Polly Wants a Cracker!

  • Mark T. Friedman
  • Kamille A. West
  • Peyman Bizargity
  • Kyle Annen
  • Jeffrey S. Jhang


A 3-year-old girl is admitted to the emergency department with fever of 101.6°F accompanied by poor feeding over the prior 3 days and a persistent cough with dyspnea. Chest x-ray reveals left lower lobe pneumonia, and blood cultures are positive for Streptococcus pneumoniae. The child was born prematurely at 34 weeks by vaginal delivery and weighed 2.5 kg (current weight 12.4 kg). Laboratory values are as follows: white blood cells (WBC) 20.0 K/μL, hemoglobin (Hgb) 7.2 g/dL, hematocrit (Hct) 24%, platelet count 62 K/μL, lactate dehydrogenase (LDH) 800 U/L, prothrombin time (PT) 17.2 s, activated partial thromboplastin time (aPTT) 48.5 s, total bilirubin 5.0 mg/dL, and creatinine 4.2 mg/dL. An ethylenediaminetetraacetic acid (EDTA) anticoagulant sample is submitted to the blood bank for type and screen.


ADAMTS13 Eculizumab Hemolytic uremic syndrome/HUS Lectins Pneumococcal pneumonia Polyagglutination Shiga toxin E. coli Soliris T-activation Thrombotic thrombocytopenic purpura/TTP Von Willebrand factor 


  1. 1.
    Legendre CM, Licht C, Muus P, Greenbaum LA, Babu S, Bedrosian C, et al. Terminal complement inhibitor eculizumab in atypical hemolytic-uremic syndrome. N Engl J Med. 2013;368:2169–81.CrossRefGoogle Scholar
  2. 2.
    Soliris® Prescribing Information. New Haven, CT: Alexion Pharmaceuticals, Inc.; 2017.Google Scholar
  3. 3.
    Ramasethu J, Luban NLC. T activation. Br J Haematol. 2001;112(2):259–63.CrossRefGoogle Scholar
  4. 4.
    Loaiza-Bonilla A, Horowitz D, Sheenu S, Baral A, Tinoco G, Kyriakopoulos C. Persistent Tn polyagglutination syndrome during febrile neutropenia: a case report and review of the literature. J Med Case Rep. 2011;5(8). Accessed 13 Oct 2017.
  5. 5.
    Fukuda MN, Klier P, Scartezzini P. Congenital dyserythropoietic anaemia type II (HEMPAS): characterization of aberrant intracellular organelles by immunogold electron microscopy. Br J Haematol. 1987;67:95–101.CrossRefGoogle Scholar
  6. 6.
    Schwartz J, Padmanbhan A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing committee of the American Society of Apheresis: the seventh special issue. J Clin Apher. 2016;31:325.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Mark T. Friedman
    • 1
  • Kamille A. West
    • 2
  • Peyman Bizargity
    • 3
  • Kyle Annen
    • 4
  • Jeffrey S. Jhang
    • 1
  1. 1.Icahn School of MedicineMount Sinai Health SystemNew YorkUSA
  2. 2.Department of Transfusion MedicineNational Institutes of Health Clinical CenterBethesdaUSA
  3. 3.Department of Molecular & Human GeneticsBaylor College of MedicineHoustonUSA
  4. 4.Department of PathologyChildren’s Hospital ColoradoAuroraUSA

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