A nurse is reviewing the laboratory test results of a client suspected of having Kawasaki disease. Which test results does the nurse expect to find with this condition? Select all that apply.

Choice A rationale Erythrocyte count (RBC) typically remains normal or may show mild anemia during the acute phase of Kawasaki disease, rather than being decreased significantly. The characteristic inflammation causes thrombocytosis (elevated platelets) and leukocytosis (elevated white blood cells), but usually does not acutely suppress red blood cell production, maintaining the count near the normal adult range of 4.2 to 5.4 &times; 1012/L for women and 4.7 to 6.1 &times; 1012/L for men. Choice B rationale Elevated liver enzymes, such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT), are commonly found in Kawasaki disease due to transient hepatic inflammation, which is part of the systemic vasculitis. These enzymes are released into the bloodstream when liver cells are damaged, and levels often rise above the normal range (AST: 8 to 48 U/L; ALT: 7 to 55 U/L) indicating liver involvement. Choice C rationale The white blood cell count (WBC) is elevated, a condition known as leukocytosis, due to the intense systemic inflammatory response that characterizes the acute phase of Kawasaki disease. The body's immune system is highly activated, leading to a WBC count frequently greater than the normal range of 4,500 to 11,000 cells/mm&sup3; (4.5 to 11.0 &times; 109/L). Choice D rationale The erythrocyte sedimentation rate (ESR) is a non-specific marker of inflammation that is typically significantly elevated in the acute phase of Kawasaki disease, often greater than the normal adult range of 0 to 20 mm/hr. This elevation occurs because inflammation increases the concentration of acute phase reactants, like fibrinogen, which causes red blood cells to settle faster. Choice E rationale C-reactive protein (CRP) is a key acute phase reactant and its levels are characteristically elevated in the acute inflammatory stage of Kawasaki disease, often exceeding the normal reference range of < 1.0 mg/dL. A decreased CRP would indicate resolving inflammation or an alternative diagnosis, making this finding unexpected for an acute presentation. Choice F rationale Platelet count (thrombocytes) is often normal or slightly low early on, but characteristically rises significantly, a condition called thrombocytosis, during the subacute phase of Kawasaki disease, usually peaking 2 to 3 weeks after fever onset, not decreased. The normal adult range is 150,000 to 450,000/mm (150 to 450 &times; 109/L).