Autoimmune Hemolytic Anemia following Septic Shock with Escherichia Coli; a Case Report

Sepsis is a severe, life-threatening illness caused when the immune system responds inappropriately to infections, causing organ deterioration and negatively affecting the systems inside the body, one of which is the coagulation system. Most hematologic changes in red blood cells (RBCs) are non-antibody-mediated hemolytic anemia (NAHA). Autoimmune hemolytic anemia (AIHA) is a rare condition, challenging in diagnosis, requiring prompt recognition and management. Warm hemolytic anemia has recently been reported in patients with septic shock. This report presents a sepsis-induced autoimmune hemolytic anemia case. A 44-year-old Vietnamese female with no chronic disease came to the emergency department because of sudden periumbilical colicky pain after consuming a fresh garden salad. The abdominal pain appeared nine hours after the meal, following vomiting. Twelve hours later, she developed diarrhea, subsequently a fever, and chills. She was admitted to the emergency department in the fifteenth hour of the first symptom. Septic shock, multiple organ failure, and warm autoimmune hemolysis were all present in the patient. Hemolytic anemia and multiorgan failure made the situation worse, leading to death. Autoimmunity hemolytic anemia in sepsis or septic shock is rare, but treating both emergency hemolytic anemia and potential infectious etiology is crucial in acute situations.

Community-acquired necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus in a healthy pregnant woman after being infected with influenza A: A case report for early warning

A previously healthy woman, 5 weeks pregnant, was admitted to the intensive care unit in critical condition for septic shock and acute respiratory distress syndrome due to methicillin-resistant Staphylococcus aureus (MRSA) after being infected with Influenza for 3 days. The patient in this case suffered from severe sequelae due to necrotizing pneumonia and later died on the 20th day after admission. We would like to remind clinicians to be aware of this rare but serious diagnosis. The key is to begin appropriate treatment immediately because MRSA necrotizing pneumonia is mediated by toxins and once the toxins are released they cannot be limited by antibiotic treatments. Necrotizing pneumonia related to MRSA should be considered in young patients with pneumonia, sepsis, and neutropenia following seasonal influenza infection with rapidly progressive symptoms.

Urinary Liver-Type Fatty Acid Binding Protein (L-FABP) in Early Detection and Outcome Prediction of Sepsis-Associated Acute Kidney Injury

Introduction

Acute kidney injury (AKI) is one of the most frequent complications in septic shock cases, and has a high mortality rate. The aim of this study was to determine the value of urinary liver-type fatty acid binding protein (L-FABP) in early detection and outcome prediction of AKI in patients with sepsis and septic shock.

Methods

This prospective cohort study was conducted on patients who presented to the emergency department (ED) with sepsis or septic shock. Urinary L-FABP levels were measured at the time of admission and patients were classified into AKI and non-AKI groups within 7 days according to the KIDGO Criteria. The screening performance characteristics of urinary L-FABP in early detection of AKI within seven days of admission and need for renal replacement therapy (RRT) were calculated and reported.

Results

212 patients with the mean age of 66.5 ± 16.2 (range 18-99) years were included (60.4% male). 54 (25.5%) patients had sepsis, and septic shock was developed in 158 (74.53%) cases. 143 (67.5%) patients were complicated with AKI. The area under the receiver operating characteristic (ROC) curve (AUC) of urinary L-FABP in early detection of sepsis-associated AKI was 0.94 (95% confidence interval (CI): 0.90 - 0.97), compared to the AUC of 0.64 (95% CI: 0.54-0.74) for serum creatinine. The sensitivity and specificity of urinary L_FABP at its best cutoff point (13.90 μg L-FABP/g Cr) were 89.9% and 86.3%, respectively. The area under the ROC curve of urinary L-FABP in predicting the need for RRT in sepsis-associated AKI patients was 0.74 (95% CI: 0.64-0.85), compared to the AUC of 0.53 (95% CI: 0.41-0.64) for serum creatinine. The sensitivity and specificity of urinary L-FABP at its best cutoff point (22.05 μg L-FABP/g Cr) were 63.6% and 71.4%, respectively.

Conclusions

It seems that, L-FABP could be considered as a valuable biomarker for early detection and predicting the severity of AKI in septic patients.