Diagnostic timeline
Test | Patient Result | Reference Range | |||||
---|---|---|---|---|---|---|---|
Day 1 | Day 5 | Day 10 | Day 20 | Day 30 | Day 50 | ||
WBC | 20.2 | 14.5 | 9.6 | 6.5 | 8.6 | 9.0 | 4.5–11 X 103/uL |
RBC | 2.48* | 2.18 | 2.44 | 2.53 | 2.64 | 2.86 | 4.0–5.4 X 106/uL |
HGB | 7.6* | 6.5 | 7.5 | 8.2 | 8.5 | 9.2 | 12.0–16.0 g/dL |
HCT | 24.0* | 19.6 | 23.2 | 26.2 | 27.9 | 29.6 | 36.0%–47.0% |
PLT | 46* | 52 | 121 | 143 | 156 | 186 | 150–450 X 103/uL |
DIFF | ↑ PMN* | ↑ PMN | ↑ PMN1 meta, 1 myelo | ||||
RBC morphology | 1+ poly1+ decryoOcc. Shisto* | 2+ aniso1+ polyOcc. Shisto | 2+ aniso1+ polyOcc. Shisto | 3+ aniso1+ macro1+ stomato1+ decryoOcc. Shisto | 3+ aniso1+ macroOcc. Shisto | ||
INR | 0.9§ | 1.3 | 1.3 | 1.0 | |||
APTT | 23.5§ | 33.2 | 33.2 | 25.1–36.5 s | |||
FIB | 229† | 292 | 635 | 200–400 mg/dL | |||
FDP | >5, <20† | <5 ug/mL | |||||
SUN | 31* | 69 | 20 | 29 | 9 | 20 | 7–18 mg/dL |
CR | 1.9* | 3.5 | 2.6 | 7.2 | 4.2 | 6.5 | 0.6–1.3 mg/dL |
ALT | 79* | 28 | 19 | 13 | 12 | 13–56 U/L | |
AST | 257* | 59 | 28 | 22 | 23 | 15–37 U/L | |
LDH | 746* | 778 | 439 | 414 | 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. |