Correct!
All of the above

In addition to the above laboratories, would also recommend adding LDH, haptoglobin, reticulocyte count, and HIT panel. This patient has acute purpura fulminans likely secondary to Streptococcus pneumococcal bacteremia with evidence of low Protein C (18%), Protein S (11%) and Antithrombin levels (20%). It is recommended to treat with supportive care using FFP transfusions, not plasmapheresis as it is not antibody mediated.  Daily Protein C levels were followed in addition to routine labs. In addition, Protein C concentrate may also be required.

References

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  2. Cervera R, Asherson RA. Clinical and epidemiological aspects in the antiphospholipid syndrome. Immunobiology. 2003;207(1):5-11. [CrossRef] [PubMed]
  3. Miret C, Cervera R, Reverter JC, García-Carrasco M, Ramos M, Mollà M, Font J, Ingelmo M. Antiphospholipid syndrome without antiphospholipid antibodies at the time of the thrombotic event: transient 'seronegative' antiphospholipid syndrome? Clin Exp Rheumatol. 1997 Sep-Oct;15(5):541-4. [PubMed]
  4. Drenkard C, Sánchez-Guerrero J, Alarcón-Segovia D. Fall in antiphospholipid antibody at time of thromboocclusive episodes in systemic lupus erythematosus. J Rheumatol. 1989 May;16(5):614-7. [PubMed]
  5. La Rosée P, Horne A, Hines M, et al. Recommendations for the management of hemophagocytic lymphohistiocytosis in adults. Blood. 2019 Jun 6;133(23):2465-2477. doi: [CrossRef] [PubMed]
  6. McGonagle D, Ramanan AV, Bridgewood C. Immune cartography of macrophage activation syndrome in the COVID-19 era. Nat Rev Rheumatol. 2021 Mar;17(3):145-157. [CrossRef] [PubMed]
  7. McGonagle D, Ramanan AV, Bridgewood C. Immune cartography of macrophage activation syndrome in the COVID-19 era. Nat Rev Rheumatol. 2021 Mar;17(3):145-157. [CrossRef] [PubMed]
  8. Scott-Charlton A, Reynolds G. A case of systemic lupus erythematosus associated auto-splenectomy presenting as invasive pneumococcal sepsis. Mod Rheumatol Case Rep. 2020 Jul;4(2):233-236. [CrossRef] [PubMed]

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