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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