From the Guidelines
Diagnostic Workup for Hemolytic Uremic Syndrome (HUS)
Hemolytic Uremic Syndrome (HUS) diagnosis should start with a thorough medical history and physical examination. Initial laboratory tests should include a complete blood count (CBC), blood smear to check for red blood cell fragmentation, renal function tests, and electrolyte panel 1.
Key Laboratory Tests
- Frequent monitoring of hemoglobin and platelet counts is crucial as a decreasing platelet count trend during the diarrheal illness can indicate a higher risk of developing HUS 1.
- Electrolytes, blood urea nitrogen (BUN), and creatinine levels should be monitored closely to detect early manifestations of HUS and renal injury, especially in patients with diagnosed E. coli O157 or another Shiga toxin-producing E. coli (STEC) infection 1.
- A peripheral white blood cell count and differential may provide clues about the etiology, though it's not recommended for establishing the diagnosis of infectious diarrhea or enteric fever 1.
Additional Diagnostic Considerations
- Serologic tests may be considered for patients with postdiarrheal HUS if a stool culture did not yield a Shiga toxin–producing organism, though their utility is generally limited 1.
- Endoscopy or proctoscopic examination may be useful in specific cases, such as persistent unexplained diarrhea in patients with AIDS or those with clinical colitis or proctitis, but is not a standard part of the HUS workup 1.
- Imaging studies like ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI) may be considered to detect complications such as aortitis, mycotic aneurysms, or signs of peritonitis, especially in older patients with invasive Salmonella or Yersinia infections 1.
Management
Supportive care, including hydration and monitoring of electrolytes, is essential. In severe cases, plasma exchange may be considered. The dose and duration of any treatment should be individualized based on the patient's condition and response to therapy. Close monitoring of the patient's renal function, hemoglobin, and platelet count is necessary to guide management 1.
From the Research
Diagnostic Workup for Hemolytic Uremic Syndrome (HUS)
There are no research papers to assist in answering this question as the provided studies do not specifically discuss the diagnostic workup for Hemolytic Uremic Syndrome (HUS). However, the studies emphasize the importance of:
- History taking and physical examination in making medical diagnoses 2, 3, 4, 5
- Laboratory investigations and diagnostic imaging in supporting the diagnosis and increasing physician confidence 5, 6 Some key points from the studies include:
- The history and physical examination have been the foundation of medical diagnosis for centuries 4
- Most diagnoses are made from the medical history, with the physical examination and laboratory investigation playing a supporting role 5
- A thorough patient history and physical examination can help narrow down or establish a diagnosis, and are essential components of patient evaluation 2, 3
- Laboratory tests and diagnostic imaging can be used to confirm a diagnosis and exclude other possibilities 5, 6