Hemophagocytic lymphohistiocytosis with jaundice as first manifestation: A case report

Table 1 Laboratory results on key dates

Item	Feb. 7	Feb. 10	Feb. 14	Feb. 21	Mar. 2	Mar. 3	Mar. 5	Mar. 8
Hb (g/L)	153	126	108	84	59	88	35	27
WBC (× 109/L)	4.67	3.36	6.24	2.07	38.68	19.79	2.47	7.2
PLT (× 109/L)	127	88	88	71	211	143	20	8
ALT (U/L)	309.4	205	102.2	36	78.2	183.5	105.1	409.6
AST (U/L)	313.1	215	117.4	55.3	265.4	871.2	367.6	2215
TBIL (μmol/L)	193.9	131.2	94	222.5	425.2	521.2	355.2	245
DBIL (μmol/L)	162.4	112.7	81	174.8	373.3	422.6	276.9	169.5
PTA (%)	68.2	59.2	70	67.3	22.5	28.3	35.4	8.3
Cre (μmol/L)	48	40	55	31	118	73	58	117
LDH (U/L)	419	367	245	413	793	1440	1182	3753
Ferritin (μg/L)	-	-	-	3881.0	-	-	> 8000	-
TG (mg/dL)	-	2.89	2.38	-	-	-	-	-
Fib (g/L)	1.05	1.07	2.04	1.58	1.49	1.34	0.8	0.74

Hb: Hemoglobin; WBC: White blood cell count; PLT: Platelet count; AST: Aspartate aminotransferase; TBIL: Total bilirubin; DBIL: Direct bilirubin; PTA: Prothrombin activity; Cre: Creatinine; LDH: Lactate dehydrogenase; Fib: Fibrinogen; TG: Triglycerides; ALT: Alanine aminotransferase.

Table 2 Diagnostic guidelines for hemophagocytic lymphohistiocytosis in 2004

Diagnostic criteria
1	Molecular diagnosis consistent with HLH
2	Five of the following eight criteria are fulfilled
	Fever
	Splenomegaly
	Cytopenias affecting at least two of the three lineages in the peripheral blood; hemoglobin < 90 g/L; platelets < 100 × 109; neutrophils < 1 × 109
	Hypertriglyceridemia and/or hypofibrinogenemia
	Hemophagocytosis in bone marrow, spleen, or lymph nodes
	Low or absent natural killer cell activity
	Hyperferritinemia
	Soluble interleukin-2 receptor alpha subunit ≥ 2400 U/mL