Sepsis as the Grand Mimic of Secondary Hemophagocytic Lymphohistiocytosis: Serratia marcescens Bacteremia with Concomitant Decompensated Cirrhotic Liver Disease
Table 1
Serum laboratory results throughout hospital course.
Laboratory test results
Reference range
Presentation ( hours)
~9 hours
~21 hours
~30 hours
White blood cell (K/μL)
3.8-10.8
5.9
1.1
5.6
6.7
Absolute neutrophil count (K/μL)
1.9-10.8
2.9
0.7
3.8
5.6
Neutrophils (%)
51-89
61.9
84
Lymphocytes (%)
10-40
28.8
11.5
Hemoglobin (g/dL)
14-18
8.2
5.4
6.6
7.2
Platelet count (K/μL)
150-450
36
51
33
39
Sodium (mmol/L)
136-145
122
124
130
127
Potassium (mmol/L)
3.6-5.1
6.2
4.3
4.6
5.5
Calcium (mg/dL)
8.6-10.3
7.2
7.7
8
7.7
HCO3- (mmol/L)
23-29
12.6
9.5
12.8
11.3
Anion gap
4
11
11
12
15
Glucose (mg/dL)
70-105
236
129
79
81
Blood urea nitrogen (mg/dL)
7-25
37
38
39
41
Creatinine (mg/dL)
0.7-1.3
1.4
1.5
1.5
2.4
Albumin (g/dL)
3.5-5.7
<1.5
2
3.2
3
Bilirubin (mg/dL)
0.1-1.0
2.6
3
4.8
5.6
Alkaline phosphatase (IU/L)
34-104
130
70
82
50
AST (IU/L)
13-39
58
75
124
137
ALT (IU/L)
7-52
29
30
47
55
Ammonia (g/dL)
25-90
142
Prothrombin time (seconds)
12.2-14.0
58.1
39.4
37.7
INR
0.9-1.1
6.5
4
3.8
aPTT (seconds)
25.9-32.8
188.6
82.8
74.3
Fibrinogen (mg/dL)
193-507
69
152
Fibrin split products (g/mL)
<40
>40
D-dimer (mg/L)
0-0.49
>20
Brain natriuretic peptide (pg/mL)
1-100
520
551
3234
>5000
Triglycerides (mg/dL)
<150
26
Ferritin (ng/mL)
30-400
2994
Lactic acid (mmol/L)
0.5-2.2
5.2
6.7
6.5
ABG pH
7.35-7.45
7.14
7.24
ABG PaO2 (mmHg)
80-100
236
107
ABG PaCO2 (mmHg)
35-45
28
23
ABG HCO3- (mmol/L)
20-26
10.4
12.5
ABG = arterial blood gas; HLH = hemophagocytic lymphohistiocytosis. ~ to denote that time of lab collection is approximate, as many labs were collected at multiple times throughout the day. Presentation ( hours) laboratory results were the first set of serum investigations collected. Laboratory results at ~9 hours were the next set of routine labs, ~21 hours was around the time HLH was considered, and ~30 hours was 1 hour prior to death.
