Article Text

Download PDFPDF
Diagnosing haemophagocytic syndrome
  1. Ethan S Sen1,
  2. Colin G Steward2,
  3. Athimalaipet V Ramanan1
  1. 1Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
  2. 2Department of Paediatric Haematology, Oncology and Bone Marrow Transplantation, Bristol Royal Hospital for Children, Bristol, UK
  1. Correspondence to Professor Athimalaipet V Ramanan, Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK; avramanan{at}


Haemophagocytic syndrome, or haemophagocytic lymphohistiocytosis (HLH), is a hyperinflammatory disorder characterised by uncontrolled activation of the immune system. It can result from mutations in multiple genes involved in cytotoxicity or occur secondary to a range of infections, malignancies or autoimmune rheumatic diseases. In the latter case, it is also known as macrophage activation syndrome (MAS). Characteristic features are persistent fever, hepatosplenomegaly, petechial/purpuric rash, progressive cytopenias, coagulopathy, transaminitis, raised C reactive protein, falling erythrocyte sedimentation rate, hypertriglyceridaemia, hypofibrinogenaemia and extreme hyperferritinaemia often associated with multi-organ impairment. Distinguishing HLH from systemic sepsis can present a major challenge. Criteria for diagnosis and classification of HLH and MAS are available and a serum ferritin >10 000 µg/L is strongly supportive of HLH. Without early recognition and appropriate treatment, HLH is almost universally fatal. However, with prompt referral and advancements in treatment over the past two decades, outcomes have greatly improved.

  • macrophage activation syndrome
  • haemophagocytic syndrome
  • Haematology
  • Rheumatology
  • Infectious Diseases

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors ESS reviewed the literature and wrote the article. CGS and AVR made significant contributions to discussion of content and review/editing of the article prior to submission. All authors read and approved the final manuscript.

  • Funding ESS is funded by a National Institute for Health Research (NIHR) Rare Disease Translational Research Collaboration (RD-TRC) clinical research fellowship.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.