{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T18:20:25Z","timestamp":1761157225566,"version":"3.37.3"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,10,13]],"date-time":"2021-10-13T00:00:00Z","timestamp":1634083200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To develop a sensitive and specific protocol for detecting preclinical hemolysis in patients with brown recluse spider (BRS) bites by comparing a large cohort of individuals with brown recluse spider (BRS) bites with and without hemolytic anemia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A cross-sectional, retrospective analysis of clinical features and laboratory values, including urinalysis (UA) and peripheral blood results, and timing of positive laboratory values prior to a significant drop in hematocrit was performed to evaluate effective predictors of clinically significant hemolysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In total, 275 patients with BRS bites were identified (64 with hemolytic anemia). Sensitivity and specificity of UA positive for blood (with and without microscopic hematuria) for detecting hemolysis were 72% and 75%, respectively. The combination of elevated serum total bilirubin (TB) and lactate dehydrogenase (LDH) had greater sensitivity (94%) and specificity (91%) for detecting patients developing hemolysis. When TB and LDH were evaluated prior to a significant decrease in hematocrit, they were positive in 82% of cases, while UA was positive for blood prior to a hematocrit decrease in 38% of cases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Serum TB and LDH levels are more effective at detecting preclinical hemolysis than UA and should be serially analyzed to triage patients with BRS bites before life-threatening hemolysis occurs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajcp\/aqab169","type":"journal-article","created":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T11:21:22Z","timestamp":1631100082000},"page":"566-572","source":"Crossref","is-referenced-by-count":10,"title":["Laboratory Predictors of Hemolytic Anemia in Patients With Systemic Loxoscelism"],"prefix":"10.1093","volume":"157","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5719-9685","authenticated-orcid":false,"given":"Jeremy W","family":"Jacobs","sequence":"first","affiliation":[{"name":"Department of Pathology, Microbiology, and Immunology , Nashville, TN , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Bastarache","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, Vanderbilt University Medical Center , Nashville, TN , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary Ann","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology, and Immunology , Nashville, TN , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,10,13]]},"reference":[{"key":"2023020617110132100_CIT0001","doi-asserted-by":"crossref","first-page":"e17731","DOI":"10.1371\/journal.pone.0017731","article-title":"Tracking a medically important spider: climate change, ecological niche modeling, and the brown recluse (Loxosceles reclusa)","volume":"6","author":"Saupe","year":"2011","journal-title":"PLoS One."},{"key":"2023020617110132100_CIT0002","article-title":"Brown recluse spider toxicity","volume-title":"StatPearls","author":"Anoka","year":"2020"},{"key":"2023020617110132100_CIT0003","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.toxicon.2014.02.023","article-title":"Recent advances in the understanding of brown spider venoms: from the biology of spiders to the molecular mechanisms of toxins","volume":"83","author":"Gremski","year":"2014","journal-title":"Toxicon."},{"key":"2023020617110132100_CIT0004","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.molimm.2006.02.002","article-title":"Sphingomyelinases D induce direct association of C1q to the erythrocyte membrane causing complement mediated autologous haemolysis","volume":"44","author":"Tambourgi","year":"2007","journal-title":"Mol Immunol."},{"key":"2023020617110132100_CIT0005","doi-asserted-by":"crossref","first-page":"164","DOI":"10.3390\/toxins12030164","article-title":"Forty years of the description of brown spider venom phospholipases-D","volume":"12","author":"Gremski","year":"2020","journal-title":"Toxins"},{"key":"2023020617110132100_CIT0006","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1080\/15563650.2020.1739701","article-title":"Cutaneous-hemolytic loxoscelism following brown recluse spider envenomation: new understandings","author":"Loden","year":"2020","journal-title":"Clin Toxicol"},{"key":"2023020617110132100_CIT0007","doi-asserted-by":"crossref","first-page":"e76558","DOI":"10.1371\/journal.pone.0076558","article-title":"Brown recluse spider bite mediated hemolysis: clinical features, a possible role for complement inhibitor therapy, and reduced RBC surface glycophorin A as a potential biomarker of venom exposure","volume":"8","author":"Gehrie","year":"2013","journal-title":"PLoS One."},{"key":"2023020617110132100_CIT0008","doi-asserted-by":"crossref","first-page":"e0174941","DOI":"10.1371\/journal.pone.0174941","article-title":"Defining the complex phenotype of severe systemic loxoscelism using a large electronic health record cohort","volume":"12","author":"Robinson","year":"2017","journal-title":"PLoS One."},{"key":"2023020617110132100_CIT0009","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1177\/0009922810388510","article-title":"Complications and outcomes of brown recluse spider bites in children","volume":"50","author":"Hubbard","year":"2011","journal-title":"Clin Pediatr (Phila)."},{"key":"2023020617110132100_CIT0010","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1002\/jcb.22148","article-title":"Identification of a direct hemolytic effect dependent on the catalytic activity induced by phospholipase-D (dermonecrotic toxin) from brown spider venom","volume":"107","author":"Chaves-Moreira","year":"2009","journal-title":"J Cell Biochem."},{"key":"2023020617110132100_CIT0011","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1182\/blood.V95.2.683","article-title":"Loxosceles intermedia spider envenomation induces activation of an endogenous metalloproteinase, resulting in cleavage of glycophorins from the erythrocyte surface and facilitating complement-mediated lysis","volume":"95","author":"Tambourgi","year":"2000","journal-title":"Blood."},{"key":"2023020617110132100_CIT0012","doi-asserted-by":"crossref","first-page":"3859","DOI":"10.3390\/jcm9123859","article-title":"New insights in autoimmune hemolytic anemia: from pathogenesis to therapy stage 1","volume":"9","author":"Barcellini","year":"2020","journal-title":"J Clin Med"},{"key":"2023020617110132100_CIT0013","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jpeds.2009.07.021","article-title":"Brown recluse spider (Loxosceles reclusa) envenomation leading to acute hemolytic anemia in six adolescents","volume":"156","author":"McDade","year":"2010","journal-title":"J Pediatr."},{"key":"2023020617110132100_CIT0014","doi-asserted-by":"crossref","first-page":"4091278","DOI":"10.1155\/2019\/4091278","article-title":"Loxoscelism: cutaneous and hematologic manifestations","volume":"2019","author":"Nguyen","year":"2019","journal-title":"Adv Hematol."},{"key":"2023020617110132100_CIT0015","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1177\/002215540405200404","article-title":"Experimental evidence for a direct cytotoxicity of Loxosceles intermedia (brown spider) venom in renal tissue","volume":"52","author":"Luciano","year":"2004","journal-title":"J Histochem Cytochem."},{"key":"2023020617110132100_CIT0016","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.taap.2005.05.015","article-title":"Brown spider dermonecrotic toxin directly induces nephrotoxicity","volume":"211","author":"Chaim","year":"2006","journal-title":"Toxicol Appl Pharmacol."}],"container-title":["American Journal of Clinical Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajcp\/article-pdf\/157\/4\/566\/49103188\/aqab169.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajcp\/article-pdf\/157\/4\/566\/49103188\/aqab169.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T17:13:13Z","timestamp":1675703593000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajcp\/article\/157\/4\/566\/6395336"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,13]]},"references-count":16,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,10,13]]},"published-print":{"date-parts":[[2022,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ajcp\/aqab169","relation":{},"ISSN":["0002-9173","1943-7722"],"issn-type":[{"type":"print","value":"0002-9173"},{"type":"electronic","value":"1943-7722"}],"subject":[],"published-other":{"date-parts":[[2022,4,1]]},"published":{"date-parts":[[2021,10,13]]}}}