Evolution of Laboratory Values in Patients With Kawasaki Disease

Abstract

BACKGROUND As outlined in the 2004 American Heart Association guidelines, the diagnosis of Kawasaki disease (KD) is supported by results of clinical laboratory studies. However, detailed information regarding the evolution of these results during illness has not been previously reported. The goals of this project were to characterize the evolution of clinical laboratory values in KD before and after treatment with intravenous immunoglobulin (IVIG). METHODS Laboratory values from 380 unselected, consecutive KD patients were analyzed at 3 times: acute (illness day 2-10, illness day 1= first day of fever and before IVIG), subacute (illness day 11-21) and convalescent (illness day 22-60). Results were stratified by IVIG response and coronary artery outcome. RESULTS While white blood cell count, percentage bands, erythrocyte sedimentation rate (ESR), and CRP values were highest and age-adjusted hemoglobin was lowest in the acute phase before IVIG, platelet count was highest in the subacute phase and percentage lymphocytes and eosinophils were highest in the convalescent phase after IVIG. KD patients with coronary artery aneurysms had a higher WBC count in the subacute phase and higher ESR in the subacute and convalescent phases compared with those with dilated or normal coronary arteries. CONCLUSIONS A consistent evolution of laboratory values is associated with KD before and after treatment. Understanding the dynamic changes in laboratory values can assist physicians in using laboratory criteria to diagnose KD following the American Heart Association guidelines.

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

“…106 Leukocytosis is typical during the acute stage of illness, with a predominance of immature and mature granulocytes. Leukopenia and lymphocyte predominance suggest an alternative diagnosis.…”

Of Mice and Children

“…18 In addition, patients can present with aneurysms within the first few days after the onset of fever, and two-thirds of patients have a normocytic, normochromic anemia at presentation that is consistent with suppression of erythropoiesis and the anemia of chronic disease. 19 Thus, we must question whether antiinflammatory therapy in KD is always too little, too late. That said, a number of safe, approved therapeutic options for IL-1␤ blockade are currently available.…”

The Relationship Between Severity of Kawasaki Disease and History of Ischemic Heart Disease in the Parents

“…This is thought to occur as a consequence of the net positive charge of IgG molecule that neutralizes the net negative charge of the red blood cell (RBC) surface (zeta potential), leading enhanced rouleaux formation and accelerated RBC sedimentation. Tremoulet et al stated no difference in comparison of convalescent ESR in IVIG-resistant vs. -subjects responsive to KD; in subjects with aneurysms suggested that the higher ESR was due to more inflammation rather than an effect of a second dose of IVIG (10). It is important to note that both groups of the current study used IVIG; therefore, the effect of IVIG on ESR rise affected both groups.…”

“…2) No decrease of erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) after one week of treatment (9,10).…”