Macrophage activation syndrome (MAS)MMacrophage activation syndrome (MAS)Macrophage activation syndrome (MAS)EnglishRheumatologyChild (0-12 years);Teen (13-18 years)NAImmune systemConditions and diseasesCaregivers Adult (19+)NA2015-10-12T04:00:00ZEvelyn Rozenblyum MD, FRCPC;Andrea Human MD, FRCPC;Shirley Tse MD, FRCPC;Sheila Weitzman, MB ChB, FRCPC;James Whitlock, MD;Ahmed Naqvi MBBS, MRCP;Rayfel Schneider MBBCH, FRCPC;Ronald Laxer MDCM, FRCPC11.000000000000047.00000000000001191.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Macrophage activation syndrome affects the immune system and causes inflamation. Learn about the signs, causes and treatment of MAS.</p><h2>What is MAS/HLH</h2> <p>The immune system is the body’s natural defense system to fight infection. It has several groups/families of cells that work together and send signals to one another to help fight against these infections. One family of cells is called macrophages, which work by destroying/ingesting infectious cells (e.g. viruses and bacteria). Macrophages can also control other cells in the immune system to help fight infection. Another family of cells in the immune system is called T cells (or T lymphocytes), which can send signals to gather and control macrophages to help fight infection as one part of their role in the immune system.</p> <p>Normally, when the immune system is activated, it fights the infection in a coordinated and controlled manner. In individuals with macrophage activation syndrome (MAS), the immune system is uncontrolled and works in overdrive, leading to too much inflammation in the entire body. The inflammation can be in any organ system including the bone marrow, liver, and spleen. This inflammation is very serious and can often make children very ill - it may also result in organ damage.</p> <p>MAS is classified as part of a group of conditions called Hemophagocytic Lymphohistiocytosis (HLH for short). HLH also results in over activation of the immune system and dangerous inflammation of the body. There are two forms of HLH. Primary HLH, the genetic form (as it is caused by gene abnormalities), usually presents early in life. Secondary HLH, a ‘reactive’ form, usually presents after a trigger (i.e. infection, autoimmune/rheumatic disease, or cancers) causing the immune system to stay in a hyperactive state. MAS is part of the Secondary HLH family. The treatments of MAS and secondary HLH are similar; therefore your healthcare provider may mention the word HLH when discussing treatment options for MAS.</p> <p>MAS is equally common in girls and boys, and can happen at any age (even as early as one year old).</p><h2>Key points</h2> <ul> <li>MAS is severe inflammation of the immune system and is a very serious condition.</li> <li>MAS is usually associated with known rheumatologic conditions, infections, and cancers.</li> <li>MAS, when diagnosed, will be monitored closely and treated aggressively.</li> <li>If treated appropriately, most children respond well to therapy.</li> </ul><h2>Signs and symptoms of MAS</h2> <p>The following symptoms can be associated with MAS:</p> <ul> <li>Continuous fevers (persistent fevers)</li> <li>Feeling tired and low energy</li> <li>Headaches, feeling confused or ‘foggy’ (mental status changes)</li> <li>Large lymph nodes (lymphadenopathy)</li> <li>Large liver and spleen (hepatosplenomegaly)</li> <li>Bleeding and clotting problems (coagulopathy) seen by nose bleeds, easy bruising, vomiting blood</li> <li>Rash</li> <li>Changes in blood pressure and heart rate</li> <li>Abnormal functioning of the liver</li> <li>Low blood counts</li> </ul><h2>Causes of MAS</h2><p>We do not know the exact cause of MAS just yet, but active research is being undertaken. There have been several triggers, genes, and proteins linked to the diseases that are being studied.</p><p>MAS can be triggered by infection, cancer, changes in medications, and by rheumatic/autoimmune diseases. Rheumatic/autoimmune disease is when the immune system attacks itself accidentally. The most common rheumatic/autoimmune diseases associated with MAS include <a href="/article?contentid=920&language=English">systemic lupus erythematosus</a>, <a href="/article?contentid=918&language=English">systemic juvenile idiopathic arthritis</a> and <a href="/article?contentid=915&language=English">Kawasaki disease</a>.</p><p>In certain cases, your medical team may approach you for genetic testing if your physician thinks MAS/HLH may be of a genetic (inherited) form and wishes to exclude that.