Case 22. A 2-Year-Old Girl with Community-Acquired Pneumonia Followed by Thrombocytopenia and Anemia: Streptococcus pneumoniae Associated with Hemolytic Uremic Syndrome

Hemolytic uremic syndrome is a complication in 0.4-0.6% of IPD cases, which is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. The symptoms of HUS typically developed 3-13 days (most at 7-9 days) after the onset of the symptoms related to pneumococcal infection. In the circumstance of HUS, the fibrinogen level, prothrombin time, and partial thromboplastin times are usually normal or slightly elevated and active bleeding is rare. Blood transfusion with washed blood product and avoiding the plasma transfusion remains an important concept because these procedures are thought to reduce the exposure to T antigen. Renal placement therapy is indicated for anuria and deteriorated renal function.