24th July 2024

Haemolytic uraemic syndrome

HUS typically occurs in children and is associated with shiga-producing toxin which causes bloody diarrhoea. Cases presenting without diarrhoea can be labelled atypical HUS.

Clinical features of HUS

HUS is characterised by a triad of findings:

• Microangiopathic haemolytic anaemia
• Thrombocytopenia
• AKI

FBC will show low Hb and low platelet count; U&E will demonstrate renal dysfunction. A blood film is vital, as it will have evidence of haemolysis such as schistocytes. A clotting screen is useful to distinguish HUS from disseminated intravascular coagulation (DIC): PT and APTT are normal in HUS. A haemolysis screen should also be ordered, including haptoglobins (low), LDH (high), Coomb’s test (negative). If diarrhoea is present, a stool test should be ordered.

Management of HUS

Management is supportive, with IV fluids and blood pressure control. Around 50% of patients may need renal replacement therapy.