Jeremy W Jacobs 1 , Lisa Bastarache 2 , Mary Ann Thompson 1 Show Affiliations »
Abstract
OBJECTIVES: To develop a sensitive and specific protocol for detecting preclinical hemolysis in patients with brown recluse spider (BRS) bites by comparing a large cohort of individuals with brown recluse spider (BRS) bites with and without hemolytic anemia. METHODS: A cross-sectional, retrospective analysis of clinical features and laboratory values, including urinalysis (UA) and peripheral blood results, and timing of positive laboratory values prior to a significant drop in hematocrit was performed to evaluate effective predictors of clinically significant hemolysis. RESULTS: In total, 275 patients with BRS bites were identified (64 with hemolytic anemia). Sensitivity and specificity of UA positive for blood (with and without microscopic hematuria) for detecting hemolysis were 72% and 75%, respectively. The combination of elevated serum total bilirubin (TB) and lactate dehydrogenase (LDH) had greater sensitivity (94%) and specificity (91%) for detecting patients developing hemolysis. When TB and LDH were evaluated prior to a significant decrease in hematocrit, they were positive in 82% of cases, while UA was positive for blood prior to a hematocrit decrease in 38% of cases. CONCLUSIONS: Serum TB and LDH levels are more effective at detecting preclinical hemolysis than UA and should be serially analyzed to triage patients with BRS bites before life-threatening hemolysis occurs. © American Society for Clinical Pathology, 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
OBJECTIVES: To develop a sensitive and specific protocol for detecting preclinical hemolysis in patients with brown recluse spider (BRS) bites by comparing a large cohort of individuals with brown recluse spider (BRS) bites with and without hemolytic anemia. METHODS: A cross-sectional, retrospective analysis of clinical features and laboratory values, including urinalysis (UA) and peripheral blood results, and timing of positive laboratory values prior to a significant drop in hematocrit was performed to evaluate effective predictors of clinically significant hemolysis. RESULTS: In total, 275 patients with BRS bites were identified (64 with hemolytic anemia). Sensitivity and specificity of UA positive for blood (with and without microscopic hematuria) for detecting hemolysis were 72% and 75%, respectively. The combination of elevated serum total bilirubin (TB) and lactate dehydrogenase (LDH) had greater sensitivity (94%) and specificity (91%) for detecting patients developing hemolysis. When TB and LDH were evaluated prior to a significant decrease in hematocrit, they were positive in 82% of cases, while UA was positive for blood prior to a hematocrit decrease in 38% of cases. CONCLUSIONS: Serum TB and LDH levels are more effective at detecting preclinical hemolysis than UA and should be serially analyzed to triage patients with BRS bites before life-threatening hemolysis occurs. © American Society for Clinical Pathology, 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Entities: Chemical
Keywords:
zzm321990 Loxosceles reclusazzm321990 ; Brown recluse spider; Hemolysis; Hemolytic anemia; Loxoscelism
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Year: 2022
PMID： 34643670 DOI： 10.1093/ajcp/aqab169
Source DB: PubMed Journal: Am J Clin Pathol ISSN： 0002-9173 Impact factor: 2.493