A 10 year old child develops hematuria after 2 days of diarhoea. Blood film shows fragmented RBCs. Which of the following is likely diagnosis-
**Core Concept**
Hemolytic uremic syndrome (HUS) is a disorder characterized by the formation of microthrombi in small blood vessels, leading to microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. It often presents with non-bloody diarrhea, followed by the development of hemolytic anemia, typically with fragmented red blood cells (schistocytes) on the blood film.
**Why the Correct Answer is Right**
The correct answer, C. Haemolytic uremic syndrome, is the most likely diagnosis in this scenario. The presence of non-bloody diarrhea followed by hematuria and fragmented RBCs on the blood film is a classic triad for HUS. The pathogenesis of HUS involves the production of Shiga toxins by certain strains of E. coli, which cause endothelial damage, leading to the formation of microthrombi and microangiopathic hemolytic anemia. The kidneys are particularly vulnerable to this damage, resulting in acute kidney injury.
**Why Each Wrong Option is Incorrect**
**Option A:** Acute pyelonephritis is an infection of the kidney, typically caused by bacterial pathogens. While it can present with hematuria, it is not associated with non-bloody diarrhea or fragmented RBCs on the blood film.
**Option B:** Disseminated intravascular coagulation (DIC) is a complex disorder characterized by the systemic activation of coagulation, leading to the formation of microthrombi and consumption of platelets and clotting factors. While it can cause hemolytic anemia, it is not typically associated with non-bloody diarrhea or the specific blood film findings seen in HUS.
**Option D:** Hemolytic crises refer to a sudden, severe episode of hemolysis, often associated with conditions such as glucose-6-phosphate dehydrogenase (G6PD) deficiency or autoimmune hemolytic anemia. While they can cause hemolytic anemia, they are not typically associated with non-bloody diarrhea or the specific blood film findings seen in HUS.
**Clinical Pearl / High-Yield Fact**
HUS is a classic example of a "triad" of symptoms, where the combination of non-bloody diarrhea, hemolytic anemia (with fragmented RBCs on the blood film), and acute kidney injury is highly suggestive of the diagnosis. This triad is often remembered using the mnemonic "DASH" (Diarrhea, Anemia, Shiga toxin, Hemolysis).
**Correct Answer Line**
✓ Correct Answer: C. Haemolytic uremic syndrome