</p><h2>Diagnosis of MAS</h2><p>There are different diagnostic criteria available for MAS. The symptoms and clinical signs listed above, as well as blood work abnormalities, are taken together to make the diagnosis.</p><p>Blood work may include the following:</p><ul><li>Complete blood counts (CBC)</li><ul><li>Hemoglobin or Red Blood Cells (Carries oxygen in the blood)</li><li>White Blood Cells Count (Cells that fight infection)</li><li>Platelets (Cells that help with clotting)</li></ul><li>High markers of inflammation</li><ul><li>CRP, Ferritin to name a few</li></ul><li>High Liver Markers:</li><ul><li>AST, ALT, GGT, LDH, Bilirubin (jaundice pigment)</li></ul><li>Clotting abnormalities</li><ul><li>High INR, PTT</li><li>Low Fibrinogen</li><li>High D-Dimer</li></ul><li>Lipid/Fat abnormalities<br></li><ul><li>High triglycerides, <a href="/article?contentid=891&language=English">high cholesterol</a></li></ul></ul><p>In addition to looking at the overall levels of these tests, your child’s doctor will keep an eye on the direction of these levels – whether they are increasing or decreasing, by how much, and how quickly. Your child’s doctor will monitor these values very closely. As a result, blood work may need to be done quite frequently; potentially even several times in the same day.</p><p>Bone marrow aspirate (bone marrow sampling) can also be useful in trying to find diagnoses that could be underlying triggers for MAS, and can help us to look at cells that we know are a part of MAS.</p><p>Your child may also need imaging tests to monitor their organs (e.g. X-rays, <a href="/article?contentid=1290&language=English">ultrasound</a>, <a href="/article?contentid=1272&language=English">CT scan</a> or <a href="/article?contentid=1270&language=English">MRI</a>). These additional tests are done on an as needed basis.</p><p>Your child will be seen by a team of different specialists who will work together to make this diagnosis; this team may include hematologists, rheumatologists, immunologists, infectious disease specialists, liver disease specialists and their pediatrician, among others.</p><h2>Treatment of MAS</h2><p>If your child is suspected of having MAS, they will be admitted to hospital for further monitoring and treatment.</p><p>The goals of treatment are to:</p><ul><li>Reduce body inflammation</li><li>Stop fevers</li><li>Prevent organ damage<br></li></ul><p>As mentioned above, your child’s blood work and symptoms will be monitored very closely. Blood tests will be repeated often to see if your child is responding to treatment, and to monitor for side effects of the medications listed below.<br></p><p>Since MAS is a dangerous and potentially fatal disease if not treated, we use very strong medications to try and stop the immune system over-activity. The medications normally used include:</p><ul><li>Steroids (High dose, usually through an IV initially, and then by mouth)</li><li> <a href="/Article?contentid=157&language=English">Intravenous immune globulin</a> (pooled antibody transfusion)</li><li>Cyclosporin (a medication that suppresses the immune system)</li><li>Biologic therapy (another class of medications that suppress different aspects of the immune system than Cyclosporin does). A common example of this type of medication that we use is called Anakinra (Kineret).</li></ul><p>In some cases, an anti-cancer drug, <a href="/Article?contentid=134&language=English">etoposide</a> has been shown to be useful when treating HLH, and may be considered in severe cases of MAS. A specialist in MAS/HLH may be consulted to help with the treatment.</p>
Syndrome d'activation macrophagique (SAM)SSyndrome d'activation macrophagique (SAM)Macrophage activation syndrome (MAS)FrenchRheumatologyChild (0-12 years);Teen (13-18 years)NAImmune systemConditions and diseasesAdult (19+) CaregiversNA2015-10-12T04:00:00ZEvelyn Rozenblyum MD, FRCPC;Andrea Human MD, FRCPC;Shirley Tse MD, FRCPC;Sheila Weitzman, MB ChB, FRCPC;James Whitlock, MD;Ahmed Naqvi MBBS, MRCP;Rayfel Schneider MBBCH, FRCPC;Ronald Laxer MDCM, FRCPCHealth (A-Z) - ConditionsHealth A-Z<p>Le syndrome d'activation macrophagique affecte le système immunitaire et provoque l'inflammation. En savoir plus sur les signes, les causes et traitement.</p><h2>Que sont le SAM et la LHH?