Table 1.

Diagnostic timeline

TestPatient ResultReference Range
Day 1Day 5Day 10Day 20Day 30Day 50
WBC20.214.59.66.58.69.04.5–11 X 103/uL
RBC2.48*2.182.442.532.642.864.0–5.4 X 106/uL
HGB7.6*6.57.58.28.59.212.0–16.0 g/dL
HCT24.0*19.623.226.227.929.636.0%–47.0%
PLT46*52121143156186150–450 X 103/uL
DIFF↑ PMN*↑ PMN↑ PMN1 meta, 1 myelo
RBC morphology1+ poly1+ decryoOcc. Shisto*2+ aniso1+ polyOcc. Shisto2+ aniso1+ polyOcc. Shisto3+ aniso1+ macro1+ stomato1+ decryoOcc. Shisto3+ aniso1+ macroOcc. Shisto
INR0.9§1.31.3 1.0
APTT23.5§33.233.2 25.1–36.5 s
FIB229292635 200–400 mg/dL
FDP>5, <20 <5 ug/mL
SUN31*6920299207–18 mg/dL
CR1.9*3.52.67.24.26.50.6–1.3 mg/dL
ALT79*28191312 13–56 U/L
AST257*59282223 15–37 U/L
LDH746* 778439414 84–246 U/L
CK-MB Low MI probability No evidence of acute MI
Troponin I Low MI probability Developing or subclinical MI
BNP 991 2744 <125 pg.mL
C3 107.0 84.4 90–180 mg/dL
C4 25.7 11.4 10–40 mg/dL
Haptoglobin 8 40–240 mg/dL
Shiga Toxin I Neg Negative
Shiga Toxin 2 Neg Negative
Cl. Diff.Neg Negative
ADAMTS13 20# >60%
Renal biopsy Changes consistent with toxemia of pregnancy with progression to frank TMA. Given history of recent pregnancy, this most likely represents HELLP syndrome. However, HUS, aHUS, and TTP cannot be excluded.
  • * TMA suggested

  • DIC ruled out

  • HUS ruled out

  • § antiphospholipid antibody syndrome ruled out

  • aHUS falsely ruled out

  • # TTP falsely suggested

  • Abbreviations: MI, myocardial infarction