Pathophysiology
- A type of microangiopathic haemolytic anaemia (MAHA)
- EColi strain O-157 (90% of cases) → produces verotoxin → verotoxin attack endothelial cells → endothelial damage triggers thrombosis, platelet consumption and fibrin deposition, mainly in renal vasculature → fibrin strands mechanically destruct passing RBCs → Haemolytic anaemia, thrombocytopaenia and AKI
Aetiology
- Shiga toxin-producing Escherichia coli (STEC) typically strain O157; (contaminated meat; typically in summer months)- typically associated with bloody diarrhoea
- Non-Shiga toxin-related- neuraminidase produced by streptococcal species; bloody diarrhoea not typical
- Other sporadic and secondary causes
Signs and symptoms
- Colitis (abdominal pain and bloody diarrhoea) →haemoglobinuria→oliguria ± CNS signs→encephalopathy→coma.
- LDH↑, WCC↑, Coombs −ve, PCV↓
Management
- Supportive with IV crystalloid fluids and treat AKI
- Avoid antibiotics
- Blood transfusion
- Early dialysis
Meticulous fluid balance and monitoring is essential in these patients. Diarrhoea is the most common presentation. Careful fluid resuscitation based on fluid balance will be needed to treat AKI and replace fluid. If fluid resuscitation is not carefully performed based on input/output chart, patient may become overloaded due to their poor kidney function.