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February 10, 2010
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Hemolytic Uremic Syndrome (cont.)

What are the signs and symptoms of hemolytic uremic syndrome?

In E. coli-related HUS, gastroenteritis occurs with abdominal cramping, vomiting and profuse bloody, watery diarrhea. This may cause significant dehydration, weakness and lethargy, as well as electrolyte imbalances because of the loss of sodium and potassium in the vomit and diarrhea. These symptoms tend to resolve before the onset of HUS.

The anemia and uremia usually present with weakness, lethargy, and sleepiness. Purpura or small bleeding areas in the skin may be seen because of low platelet counts.

How is hemolytic uremic syndrome diagnosed?

The healthcare provider will have a suspicion of the disease based on the history and physical examination. Abnormal laboratory tests help confirm the diagnosis. They include:

  • Hemolytic anemia: the red blood cell count is low and a peripheral blood smear, in which blood is examined under a microscope, will show that the red cells have been damaged and destroyed. This differentiates hemolysis (hemo=blood + lysis=destruction) from anemia caused by decreased production of blood cells in the bone marrow.

  • Thrombocytopenia: a low platelet count

  • Uremia: Kidney function can be measured by testing the level of waste products in the blood normally filtered by the kidney. Creatinine is a breakdown product of a muscle protein called creatine .When this level rises, it is an indication of kidney failure or uremia.

  • Abnormal urine findings: Blood and protein may be found in the urine when normally they are not present.

  • Stool cultures: Since E. coli O157:O7 is the most common cause of HUS, attempts are made to culture the bacteria from stool samples. The body usually clears the bacteria from the stool within a week, so a negative test does not exclude the disease. A positive test helps confirm HUS and will be reported to public health authorities to try to determine the source of the infection. Recent public health success stories in the news include tracking down tainted spinach from a single farm in California that sickened many around the country.

One of the distinguishing findings between HUS and TTP is a normal neurologic examination. The brain function is normal in HUS.



Next: What is the treatment for hemolytic uremic syndrome? »

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