</h2><p>Le système immunitaire est le mécanisme de défense naturelle de l'organisme contre les infections. Il comporte plusieurs groupes ou familles de cellules qui travaillent ensemble et qui se transmettent des signaux pour lutter contre les infections. Une des familles de cellules sont les macrophages. Ceux-ci agissent en detruisant ou en ingérant des cellules infectieuses (p. ex. des virus et des bactéries). Les macrophages peuvent aussi contrôler d’autres cellules du système immunitaire pour aider à combattre une infection. Les cellules T (ou lymphocytes T) sont une autre famille de cellules du système immunitaire. Une partie de leur rôle est de transmettre des signaux destinés à réunir et à contrôler les macrophages pour lutter contre les infections.</p><p>Normalement, lorsque le système immunitaire est activé, il combat les infections de façon coordonnée et contrôlée. Chez les personnes atteintes du syndrome d'activation macrophagique (SAM), le système immunitaire est incontrôlé et suractivé, ce qui provoque une inflammation trop grande dans tout le corps. L'inflammation peut se trouver dans n'importe quel système d’organe, dont la moelle osseuse, le foie et la rate. Il s’agit d’un état très grave qui peut souvent rendre les enfants très malades et provoquer des lésions aux organes.</p><p>Le SAM fait partie d'un groupe d'affections appelé lymphohistiocytose hémophagocytaire (ou LHH). La LHH provoque également une hyperstimulation du système immunitaire et une inflammation grave dans l’organisme. Il existe deux formes de LHH. La LHH primaire ou familiale (causée par des anomalies dans les gènes) se présente généralement tôt dans la vie. La LHH secondaire ou « réactionnelle » se présente généralement après un agent déclencheur (une infection, une maladie auto-immune/rhumatismale ou un cancer) qui provoque une hyperstimulation du système immunitaire. Le SAM appartient au groupe des LHH secondaires. Les traitements du SAM et de la LHH secondaire sont semblables; or, votre fournisseur de soins de santé peut mentionner le mot LHH lorsqu’il examine des options de traitement du SAM.</p><p>Le SAM est tout aussi fréquent chez les filles que chez les garçons, et il peut survenir à tout âge (même dès l’âge d’un an).</p><h2>À retenir</h2><ul><li>Le SAM est une inflammation grave du système immunitaire; il s’agit d’un trouble très grave.</li><li>Le SAM est généralement associé à un cancer, une infection et aux maladies rhumatologiques connues.</li><li>Après un diagnostic du SAM, votre enfant sera surveillé de très près et traité de façon agressive.</li><li>S’ils sont soignés de manière appropriée, la plupart des enfants répondent bien au traitement du SAM.</li></ul><h2>Signes et symptômes du SAM</h2><p>Les symptômes suivants peuvent être associés au SAM :</p><ul><li>fièvres continues (fièvres persistantes)</li><li>Sentiment de fatigue et manque d’énergie</li><li>maux de tête, état de confusion ou un peu « brumeux » (changement dans l'état mental)</li><li>ganglions lymphatiques hypertrophiés (adénopathie)</li><li>augmentation du volume du foie et de la rate (hépatosplénomégalie)</li><li>saignements et problèmes de coagulation (coagulopathie) se manifestant par des saignements de nez, des ecchymoses et des vomissements de sang</li><li>éruption cutanée</li><li>changements dans la pression artérielle et le rythme cardiaque</li><li>fonctionnement anormal du foie</li><li>faible numération globulaire</li></ul><h2>Causes du SAM</h2><p>Nous ne connaissons pas encore la cause exacte du SAM, mais une recherche active est en cours. Plusieurs agents déclencheurs, protéines et gènes liés aux maladies sont à l'étude.</p><p>Le SAM peut être déclenché par une infection, un cancer, un changement de médicaments et des maladies auto-immunes ou rhumatismales. Les maladies auto-immunes ou rhumatismales surviennent lorsque le système immunitaire s'attaque lui-même accidentellement. Les maladies auto-immunes ou rhumatismales les plus communes qui sont associées au SAM comprennent le <a href="/article?contentid=920&language=French">lupus érythémateux disséminé</a>, <a href="/article?contentid=918&language=French">l'arthrite idiopathique juvénile systémique</a> et la <a href="/article?contentid=915&language=English">maladie de Kawasaki</a>.<br></p><p>Dans certains cas, votre équipe médicale peut vous recommander des tests génétiques si votre médecin pense que le SAM ou la LHH peut être familial (hérité) et souhaite exclure cette possibilité.