sx of haemolytic uraemic syndrome (HUS)

Answer 4

E.coli related-
nearly always in children under 5
and preceded (5-10days) by diarrhoea (often bloody)
Abdo pain

Hard diagnosis clinically-rely on FBC to get a proper indication

also want to suspect and check in anyone with risk factors (pregnancy, ciclosporin use, etc)

Sx of thrombocytopenia and anaemia
Signs of heamolytic aneamia-JAUDICE, purpura

Question 5

Investigations of haemolytic uraemic syndrome (HUS)

Answer 5

FBC-
Anemia
Thrombocytopenia

Blood film-fragmented red cells-shicstocytes

U&E-sign of AKI-raised creatinine
Electrolytes can be whack due to diarrhoea and AKI

Urine dip-heamaturia, proteinuria

check PT/APTT-in case of DIC

LDH (enzyme from RBC-sign of heamolytic aneamia)-raised

Stool culture to detect e.colis/streptococcus