Background The systemic lupus erythematosus is an autoimmune chronic disease that affects most of the body systems including the hematologic system, being a prognostic marker in terms of morbidity and mortality. However, little is known about the specific repercussion of the disease in each one of the cell lines, and its physiopathological mechanisms or the aspects that can be used as predictors of the damage remain unclear.
Objectives To analyze the Flow cytometry findings and Bone Marrow in adult patients with hematological manifestations and systemic lupus erythematosus (SLE).
Methods A descriptive retrospective study was performed, evaluating the bone marrow findings (aspiration, biopsy and flow cytometry) of 15 adult patients that had anemia or leukopenia in monthly hemograms in a six-month period that had diagnostic criteria for SLE.
Results The average age was 39 years with a standard deviation of 12.9 years. The minor age was 21 years and the oldest age 64 years. 93% of the subjects were women, 93% of them had positive ANAS, 53% had positive AntiDNA, arthralgia and photosensitivity were present in 93% of the patients, sores in 100%, renal compromise evidenced by hematuria, proteinuria; nitrate elevation in 46%, serositis in 12%, antiphospholipid antibodies were present in 20% of the subjects, anti Smith were not evidence in any one of the cases, Anti Ro were positive in 66% of the cases, anti RNP in 6%. 20% of the subjects were in treatment with steroids, 26% with hydroxicloroquine and 6% were in therapy with rituximab. The average number of leucocytes was 2972, lymphocytes 1660, neutrophils 1237, platelets 167606, average hemoglobin concentration was 10,8. Megaloblastic changes were present in 6%, erythroid hyperplasia in 20%, immature cells were found in 33% of the cases, chromatin accumulation in 33%, augmentation of reticular cell concentration in 12%, hypocellularity in 33%, inversion of myeloid erythroid rate in 26% of the subjects, immature myeloid lines in 13%, megakariocyte augmentation in 6%. CD8 T lymphocytes were present in 93% of the cases; average number of promyelocytes (CD13++/CD11b-) was 4,86; myelocytes (weak CD13+/CD11b-) 25,6; metamyelocyte bands (CD13+/CD11b+) 37,5; mature neutrophils (CD13++/CD11b+) 33,2; monocytes 3,13; eosinophils 1, T lymphocytes 9,53; CD4 2,86; CD8 6,13; CD4-CD8- 0,73; NK cells 0,06; CD34+ myeloid cells 0,93.
Conclusions Bone marrow findings in 15 patients were studied. It is important to note that between ENAs, there was a high frequency of positive Anti Ro antibodies (66%). In the flow cytometry findings there was a strong depletion in B-lymphocytes with a mild augmentation of T-lymphocytes, especially CD34, in comparison to the data found in healthy subjects. Bone marrow aspiration findings didn’t evidence any relevant alterations, but bone marrow biopsy findings showed frequent alteration of nuclear chromatin, positive Prussian blue staining, and augmentation of reticular cell concentration, but the meaning of these findings has not been elucidated. Other relevant results were the hypocelularity and immature B-cells.
References Nossent JC, Swaak AJ. Prevalence and significance of hematologic abnormalities in patients with systemic lupus erythematosus. 1991. Q. J. Med. 80, 605.
Disclosure of Interest None Declared