</p><h2>Diagnostic du SAM</h2><p>Il y a différents critères qui permettent de confirmer un diagnostic du SAM. Les symptômes et les signes cliniques mentionnés ci-dessus, ainsi que des anomalies dans les analyses sanguines sont réunis pour confimer un diagnostic.</p> Les analyses sanguines peuvent comprendre les analyses suivantes : <ul><li>Formule sanguine complète (FSC)</li><ul><li>hémoglobine ou globules rouges (cellules qui transportent l'oxygène dans le sang)</li><li>taux de globules blancs (cellules qui combattent l'infection)</li><li>plaquettes (cellules qui aident à la coagulation)</li></ul><li>Marqueurs élevés d’inflammation</li><ul><li>CRP et ferritine, pour n'en nommer que quelques-uns</li></ul><li>Marqueurs hépatiques élevées</li><ul><li>AST, ALT, GGT, LDH, bilirubine (pigment de la jaunisse)</li></ul><li>Anomalies de la coagulation</li><ul><li>niveau élevé d’INR et de PTT</li><li>faible taux de fibrinogène</li><li>taux élevé de D-dimères</li></ul><li>Anomalies dans les lipides et les gras</li><ul><li>taux élevés de triglycérides et de <a href="/article?contentid=891&language=French">cholestérol</a></li></ul></ul><p>En plus d'examiner les résultats de l’ensemble de ces analyses, le médecin de votre enfant gardera un œil sur les variations dans les marqueurs – s’ils sont à la hausse ou à la baisse – ainsi que sur leurs niveaux et le rythme des variations. Il suivra de très près ces marqueurs. Ainsi, il se peut que des analyses sanguines soient faites fréquemment, peut-être même plusieurs fois dans la même journée.</p><p>Une ponction de la moelle osseuse (prélèvement de moelle osseuse) peut également être utile pour diagnostiquer des agents déclencheurs sous-jacents du SAM et aider à examiner des cellules associées au SAM. Votre enfant aura peut-être aussi besoin de tests d’imagerie pour surveiller ses organes (p. ex. des radiographies, une <a href="/article?contentid=1290&language=French">échographie</a>, une <a href="/article?contentid=1272&language=French">tomodensitométrie</a> ou une <a href="/article?contentid=1270&language=French">IRM</a>). Ces tests complémentaires sont effectués au besoin.</p><p>Une équipe de spécialistes de différents domaines travailleront ensemble pour confimer le diagnostic de votre enfant. L’équipe peut comprendre, entre autres, des hématologues, des rhumatologues, des immunologistes, des infectiologues, des spécialistes des maladies du foie et son pédiatre.</p><h2>Traitement du SAM</h2><p>Si l’on soupçonne que votre enfant est atteint du SAM, il sera admis à l'hôpital pour être surveillé de plus près et recevoir un traitement.</p><p>Le traitement vise :</p><ul><li>à réduire l'inflammation dans le corps;</li><li>à arrêter les fièvres;</li><li>à prévenir des lésions aux organes.</li></ul><p>Comme mentionné ci-dessus, les analyses sanguines et les symptômes de votre enfant seront surveillés de très près. Les analyses sanguines seront répétées souvent pour établir si votre enfant répond au traitement et surveiller les effets secondaires des médicaments énumérés ci-dessous.</p><p>Comme le SAM est une maladie dangereuse et potentiellement mortelle si elle n'est pas traitée, nous utilisons des médicaments très forts pour essayer de bloquer l’hyperstimulation du système immunitaire. Les médicaments habituellement utilisés comprennent :</p><ul><li>les stéroïdes (une dose élevée, habituellement par perfusion IV au début et puis par la bouche);</li><li>les <a href="/Article?contentid=157&language=French">immunoglobulines intraveineuses</a> (transfusion d'anticorps mis en commun)</li><li>la cyclosporine (un médicament qui supprime le système immunitaire);</li><li>la thérapie biologique (une autre classe de médicaments qui suppriment d’autres aspects du système immunitaire que la cyclosporine). Un exemple courant du type de médicaments utilisés est l’anakinra (kineret).</li></ul><p>Dans certains cas, un médicament anticancéreux, l’<a href="/Article?contentid=134&language=French">étoposide​</a>, s'est avéré utile lors du traitement de la LHH et peut être envisagé dans les cas graves du SAM. Un spécialiste du SAM ou de la LHH peut être consulté pour aider avec le traitement.</p>

 

 

