Table 1 Laboratory and imaging tests on admission
From: Hemophagocytic lymphohistiocytosis after COVID-19 vaccination
Tests on admission | Results | Normal ranges |
|---|---|---|
Complete blood count | ||
White blood cell (109/L) | 1.26 | 3.5–9.5 |
Neutrophil count (109/L) | 0.70 | 1.8–6.3 |
Lymphocyte count (109/L) | 0.49 | 1.1–3.2 |
Hemoglobin (g/L) | 113 | 130–175 |
Platelet (109/L) | 27 | 125–350 |
Reticulocyte count (1012/L) | 0.04 | 0.024–0.084 |
Coagulation | ||
APTT (s) | 61.6 | 28.0–43.5 |
PT (s) | 13.9 | 11.0–16.0 |
Thrombin time (s) | 39.9 | 14.0–21.0 |
Fibrinogen (g/L) | 1.41 | 2.0–4.0 |
D-Dimer (mg/L) | 6.80 | < 0.5 |
Hepatic and renal function | ||
ALT (U/L) | 141 | 5–35 |
AST (U/L) | 254 | 8–40 |
Total bilirubin (μmol/L) | 7.1 | 3–22 |
Direct bilirubin (μmol/L) | 0.0 | 0–5 |
Lactate dehydrogenase (U/L) | 1033 | 109–245 |
Albumin (g/L) | 27.2 | 35–50 |
Globulin (g/L) | 27.1 | 23–32 |
Blood urea nitrogen (mmol/L) | 2.43 | 2.5–6.1 |
Creatinine (μmol/L) | 54.0 | 46.0–92.0 |
Fasting lipid | ||
Triglycerides (mmol/L) | 2.43 | < 1.7 |
Total cholesterol (mmol/L) | 2.44 | < 5.2 |
HDL-C (mmol/L) | 0.45 | 1.29–1.55 |
LDL-C (mmol/L) | 1.05 | 2.7–3.1 |
Lymphocyte subsets | ||
CD4+ T cells (%) | 17.67 | 25.34–51.37 |
CD8+ T cells (%) | 71.72 | 14.23–38.95 |
NK cells (%) | 3.78 | 3.33–30.47 |
NK cell cytotoxicity-granzyme (%) | 50.13% | > 78% |
NK cell cytotoxicity-perforin (%) | 60.83% | > 84% |
Inflammatory factors | ||
Ferritin (μg/L) | 8140.4 | 4.6–204.0 |
hsCRP (mg/L) | 10.75 | 0–5 |
sCD25 (pg/ml) | 204.99 | 3.71–16.05 |
IL-1β (pg/ml) | 8.21 | < 3.40 |
IL-2 (pg/ml) | 0.76 | < 6.64 |
IL-4 (pg/ml) | 1.67 | < 4.19 |
IL-6 (pg/ml) | 17.55 | < 5.30 |
IL-8 (pg/ml) | 90.41 | < 15.71 |
IL-10 (pg/ml) | 18.45 | < 4.91 |
IL-12p70 (pg/ml) | 0.00 | < 10.18 |
IL-17A (pg/ml) | 2.33 | < 4.74 |
IL-17F (pg/ml) | 0.19 | < 4.66 |
IL-22 (pg/ml) | 0.4 | < 3.64 |
TNF-α (pg/ml) | 3.96 | < 4.50 |
TNF-β (pg/ml) | 17.63 | < 2.54 |
INF-γ (pg/ml) | 1.86 | < 4.43 |
Complement 3 (g/L) | 0.625 | 0.790–1.520 |
Complement 4 (g/L) | 0.182 | 0.160–0.380 |
Virus | ||
Whole blood EBV DNA (copy/ml) | 2.47 × 105 | < 400.00 |
Plasma EBV DNA (copy/ml) | 824 | < 400.00 |
EB-VCA IgA (AU/ml) | 0.79 | < 4.00 |
EB-VCA IgM (AU/ml) | 0.45 | < 3.00 |
EB-VCA IgG (AU/ml) | > 50.00 | < 2.00 |
EB-VEA IgA (AU/ml) | 0.44 | < 3.00 |
EB-VEA IgG (AU/ml) | 0.36 | < 2.00 |
EB-VNA IgG (AU/ml) | > 50.00 | < 2.00 |
Whole blood CMV DNA (copy/ml) | < 400.00 | < 400.00 |
Plasma CMV DNA (copy/ml) | < 400.00 | < 400.00 |
SARS-CoV-2 RNA | Negative | Negative |
Anti-SARS-CoV-2 IgM | Negative | Negative |
Anti-SARS-CoV-2 IgG | Negative | Negative |
Hepatitis B surface antigen | Negative | Negative |
Hepatitis C virus antibody | Negative | Negative |
HIV antibody | Negative | Negative |
Anti-nuclear antibody spectrum | Negative | Negative |
Hemophagocytosis in bone marrow | Positive | Negative |
Superficial lymph nodes (Ultrasonography) | Negative imaging | Negative imaging |
Color Doppler echocardiography | Negative imaging | Negative imaging |
Chest CT scan | Negative imaging | Negative imaging |
Abdominal CT scan | Negative imaging | Negative imaging |
Pelvic CT scan | Negative imaging | Negative imaging |
HLH-associated genes | Wild type | Wild type |
HLH-2004 diagnostic criteria | 6 of the 8 criteria | Cut-off: 5 of the 8 criteria |
HLH-probability calculator (HScore) | 261 | Cut-off: 169 |