Common laboratory studies | |
CBC, hepatic panel, fibrinogen, triglycerides
Ferritin
Cultures, viral PCRs: EBV, CMV, adenovirus
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Essential to define typical features of HLH. Though not part of diagnostic criteria, hepatitis is extremely common in HLH.
Usually (but not always) very elevated
Search for triggering infection
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Specialized laboratory studies | |
Markers of immune activation: sCD25, granzyme B expression, CXCL9
IL‐18 level
Measurement of proteins affected in familial HLH: perforin, SAP, XIAP
Functional studies: lymphocyte degranulation (CD107a mobilization), NK cell function
Lymphocyte subsets, T‐cell subsets, immune globulin levels
Genetic testing (multigene panel or whole exome)
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Essentially always elevated in untreated HLH; very sensitive, but not specific. sCD25, and perhaps CXCL9, are also useful for monitoring response to therapy
Elevated in HLH associated with inflammasome‐opathies (XIAP, NLRC4, soJIA)
Helpful to quickly confirm a suspected familial HLH diagnosis
May help to fulfill diagnostic criteria. Degranulation is the preferred functional assay over NK cell function. 102
Screening studies for PID
Essential for defining HLH recurrence risk
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Imaging | |
- Body cavity CT's (chest/abd/pelvis)
- Consider PET‐CT if suspicion of lymphoma
- MRI of brain
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- Should be routinely performed to help rule out malignancy, or unusual infections if trigger is unknown (CXR/abdominal ultrasound may suffice)
- PET‐CT very helpful for guiding biopsy if concern for lymphoma
- Brain MRI complements LP for CNS assessment
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Tissue sampling | |
- Bone marrow biopsy
- Lumbar puncture
- Other tissue biopsies as appropriate: liver, lymph node, masses
| Essential to rule out malignancy, identify hemophagocytosis, and identify CNS involvement |
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