What is the role of lab testing in the workup of cholesterol embolism syndrome?

Updated: Oct 25, 2019
  • Author: Lisa Kirkland, MD, FACP, FCCM, MSHA; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

Laboratory studies to be considered in the workup for cholesterol embolism include the following:

  • Complete blood count (CBC) - Leukocytosis with left shift is nonspecific; eosinophilia strongly suggests atheroembolization and is present in as many as 80% of patients with cholesterol embolism syndrome
  • Chemistry - Elevated blood urea nitrogen (BUN) and creatinine levels are present in virtually all cases of cholesterol embolism syndrome (CES)
  • Urinalysis - Microscopic hematuria, proteinuria, and hyaline casts are common; pyuria actually may be eosinophiluria, a major clue for the diagnosis of CES
  • Tissue-specific laboratory tests - Muscle injury causes an elevated creatine kinase (CK) level; myocardial, pancreatic, and hepatobiliary involvement produces increases in cardiac enzymes, amylase, and hepatobiliary enzymes
  • Inflammatory mediators - Nonspecific findings include hypocomplementemia, positive rheumatoid factor (RF), antinuclear antibodies (ANAs), and elevated C-reactive protein [6] (CRP) and erythrocyte sedimentation rate (ESR); one study found a CRP level higher than 1.0 mg/dL to be an independent predictor of cholesterol emboli in patients with coronary artery disease (CAD)

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