Minor Cross-Matching in the Diagnosis of Pneumococcal Hemolytic Uremic Syndrome in an 18-Month-Old Boy

Abstract In developing nations, limitations in diagnostic facilities act as a barrier for differentiation of hemolytic uremic syndrome (HUS) based on the etiology. A sick-looking 18-month-old boy presented to our hospital in Bhubaneswar, India, with clinical signs and symptoms of left lobar pneumonia, abnormal hematological and renal parameters, no growth in blood culture, a negative direct antiglobulin test (DAT) result, and low complement levels. A rapid deterioration in his clinical condition necessitated intensive care support, blood transfusion, and renal replacement therapy (peritoneal dialysis and hemodialysis). Because his health care team suspected atypical HUS, therapeutic plasma exchange (TPE) was initiated as soon as possible. In the absence of a lectin panel, minor cross-matching confirmed T-antigen exposure. With a diagnosis of HUS induced by Streptococcus pneumoniae (sp-HUS), TPE was stopped immediately, and washed blood components were administered. Despite the aforementioned measures, the boy died of HUS on day 20 after presentation. This case emphasized the role of minor cross-matching in the detecting of polyagglutination in resolving the diagnostic dilemma of sp-HUS.