Ann Pediatr Res | Volume 2, Issue 3 | Research Article | Open Access

Hematologic and Hepatic Anomalies in Pediatric Acute Rheumatic Fever

Malia Rasa1, Alan Garcia2, Karen Yamaga1, Lynn Nguyen1, Faith D Hamamura1, Elizabeth Tam3, Venu Reddy1, Kara Yamamoto1 and David Kurahara1*

1Department of Pediatrics, John A. Burns School of Medicine, USA
2Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, USA
3Department of Medicine, John A. Burns School of Medicine, USA

*Correspondance to: David Kurahara 

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Abstract

Anemia and hepatic transaminitis were seen in a cohort of Acute Rheumatic Fever (ARF) and were studied. An innovative approach to quantifying Anti-Streptolysin O (ASO) using a multiplex assay was utilized to study the anemia in ARF and indirect agglutination to test for possible autoimmune hemolysis. Subjects with mild hepatic transaminitis prior to the start of Aspirin (ASA), worsened when ASA was started, and this medication had to be stopped. A one week course of steroids followed by naproxen therapy worked. In 78% of anemic subjects, a general trend of increased hemoglobin with a concurrent decrease in ASO was found. No agglutination was observed by indirect agglutination. Multiplex assay and traditional ASO methodology revealed a positive correlation, and the data displayed evidence for multiplex assay as an alternative method. The cause of liver dysfunction may be due to inflammatory processes involving the liver and worsens with ASA therapy. Our findings support the treatment of ARF with an alternate NSAID like naproxen instead of ASA due to the possible adverse effects associated with high dose ASA therapy. However, if ASA therapy is used for ARF serial liver enzyme measurements should be done prior to and after starting salicylates. Anemia appears to be related to the disease process and improves with resolution of the disease clinically and a drop of the ASO titer in most subjects. Seventy-six percent of anemic patients also had evidence of carditis, suggesting that anemia may be caused by inflammation and cytokines, such as TNF-α, which may diminish erythropoiesis.

Citation:

Rasa M, Garcia A, Yamaga K, Nguyen L, Hamamura FD, Tam E, et al. Hematologic and Hepatic Anomalies in Pediatric Acute Rheumatic Fever. Ann Pediatr Res. 2018; 2(3): 1016.

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