Presented in Asia Pacific International Conference of International Society of Blood Transfusion – International conference, held at New Delhi 2003, Published in Indian Journal of Hematology and Transfusion Medicine, November 2003.
Hematological abnormalities in SLE
Introduction: Many hematological abnormalities were known to present in Systemic Lupus Erythematosus (SLE). In fact hematological abnormality is one of the ARA criteria for SLE diagnosis. SLE & its treatment, coexisting infections & other autoimmune disorders can produce many hematological abnormalities in blood counts.
Aim: Study of hematological abnormalities in SLE.
Material and Methods: Clinical records of 100 consecutive patients with SLE were collected in the last 10 years. Case records of patients satisfying the ARA criteria for SLE were taken for analysis. The hematological abnormalities noted at the time of making diagnosis of SLE were analyzed retrospectively.
Results: Hematological abnormalities qualifying for ARA criteria were seen in total 64 cases. In 18 they were noted as a presenting problem but in the rest they were noted on evaluation.
Anemia was noted in total 93 cases. Autoimmune hemolytic anemia (AIHA) was noted in 16. Anemia of chronic disease (ACD) in 38, nutritional iron deficiency anemia (IDA) in 29 and IDA due to bleeding was noted in 10.
Leukopenia was seen in12. Lymphocytopenia was noted in 9. Thrombocytopenia (ITP) was seen in 16. Two cases of this group had intra-cranial bleed. Evan’s syndrome was seen in 5. Pancytopenia was noted in 13.
ESR of 50 mm or above was present in 65. ESR of 100 mm or above was present in 30 cases.
Vascular thromboses were seen in 4 cases (venous 3 and arterial 1). But Anti phaspholipid antibody syndrome was in 3. Lupus anticoagulant was positive in 2 cases. But Anti cardiolepin antibodies were positive in 28 cases.
Bone marrow study was done in 31 cases. Normal study was noted in 5. Bone marrow consistent with ITP was seen in 6. Hypo cellular marrow was seen in 3 cases, one was found to have AML M2. Megaloblastoid maturation was observed in 2. Reactive hyperplasia in 11, reactive lymphocytosis in 3 and reactive plasmacytosis in 1 were seen. Iron stores were absent in 14 and decreased in 1 case.
Conclusions: 1. Commonest hematological abnormality noted was anemia. ACD was the commonest. Coexisting autoimmune diseases and chronic infections noted were 29 that can also contribute to this abnormality.
2. Only 18% of cases presented with a hematological criterion. Hence blood tests should be carried out for documenting other abnormalities and planning the treatment accordingly.
3. Common hematological ARA criteria observed were AIHA & ITP followed by pancytopenia, leukopenia and lymphocytopenia in order of frequency.
4. Bleeding manifestations were common than vascular thrombosis.
5. Commonest observation in the bone marrow study was reactive marrow hyperplasia.
6. Intra-cranial bleed due to ITP contribute to mortality.