| Test | Suggestions for testing and unique findings in systemic anthrax |
| Initial | Serial monitoring |
| Complete blood count | - Marked hemoconcentration
- Thrombocytopenia may not be present
- Leukocyte count frequently at reference level
| - Anemia can suddenly develop
- Thrombocytopenia onset often associated with hemolytic anemia
- Leukocytosis usually not seen until late in disease
|
| Electrolytes, renal panel, lactate level | - Decreased sodium level
- HCO3 level can be at reference level even with sepsis
- Increased blood urea nitrogen level
| - Decreased sodium level
- HCO3 level can be at reference level even with sepsis
- Increased blood urea nitrogen level
|
| Liver enzymes, serum albumin | - Mildly elevated transaminase levels
- Hypoalbuminemia related to acute infection
| - Mildly elevated transaminase levels
- Hypoalbuminemia related to acute infection
|
| PT, PTT, D-dimer, fibrinogen | - Reference PT/PTT at admission does not exclude coagulopathy or disseminated intravascular coagulopathy
| - Maintain a low threshold for hypercoagulability workup, including:
- Haptoglobin
- Lactate dehydrogenase
- Fibrin split products
- If there is evidence of hemolytic anemia, assess ADAMTS13 (von Willebrand factor-cleaving protease)
|
| Erythrocyte sedimentation rate, CRP | - Useful for characterizing inflammatory response
- Low CRP characteristic in injection anthrax
| - Useful for characterizing inflammatory response
- Low CRP characteristic in injection anthrax
|
| Gram stain, cultures, toxin assays | | - Cultures usually negative after antimicrobials
- Toxin may be detectable at multiple time points
|
| Cardiac enzymes with or without B-type natriuretic peptide | - Troponin leak caused by increased cardiac demands from acute infection (especially if atrial fibrillation with rapid ventricular response)
| - Troponin leak caused by increased cardiac demands from acute infection (especially if atrial fibrillation with rapid ventricular response).
|
| Electrocardiogram/continuous telemetry | - Atrial fibrillation with rapid ventricular response.
| - Atrial fibrillation with rapid ventricular response.
|
| Posterior-anterior and lateral chest radiograph | - Any abnormality could be consistent
- Characteristic mediastinal widening and pleural effusions may be subtle or inapparent
| - Perform daily chest radiographs or other thoracic imaging until pleural effusions are stable or decreasing
|
| Chest computerized tomography | - To evaluate for severity of pleural effusions, presence of mediastinal widening or pericardial effusion, and to rule out thromboembolic disease
| - Repeat if major clinical status change
|
| Lumbar puncture | - Perform at admission unless contraindicated
| - Perform for headache/confusion or other neurologic symptoms
- Meningeal signs are usually not present until late stage if meningitis is present.
|
| Other imaging | - Perform as relevant to site of exposure to evaluate edema, inflammation, and necrosis.
| - Perform neuroimaging for headache/confusion or other neurologic symptoms
- Meningeal signs are usually not present until late stage if meningitis is present
|
| Echocardiogram | - To evaluate for pericardial effusion and myocardial dysfunction
| - To evaluate for pericardial effusion and myocardial dysfunction
|
