ICD-10: D59.31

Infection-associated hemolytic-uremic syndrome (HUS) is a serious condition characterized by a triad of symptoms: hemolytic anemia, acute renal failure, and thrombocytopenia. This syndrome is often triggered by infections, particularly those caused by certain strains of Escherichia coli (E. coli), such as Shiga toxin-producing E. coli (STEC). Below is a detailed clinical description and relevant information regarding ICD-10 code D59.31.

Clinical Description of Infection-Associated Hemolytic-Uremic Syndrome

Pathophysiology

Infection-associated HUS typically arises following gastrointestinal infections, particularly those linked to contaminated food or water. The Shiga toxin produced by pathogenic E. coli damages the endothelial cells of blood vessels, leading to the formation of microthrombi. This process results in hemolytic anemia due to the destruction of red blood cells, a decrease in platelet count (thrombocytopenia), and acute kidney injury due to reduced blood flow and damage to the renal vasculature[1][2].

Symptoms

Patients with infection-associated HUS may present with:
- Hemolytic Anemia: Symptoms include fatigue, pallor, and jaundice due to the breakdown of red blood cells.
- Thrombocytopenia: This can lead to easy bruising, petechiae, or bleeding complications.
- Acute Renal Failure: Symptoms may include decreased urine output, swelling due to fluid retention, and elevated blood urea nitrogen (BUN) and creatinine levels.
- Gastrointestinal Symptoms: Prior to the onset of HUS, patients often experience diarrhea (which may be bloody), abdominal pain, and vomiting[3][4].

Diagnosis

The diagnosis of infection-associated HUS is primarily clinical, supported by laboratory findings. Key diagnostic criteria include:
- Evidence of hemolytic anemia (elevated lactate dehydrogenase, low haptoglobin, and the presence of schistocytes on a blood smear).
- Thrombocytopenia (platelet count <150,000/µL).
- Acute renal impairment (elevated serum creatinine) following a gastrointestinal infection[5].

Treatment

Management of infection-associated HUS is largely supportive. Key treatment strategies include:
- Fluid Management: Careful monitoring and management of fluid balance to prevent dehydration or fluid overload.
- Dialysis: In cases of severe renal failure, dialysis may be necessary.
- Transfusions: Blood transfusions may be required for severe anemia or significant bleeding.
- Avoidance of Antibiotics: Antibiotics are generally avoided in cases of STEC infection, as they may increase the risk of HUS development[6][7].

ICD-10 Code D59.31

The ICD-10-CM code D59.31 specifically designates "Infection-associated hemolytic-uremic syndrome." This code is used for billing and coding purposes in healthcare settings to identify patients diagnosed with this condition. It falls under the broader category of hemolytic anemias and is crucial for tracking epidemiological data and healthcare resource utilization related to HUS[8][9].

Coding Guidelines

When coding for D59.31, it is essential to document the underlying infection, particularly if it is due to a specific pathogen like STEC. Accurate coding ensures appropriate treatment protocols and resource allocation in clinical settings.

Conclusion

Infection-associated hemolytic-uremic syndrome is a critical condition that requires prompt recognition and management. Understanding its clinical presentation, diagnostic criteria, and treatment options is vital for healthcare providers. The ICD-10 code D59.31 serves as an important tool for documenting and managing cases of this syndrome, facilitating better patient care and resource management in healthcare systems.

For further information or specific case inquiries, consulting clinical guidelines or infectious disease specialists may be beneficial.

Infection-associated hemolytic-uremic syndrome (HUS) is a serious condition characterized by a triad of symptoms: hemolytic anemia, acute renal failure, and thrombocytopenia. This syndrome is often associated with infections, particularly those caused by certain strains of Escherichia coli (E. coli), such as Shiga toxin-producing E. coli (STEC). Below, we explore the clinical presentation, signs, symptoms, and patient characteristics associated with ICD-10 code D59.31.

Clinical Presentation

Triad of Symptoms

1. Hemolytic Anemia: Patients typically present with signs of hemolytic anemia, which may include fatigue, pallor, and jaundice. Laboratory findings often reveal low hemoglobin levels and elevated levels of lactate dehydrogenase (LDH) due to red blood cell destruction.

2. Thrombocytopenia: A significant drop in platelet count is common, leading to increased bleeding tendencies. Patients may experience petechiae, purpura, or more severe bleeding complications.

3. Acute Renal Failure: Renal impairment is a hallmark of HUS, often manifesting as oliguria or anuria. Laboratory tests may show elevated serum creatinine and blood urea nitrogen (BUN) levels, indicating reduced kidney function.

Additional Symptoms

• Gastrointestinal Symptoms: Many patients report gastrointestinal symptoms such as abdominal pain, diarrhea (often bloody), and vomiting, particularly if the syndrome is triggered by an infectious agent like STEC.
• Neurological Symptoms: In some cases, neurological manifestations such as seizures or altered mental status may occur, especially in severe cases.

