Pediatric emergency medicine trisk 1683 1683
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TABLE 85.2
POSSIBLE LABORATORY EVALUATION OF SERUM SICKNESS a
Blood tests
Erythrocyte sedimentation rate
Complete blood cell count with differential
CH5 O, C3, C4
Blood urea nitrogen, creatinine
Antinuclear antibody
Rheumatoid factor
Hepatic enzymes
Hepatitis B screen
Heterophile antibody
Immune complex assay
Other laboratory tests
Urinalysis
Electrocardiogram
Stool heme test
Computed tomography scan
a Laboratory
evaluation should be tailored for each individual patient as noted in the text.
The erythrocyte sedimentation rate may be elevated and a CBC with
differential may reveal leukopenia or leukocytosis. The C3, C4, and CH50 may be
low secondary to complement activation and tests of circulating immune
complexes (e.g., cryoglobulins) may be elevated. Stool testing for blood should
be considered for patients with abdominal pain or other signs of gastrointestinal
involvement. The initial evaluation of carditis should include an
electrocardiogram and chest radiograph as well as point-of-care cardiac
ultrasound based on clinician expertise. A formal echocardiogram may be
considered based on findings from these tests and in consultation with a
cardiology specialist. Severe headache or focal neurologic deficits are indications
for neuroimaging, usually a computed tomography scan. Serum sickness–like
reactions will not be accompanied by hypocomplementemia or renal dysfunction.
Management
