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Erika Franz-O’Neal
PGY-2 Pediatric Resident
Definition of Anemia
• Hgb < 13.5 within the first month of life
• Anemia worse than what you would expect with physiologic
nadir (hgb <9)
• After 1 year of age, Varies with age and ethnicity
• Differential Diagnosis?
• Additional Labs?
Labs
• Frac Bilirubin: total bili 3.0, indirect bili 2.2
• LDH: >1000
• Haptoglobin: <8 (not reliable in infants < 18 months)
• Plasma free hgb: not done
• CMP:
• Na 138
• K 4.5
• Cr .7
• BUN 26
• LFTS WNL
• Protein 6 (low)
• UA: 3+ protein, large hgb
• UR protein/Cr ratio 5.8 mg/mg
• No diarrhea, could not get GI PCR
• Blood smear: normocytic, normochromic anemia with frequent
schistocytes
Kidney biopsy
THROMBOTIC MICROANGIOPATHY.
ACUTE TUBULAR INJURY.
FOCAL TUBULAR ATROPHY AND SLIGHT TO MODERATE
INTERSTITIAL FIBROSIS.
Patient Z
• Most likely typical HUS
• Did have diarrheal illness that resolved 1 week before
hospitalization
• Could not rule out atypical HUS so will need long term follow
up
• Platelets were confusing so obtained renal biopsy
• Got RBC transfusion and did great! Went on vacation 2 days
later after 3 days in the hospital
Due to copyright images were removed. See overview of
hemolytic anemias in children at UpToDate.