Macrophage activation syndrome (MAS)2310.00000000000Macrophage activation syndrome (MAS)Macrophage activation syndrome (MAS)MEnglishRheumatologyChild (0-12 years);Teen (13-18 years)NAImmune systemConditions and diseasesCaregivers Adult (19+)NA2015-10-12T04:00:00ZEvelyn Rozenblyum MD, FRCPC;Andrea Human MD, FRCPC;Shirley Tse MD, FRCPC;Sheila Weitzman, MB ChB, FRCPC;James Whitlock, MD;Ahmed Naqvi MBBS, MRCP;Rayfel Schneider MBBCH, FRCPC;Ronald Laxer MDCM, FRCPC11.000000000000047.00000000000001191.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Macrophage activation syndrome affects the immune system and causes inflamation. Learn about the signs, causes and treatment of MAS.</p><h2>What is MAS/HLH</h2> <p>The immune system is the body’s natural defense system to fight infection. It has several groups/families of cells that work together and send signals to one another to help fight against these infections. One family of cells is called macrophages, which work by destroying/ingesting infectious cells (e.g. viruses and bacteria). Macrophages can also control other cells in the immune system to help fight infection. Another family of cells in the immune system is called T cells (or T lymphocytes), which can send signals to gather and control macrophages to help fight infection as one part of their role in the immune system.</p> <p>Normally, when the immune system is activated, it fights the infection in a coordinated and controlled manner. In individuals with macrophage activation syndrome (MAS), the immune system is uncontrolled and works in overdrive, leading to too much inflammation in the entire body. The inflammation can be in any organ system including the bone marrow, liver, and spleen. This inflammation is very serious and can often make children very ill - it may also result in organ damage.</p> <p>MAS is classified as part of a group of conditions called Hemophagocytic Lymphohistiocytosis (HLH for short). HLH also results in over activation of the immune system and dangerous inflammation of the body. There are two forms of HLH. Primary HLH, the genetic form (as it is caused by gene abnormalities), usually presents early in life. Secondary HLH, a ‘reactive’ form, usually presents after a trigger (i.e. infection, autoimmune/rheumatic disease, or cancers) causing the immune system to stay in a hyperactive state. MAS is part of the Secondary HLH family. The treatments of MAS and secondary HLH are similar; therefore your healthcare provider may mention the word HLH when discussing treatment options for MAS.</p> <p>MAS is equally common in girls and boys, and can happen at any age (even as early as one year old).</p><h2>Key points</h2> <ul> <li>MAS is severe inflammation of the immune system and is a very serious condition.</li> <li>MAS is usually associated with known rheumatologic conditions, infections, and cancers.</li> <li>MAS, when diagnosed, will be monitored closely and treated aggressively.</li> <li>If treated appropriately, most children respond well to therapy.</li> </ul><h2>Signs and symptoms of MAS</h2> <p>The following symptoms can be associated with MAS:</p> <ul> <li>Continuous fevers (persistent fevers)</li> <li>Feeling tired and low energy</li> <li>Headaches, feeling confused or ‘foggy’ (mental status changes)</li> <li>Large lymph nodes (lymphadenopathy)</li> <li>Large liver and spleen (hepatosplenomegaly)</li> <li>Bleeding and clotting problems (coagulopathy) seen by nose bleeds, easy bruising, vomiting blood</li> <li>Rash</li> <li>Changes in blood pressure and heart rate</li> <li>Abnormal functioning of the liver</li> <li>Low blood counts</li> </ul><h2>Causes of MAS</h2><p>We do not know the exact cause of MAS just yet, but active research is being undertaken. There have been several triggers, genes, and proteins linked to the diseases that are being studied.</p><p>MAS can be triggered by infection, cancer, changes in medications, and by rheumatic/autoimmune diseases. Rheumatic/autoimmune disease is when the immune system attacks itself accidentally. The most common rheumatic/autoimmune diseases associated with MAS include <a href="/article?contentid=920&language=English">systemic lupus erythematosus</a>, <a href="/article?contentid=918&language=English">systemic juvenile idiopathic arthritis</a> and <a href="/article?contentid=915&language=English">Kawasaki disease</a>.</p><p>In certain cases, your medical team may approach you for genetic testing if your physician thinks MAS/HLH may be of a genetic (inherited) form and wishes to exclude that.</p><h2>Diagnosis of MAS</h2><p>There are different diagnostic criteria available for MAS. The symptoms and clinical signs listed above, as well as blood work abnormalities, are taken together to make the diagnosis.