Kawasaki Disease or Incomplete Kawasaki Disease Clinical Pathway — Emergency Department and Inpatient

Laboratory Testing

Laboratory tests typically reveal normal or elevated white blood cell count with neutrophil predominance and elevated acute phase reactants such as C-reactive protein and erythrocyte sedimentation rate during the acute phase. Low serum sodium and albumin levels, elevated serum liver enzymes, and sterile pyuria can be present. In the second week after fever onset, thrombocytosis is common.

Initial Diagnostic Testing
  • Laboratory studies
    • CBC w/ diff, CRP, ESR
    • CMP
    • UA or Urine POC from bag or clean catch (catheterization will not capture urethritis)
  • Consider:
    • Blood culture
    • Urine culture (from clean catch or catheterization) if pyuria on initial specimen
    • UTI Pathway
Lab Findings in KD
  • Elevated CRP
  • Elevated ESR
  • Anemia for age
  • Leukocytosis with neutrophils and immature forms
  • Thrombocytosis after 1 week
  • Sterile pyuria
  • Hyponatremia
  • Elevated serum transaminases
  • Elevated serum gamma glutamyl transpeptidase
  • Hypoalbuminemia
  • Abnormal plasma lipids
  • Pleocytosis of CSF
  • Leukocytosis in synovial fluid
Labs for alternative diagnoses
  • Rapid Strep/Strep culture
  • RRP

American Heart Association. 2017 Mar: Circulation 135:00-00. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. McCrindle et al.