Signs and Symptoms

Common Signs

• Pallor: Due to anemia.
• Jaundice: Resulting from hemolysis.
• Petechiae and Purpura: Indicative of thrombocytopenia.
• Hypertension: Can occur due to fluid overload or renal impairment.

Laboratory Findings

• Complete Blood Count (CBC): Shows low hemoglobin and low platelet count.
• Peripheral Blood Smear: May reveal schistocytes, which are fragmented red blood cells.
• Renal Function Tests: Elevated creatinine and BUN levels indicate renal dysfunction.
• Coagulation Studies: Typically show normal coagulation parameters, distinguishing HUS from other thrombotic microangiopathies.

Patient Characteristics

Demographics

• Age: HUS can affect individuals of all ages but is most commonly seen in children, particularly those under five years old. Adults can also be affected, especially the elderly or those with compromised immune systems.
• Gender: There is no significant gender predisposition, although some studies suggest a slight male predominance.

Risk Factors

• Recent Infection: A history of gastrointestinal infection, particularly with STEC, is a significant risk factor. Outbreaks are often linked to undercooked beef, unpasteurized dairy products, or contaminated water.
• Immunocompromised Status: Patients with weakened immune systems may be at higher risk for developing severe forms of HUS.

Prognosis

The prognosis for patients with infection-associated HUS varies. While many children recover completely, some may experience long-term complications, including chronic kidney disease. Early recognition and supportive care are crucial for improving outcomes.

Conclusion

Infection-associated hemolytic-uremic syndrome (ICD-10 code D59.31) presents a complex clinical picture characterized by hemolytic anemia, thrombocytopenia, and acute renal failure, often following an infectious episode. Understanding the signs, symptoms, and patient characteristics associated with this condition is essential for timely diagnosis and management. Early intervention can significantly improve patient outcomes, particularly in vulnerable populations such as young children and the elderly.

Infection-associated hemolytic-uremic syndrome (HUS) is a serious condition characterized by a triad of symptoms: hemolytic anemia, acute renal failure, and thrombocytopenia. The ICD-10 code D59.31 specifically refers to this condition when it is associated with an infection. Below are alternative names and related terms that are commonly used in medical literature and practice.

Alternative Names for Infection-Associated Hemolytic-Uremic Syndrome

1. Hemolytic Uremic Syndrome (HUS): This is the most common term used to describe the condition, encompassing both infection-associated and non-infection-associated forms.

2. Post-Diarrheal Hemolytic Uremic Syndrome: This term is often used when the syndrome follows gastrointestinal infections, particularly those caused by Escherichia coli (E. coli) strains, such as O157:H7.

3. Shiga Toxin-Associated Hemolytic Uremic Syndrome: This name highlights the role of Shiga toxin-producing bacteria, which are frequently implicated in the development of HUS.

4. Thrombotic Microangiopathy: While broader, this term includes HUS as a subtype and refers to conditions characterized by small blood vessel damage leading to hemolytic anemia and thrombocytopenia.

5. Infectious Hemolytic Uremic Syndrome: This term emphasizes the infectious etiology of the syndrome, distinguishing it from other forms of HUS that may not be infection-related.

Related Terms

1. Acute Kidney Injury (AKI): A common complication of HUS, referring to a sudden decrease in kidney function.

2. Thrombocytopenia: A condition characterized by low platelet counts, which is one of the hallmark features of HUS.

3. Hemolytic Anemia: This refers to the breakdown of red blood cells, which is a key component of the syndrome.

4. E. coli O157:H7 Infection: This specific bacterial infection is a well-known cause of infection-associated HUS.

5. Diarrhea-Associated HUS: This term is used to describe cases of HUS that develop following severe diarrhea, often due to bacterial infections.

6. Microangiopathic Hemolytic Anemia: This term describes the hemolytic anemia that occurs due to small blood vessel damage, which is a feature of HUS.

Understanding these alternative names and related terms can help in recognizing the various contexts in which infection-associated hemolytic-uremic syndrome may be discussed in clinical settings. Each term may highlight different aspects of the syndrome, such as its causes, symptoms, or complications, which can be crucial for accurate diagnosis and treatment.

Infection-associated hemolytic-uremic syndrome (HUS) is a serious condition characterized by a triad of symptoms: hemolytic anemia, acute renal failure, and thrombocytopenia. The ICD-10-CM code D59.31 specifically pertains to this diagnosis. Understanding the criteria for diagnosing this syndrome is crucial for accurate coding and effective patient management.

Diagnostic Criteria for Infection-Associated HUS

1. Clinical Presentation

The diagnosis of infection-associated HUS typically begins with a clinical evaluation that includes:

• Hemolytic Anemia: Evidence of hemolysis is essential. This can be indicated by:
• Decreased hemoglobin levels.
• Elevated levels of lactate dehydrogenase (LDH).
• Presence of schistocytes (fragmented red blood cells) on a peripheral blood smear.