</p><p>Blood work may include the following:</p><ul><li>Complete blood counts (CBC)</li><ul><li>Hemoglobin or Red Blood Cells (Carries oxygen in the blood)</li><li>White Blood Cells Count (Cells that fight infection)</li><li>Platelets (Cells that help with clotting)</li></ul><li>High markers of inflammation</li><ul><li>CRP, Ferritin to name a few</li></ul><li>High Liver Markers:</li><ul><li>AST, ALT, GGT, LDH, Bilirubin (jaundice pigment)</li></ul><li>Clotting abnormalities</li><ul><li>High INR, PTT</li><li>Low Fibrinogen</li><li>High D-Dimer</li></ul><li>Lipid/Fat abnormalities<br></li><ul><li>High triglycerides, <a href="/article?contentid=891&language=English">high cholesterol</a></li></ul></ul><p>In addition to looking at the overall levels of these tests, your child’s doctor will keep an eye on the direction of these levels – whether they are increasing or decreasing, by how much, and how quickly. Your child’s doctor will monitor these values very closely. As a result, blood work may need to be done quite frequently; potentially even several times in the same day.</p><p>Bone marrow aspirate (bone marrow sampling) can also be useful in trying to find diagnoses that could be underlying triggers for MAS, and can help us to look at cells that we know are a part of MAS.</p><p>Your child may also need imaging tests to monitor their organs (e.g. X-rays, <a href="/article?contentid=1290&language=English">ultrasound</a>, <a href="/article?contentid=1272&language=English">CT scan</a> or <a href="/article?contentid=1270&language=English">MRI</a>). These additional tests are done on an as needed basis.</p><p>Your child will be seen by a team of different specialists who will work together to make this diagnosis; this team may include hematologists, rheumatologists, immunologists, infectious disease specialists, liver disease specialists and their pediatrician, among others.</p><h2>Treatment of MAS</h2><p>If your child is suspected of having MAS, they will be admitted to hospital for further monitoring and treatment.</p><p>The goals of treatment are to:</p><ul><li>Reduce body inflammation</li><li>Stop fevers</li><li>Prevent organ damage<br></li></ul><p>As mentioned above, your child’s blood work and symptoms will be monitored very closely. Blood tests will be repeated often to see if your child is responding to treatment, and to monitor for side effects of the medications listed below.<br></p><p>Since MAS is a dangerous and potentially fatal disease if not treated, we use very strong medications to try and stop the immune system over-activity. The medications normally used include:</p><ul><li>Steroids (High dose, usually through an IV initially, and then by mouth)</li><li> <a href="/Article?contentid=157&language=English">Intravenous immune globulin</a> (pooled antibody transfusion)</li><li>Cyclosporin (a medication that suppresses the immune system)</li><li>Biologic therapy (another class of medications that suppress different aspects of the immune system than Cyclosporin does). A common example of this type of medication that we use is called Anakinra (Kineret).</li></ul><p>In some cases, an anti-cancer drug, <a href="/Article?contentid=134&language=English">etoposide</a> has been shown to be useful when treating HLH, and may be considered in severe cases of MAS. A specialist in MAS/HLH may be consulted to help with the treatment.</p><h2>Outlook for children with MAS</h2> <p>In recent years, there has been increased awareness of MAS, which means that it is being diagnosed much earlier, and children have been receiving appropriate treatments. As a result, most children recover and experience less organ damage than in the past. However, since it is a serious and potentially fatal condition, we treat it very seriously from the onset of symptoms.</p> <h2>Follow-up care</h2> <p>We will only discharge your child from the hospital once we are sure that the inflammation is under control. MAS has been known to recur, therefore we will monitor your child regularly in clinics after discharge. Blood work will be taken at every visit following the episode to ensure that the blood values continue to improve, and are not showing abnormalities.</p> <p>Once your child is discharged, you will be asked to monitor your child closely for recurrent signs of the disease (fevers, feeling unwell) and seek prompt medical attention if these occur. Blood tests may be done urgently to determine if there is a recurrence of MAS.</p>Macrophage activation syndrome (MAS)

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