Anaemia is normocytic and may be "severe" (haemoglobin < 4 g/dl). Thrombocytopenia (< 100 000 platelets/pl) is usually present, and peripheral leukocytosis is found in patients with the most severe disease. Elevation of serum creatinine, bilirubin and enzymes, e.g. aminotransferases and 5'-nucleotidase, may be found. Levels of liver enzymes are much lower than in acute viral hepatitis. Severely ill patients are commonly acidotic, with low capillary plasma pH and bicarbonate concentrations. Fluid and electrolyte disturbances (sodium, potassium, chloride, calcium and phosphate) are variable. Concentrations of lactic acid in the blood and cerebrospinal fluid are often high in both adults and children, in proportion to the severity of the disease.
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