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Volume 24, Number 5—May 2018
Dispatch

Heartland Virus and Hemophagocytic Lymphohistiocytosis in Immunocompromised Patient, Missouri, USA

Abigail L. CarlsonComments to Author , Daniel M. Pastula, Amy J. Lambert, J. Erin Staples, Atis Muehlenbachs, George Turabelidze, Charles S. Eby, Jesse Keller, Brian Hess, Richard S. Buller, Gregory A. Storch, Kathleen Byrnes, Louis Dehner, Nigar Kirmani, and F. Matthew Kuhlmann
Author affiliations: Veterans Affairs St. Louis Health Care System, St. Louis, Missouri, USA (A.L. Carlson); Washington University School of Medicine, St. Louis (A.L. Carlson, C.S. Eby, J. Keller, B. Hess, R.S. Buller, G.A. Storch, K. Byrnes, L. Dehner, N. Kirmani, F.M. Kuhlmann); Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (D.M. Pastula, A.J. Lambert, J.E. Staples); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (D.M. Pastula, A. Muehlenbachs); Missouri Department of Health and Senior Services, Jefferson City, Missouri, USA (G. Turabelidze)

Main Article

Table 1

Selected laboratory values of immunocompromised patient leading to diagnoses of Heartland virus and hemophagocytic lymphohistiocytosis, Missouri, USA*

Test type
 Reference range
 4 mo before symptom onset
 Post–symptom onset day
6
 8
 11
 18
 20
Leukocyte count, × 103 cells/µL 3.8–9.8 13.7 5.8 5.00 1.60 0.2 NR
Absolute neutrophil count, cells/µL 1,800–6,600 7,400 5,000 4,100 1,200 <100 NR
Absolute lymphocyte count, cells/µL 1,200–3,300 3,300 700 500 400 100 NR
Hemoglobin, g/dL 13.8–17.2 12.1 11.8 10.5 7.1 7.0 NR
Hematocrit, % 40.7–50.3 36.4 32.5 30.5 21.2 21.2 NR
Platelets, × 103/µL 140–440 202 76 42 47 19 NR
International normalized ratio 0.90–1.20 1.06 1.0 1.19 1.15 1.47 NR
Partial thromboplastin time, s 25.0–37.0 46 40 53.1 56.6 39.7 38.3
Lactate dehydrogenase, units/L 100–250 NR 422 641 3040 NR NR
Haptoglobin, mg/dL 27–220 NR NR 208 227 NR NR
Ferritin, ng/mL 22–322 NR NR 6,308 53,666 NR NR
Fibrinogen, mg/dL 170–400 NR NR NR 215 NR NR
Sodium, mmol/L 135–145 139 128 141 141 138 136
Potassium, mmol/L 3.3–4.9 4.0 5.1 5.9 5.1 5.5 4.8
Carbon dioxide, mmol/L 22–32 27 13 15 16 21 25
Blood urea nitrogen, mg/dL 8–25 16 90 63 94 60 50
Creatinine, mg/dL 0.70–1.30 1.31 3.38 1.75 4.74 1.95† 1.80†
Troponin I, ng/mL 0.00–0.03 2.55 0.76 0.27 NR NR NR
Cholesterol, total, mg/dL 0–200 258 115 NR NR NR NR
Triglycerides, mg/dL 0–150 426 532 NR NR NR NR
Aspartate aminotransferase, units/L 11–47 32 231 147 684 NR 146
Alanine aminotransferase, units/L 7–53 17 186 112 118 NR 52
Alkaline phosphatase, units/L 38–126 85 60 65 111 NR 65
Bilirubin, total, mg/dL 0.3–1.1 0.3 0.1 0.2 0.2 NR 0.7
Bilirubin, direct, mg/dL 0.0–0.3 0.1 0.1 NR 0.2 NR NR
Amylase, units/L 28–100 NR 234 NR NR NR NR
Lipase, units/L 0–99 NR 578 NR NR NR NR
pH 7.35–7.45 NR 7.31 7.17 7.24 7.42 7.32
PaCO2, mm Hg 35–45 NR 21 41 38 36 47
PaO2, mm Hg 80–105 NR 125 93 108 159 96
Temperature, °C 35.5–38.3 NR 36.6 38.9 38.2 37.3 35.4
FiO2 0.21 NR 0.40 0.40 NR 0.40 NR

*FiO2, fraction of inspired oxygen; NR, not reported; PaCO2, arterial partial pressure of carbon dioxide; PaO2, arterial partial pressure of oxygen.
†On continuous venovenous hemodialysis.

Main Article

Page created: April 17, 2018
Page updated: April 17, 2018
Page reviewed: April 17, 2018
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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