• Increased indirect bilirubin levels.

• Thrombocytopenia: A significant drop in platelet count is observed, usually defined as a platelet count of less than 150,000 cells per microliter.

• Acute Renal Failure: This is often assessed through:

• Elevated serum creatinine levels.
• Decreased urine output (oliguria or anuria).
• Abnormalities in urinalysis, such as hematuria or proteinuria.

2. Infectious Etiology

Infection-associated HUS is often precipitated by a preceding gastrointestinal infection, most commonly caused by:

• Escherichia coli O157:H7: This strain is frequently linked to outbreaks of HUS, particularly following the consumption of undercooked beef or contaminated produce.
• Other pathogens, such as Shigella dysenteriae and certain strains of Salmonella, can also be implicated.

3. Exclusion of Other Causes

To confirm a diagnosis of infection-associated HUS, it is important to rule out other potential causes of similar symptoms, including:

• Thrombotic thrombocytopenic purpura (TTP).
• Other forms of hemolytic anemia.
• Renal diseases that may present with similar clinical features.

4. Laboratory Tests

Diagnostic laboratory tests play a critical role in confirming the diagnosis. These may include:

• Complete blood count (CBC) to assess hemoglobin and platelet levels.
• Peripheral blood smear to identify schistocytes.
• Renal function tests to evaluate creatinine and electrolyte levels.
• Stool cultures or PCR testing to identify the presence of pathogenic bacteria.

Conclusion

The diagnosis of infection-associated hemolytic-uremic syndrome (ICD-10 code D59.31) relies on a combination of clinical findings, laboratory tests, and the identification of an infectious trigger. Accurate diagnosis is essential for appropriate management and treatment of affected patients. If you have further questions or need additional information on this topic, feel free to ask!

Infection-associated hemolytic-uremic syndrome (HUS), particularly as classified under ICD-10 code D59.31, is a serious condition often resulting from infections, most notably those caused by Shiga toxin-producing Escherichia coli (STEC). This syndrome is characterized by a triad of symptoms: hemolytic anemia, acute renal failure, and thrombocytopenia. Understanding the standard treatment approaches for this condition is crucial for effective management and patient outcomes.

Overview of Infection-Associated HUS

Infection-associated HUS typically follows gastrointestinal infections, particularly those caused by STEC, which can lead to severe complications. The pathophysiology involves the production of toxins that damage the endothelial cells of blood vessels, particularly in the kidneys, leading to the clinical manifestations of HUS[1].

Standard Treatment Approaches

1. Supportive Care

The cornerstone of treatment for infection-associated HUS is supportive care, which includes:

• Fluid Management: Careful monitoring and management of fluid intake and output are essential to prevent dehydration and manage renal function. Intravenous fluids may be administered to maintain hydration, especially in cases of acute kidney injury[2].

• Electrolyte Monitoring: Regular monitoring of electrolytes is critical, as renal impairment can lead to imbalances, particularly hyperkalemia, which can be life-threatening[3].

2. Management of Anemia and Thrombocytopenia

• Transfusions: Blood transfusions may be necessary for patients with severe anemia or significant thrombocytopenia. However, the use of platelet transfusions is generally avoided unless there is a life-threatening hemorrhage, as they can exacerbate thrombotic complications[4].

3. Renal Support

• Dialysis: In cases of acute renal failure, dialysis may be required to manage fluid overload and electrolyte imbalances. This is particularly important for patients who do not respond to conservative management or who develop severe renal impairment[5].

4. Antibiotic Therapy

• Caution with Antibiotics: The use of antibiotics in infection-associated HUS is controversial. While they are indicated for treating the underlying infection, they may also increase the risk of HUS complications by promoting the release of more toxins from bacteria. Therefore, the decision to use antibiotics should be made on a case-by-case basis, considering the severity of the infection and the patient's overall condition[6].

5. Avoidance of Certain Medications

• Avoiding Antimotility Agents: Medications that slow intestinal motility, such as loperamide, should be avoided in cases of diarrhea caused by STEC, as they can prolong the duration of the infection and increase the risk of HUS[7].

6. Monitoring and Follow-Up

• Regular Monitoring: Continuous monitoring of renal function, hematologic parameters, and overall clinical status is essential. This includes regular blood tests to assess hemoglobin levels, platelet counts, and renal function tests[8].

Conclusion

Infection-associated hemolytic-uremic syndrome (ICD-10 code D59.31) requires a multifaceted approach focused on supportive care, careful management of complications, and monitoring. While the condition can be severe, timely and appropriate treatment can significantly improve outcomes. Clinicians must remain vigilant in managing the various aspects of this syndrome, particularly in the context of underlying infections. As research continues, treatment protocols may evolve, emphasizing the importance of staying updated with the latest clinical guidelines and evidence-based practices.