Table.
Laboratory and clinical course of 6 patients with acute hemolytic anemia from presumed L. reclusa toxin exposure. All laboratory values are at clinical presentation except for the hemoglobin nadir (Lowest Hb), peak reticulocyte count, and the maximum total bilirubin value (Peak T Bili).
| Patient 1 17 y/o AAF |
Patient 2 16 y/o AAM |
Patient 3 13 y/o AAM |
Patient 4 12 y/o AAF |
Patient 5 13 y/o AAF |
Patient 6 14 y/o AAF |
|
|---|---|---|---|---|---|---|
| Initial Hb (gm/dL) | 4.8 | 12.9 | 8.8 | 6.5 | 4.9 | 13.7 |
| Lowest Hb (gm/dL) | 4.8 | 7.1 | 8.7 | 5.6 | 4.5 | 5.9 |
| Initial Reticulocytes × 109/L (%) |
25 (1.6%) | 41 (1.1%) | 181 (6.3%) | 177 (8.3%) | 207 (14.6%) | 125 (4.2%) |
| Peak Reticulocytes × 109/L (%) |
255 (8.3%) | 229 (8.8%) | 226 (7.4%) | 222 (11.7%) | 364 (15.1%) | 155 (3.8%) |
| Platelets (× 109/L) | 260 | 182 | 535 | 383 | 344 | 222 |
| WBC (× 109/L) | 37.4 | 16.6 | 17.9 | 18.8 | 35.5 | 19 |
| ANC (× 109/L) | 34.4 | 11.0 | 9.7 | 11.8 | 20.6 | 14.8 |
| Peak T Bili (mg/dL) | 13.8 | 7.2 | 3.2 | 3.2 | 2.7 | 15.1 |
| LDH (U/L) | Not available | Not available | Not available | 4656 | 483 | 2611 |
| DAT | Positive | Positive | Positive | Positive | Positive | Positive |
| Surface IgG | Trace | Positive | − | − | − | Positive |
| Surface C3 | 3+ | Positive | 2+ | 1+ | 3+ | Positive |
| Hospital admission | ICU | Inpatient | Inpatient | Inpatient | ICU | ICU |
| BP Support | IV fluids, Dopamine |
Not required | Not required | Not required | IV fluids, Dopamine |
IV fluids |
| PRBC Transfusion | 4 units | 2 units | Not required | Not required | 1 unit | 5 units |
| Surgical wound care | I&D | Bedside Debride | Not required | Not required | Not required | Not required |