Abstract
Hematological disturbances are common in systemic lupus erythematous (SLE). Specifically, autoimmune hemolytic anemia (AHA) may manifest in SLE patients at the time of diagnosis or within the first year of the disease. AHA is often associated with thrombocytopenia, lupus nephritis, and central nervous system activity. In this study we investigated these associations in Brazilian patients with SLE. Forty-four consecutive SLE patients who had a history of AHA were age, gender, and disease duration matched with 318 SLE patients without AHA who formed the control group. All patients fulfilled the revised American College of Rheumatology criteria for SLE and were followed-up within our Service. Clinical and laboratorial manifestations were similar in both groups, except for the predominance of leukopenia, thrombocytopenia, and anti-dsDNA on univariate analysis in the AHA group. The multivariate logistic regression model revealed risk only for thrombocytopenia in the AHA group compared to the control group (odds ratio, 2.70; 95% confidence interval, 1.32–5.50). Our results corroborate previous data that AHA in SLE increases the risk of thrombocytopenia in individuals with SLE. This association suggests a common mechanism in AHA and SLE pathophysiologies.
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Giannouli S, Voulgarelis M, Ziakas PD, Tzioufas AG (2006) Anaemia in systemic lupus erythematosus: from pathophysiology to clinical assessment. Ann Rheum Dis 65:144–148
Budman DR, Steinberg AD (1977) Hematologic aspect of systemic lupus erythematosus. Current concepts. Ann Intern Med 86:220–229
Sultan SM, Begum S, Isenberg DA (2003) Prevalence, patterns of disease and outcome in patients with systemic lupus erythematosus who develop severe haematological problems. Rheumatology (Oxford) 42:230–234
Jacobsen S, Petersen J, Ullman S, Junker P, Voss A, Rasmussen JM, Tarp U, Poulsen LH, van Overeem Hansen G, Skaarup B, Hansen TM, Podenphant J, Halberg P (1998) A multicentre study of 513 Danish patients with systemic lupus erythematosus. I. Disease manifestations and analyses of clinical subsets. Clin Rheumatol 17:468–477
Durán S, Apte M, Alarcón GS, Marion MC, Edberg JC, Kimberly RP, Zhang J, Langefeld CD, Vilá LM, Reveille JD, Lumina Study Group (2008) Features associated with, and the impact of, hemolytic anemia in patients with systemic lupus erythematosus: LX, results from a multiethnic cohort. Arthritis Rheum 59:1332–1340
Kokori SI, Ioannidis JP, Voulgarelis M, Tzioufas AG, Moutsopoulos HM (2000) Autoimmune hemolytic anemia in patients with systemic lupus erythematosus. Am J Med 108:198–204
Kasitanon N, Magder LS, Petri M (2006) Predictors of survival in systemic lupus erythematosus. Medicine (Baltimore) 85:147–156
Sturfelt G, Nived O, Norberg R, Thorstensson R, Krook K (1987) Anticardiolipin antibodies in patients with systemic lupus erythematosus. Arthritis Rheum 30:382–388
Fong KY, Loizou S, Boey ML, Walport MJ (1992) Anticardiolipin antibodies, haemolytic anaemia and thrombocytopenia in systemic lupus erythematosus. Br J Rheumatol 31:453–455
Jeffries M, Hamadeh F, Aberle T, Glenn S, Kamen DL, Kelly JA, Reichlin M, Harley JB, Sawalha AH (2008) Haemolytic anaemia in a multi-ethnic cohort of lupus patients: a clinical and serological perspective. Lupus 17:739–743
Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725
Keren DF (2002) Antinuclear antibody testing. Clin Lab Med 22:447–474
Aarden LA, Lakmaker F, de Groot ER, Swaak AJ, Feltkamp TE (1975) Detection of antibodies to DNA by radioimmunoassay and immunofluorescence. Scand J Rheumatol 11:12–19
Benito-Garcia E, Schur PH, Lahita R, The American College of Rheumatology Ad Hoc Committee on Immunologic Testing Guidelines (2004) Guidelines for immunologic laboratory testing in the rheumatic diseases: anti-Sm and anti-RNP antibody tests. Arthritis Rheum 51:1030–1044
Anderson JR, Gray KG, Beck JS, Buchanan WU, McElhinney AJ (1962) Precipitating antibodies in the connective tissue diseases. Ann Rheum Dis 21:360–369
Passam F, Krilis S (2004) Laboratory tests for the antiphospholipid syndrome: current concepts. Pathol 36:129–138
Bonfa E, Gaburo Júnior N, Tavares AV, Cossermelli W (1994) Comparison of five methods for the detection of antiribosomal P protein antibody. Braz J Med Biol Res 27:637–643
Leddy JP, Falany JL, Kissel GE, Passador ST, Rosenfeld SI (1993) Erythrocyte membrane proteins reactive with human (warm-reacting) anti-red cell autoantibodies. J Clin Invest 91:1672–1680
Victoria EJ, Pierce SW, Branks MJ, Masouredis SP (1990) IgG red blood cell autoantibodies in autoimmune hemolytic anemia bind to epitopes on red blood cell membrane band 3 glycoprotein. J Lab Clin Med 115:74–88
Kay MM, Marchalonis JJ, Hughes J, Watanabe K, Schluter SF (1990) Definition of a physiologic aging autoantigen by using synthetic peptides of membrane protein band 3: localization of the active antigenic sites. Proc Natl Acad Sci U S A 87:5734–5738
Richaud-Patin Y, Perez-Romano B, Carrillo-Maravilla E, Rodriguez AB, Simon AJ, Cabiedes J, Jakez-Ocampo J, Llorente L, Ruiz-Argüelles A (2003) Deficiency of red cell bound CD55 and CD59 in patients with systemic lupus erythematosus. Immunol Lett 88:95–99
Scofield RH, Bruner GR, Kelly JA, Kilpatrick J, Bacino D, Nath SK, Harley JB (2003) Thrombocytopenia identifies a severe familial phenotype of systemic lupus erythematosus and reveals genetic linkages at 1q22 and 11p13. Blood 101:992–997
Evans RS, Takahashi K, Duane RT, Payne R, Liu C (1951) Primary thrombocytopenic purpura and acquired hemolytic anemia. Arch Intern Med 87:48–65
Lang B, Straub RH, Weber S, Rother E, Fleck M, Peter HH (1997) Elevated anticadiolipin antibodies in autoimmune haemolytic anaemia irrespective of underlying systemic lupus erythematosus. Lupus 6:652–655
Cheng HM (1993) IgG antiphospholipid autoantibody in normal human sera is reactive against bromelain treated human erythrocytes. J Rheumatol 20:400–401
Deleze M, Alarcon-Segovia D, Oria CV, Sanchez-Guerrero J, Fernandez-Dominguez L, Gomez-Pacheco L, Ponce de León S (1989) Hemocytopenia in systemic lupus erythematosus: relationship to antiphospholipid antibodies. J Rheumatol 16:926–930 [published erratum appears in J Rheumatol 1989;16:1523]
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Domiciano, D.S., Shinjo, S.K. Autoimmune hemolytic anemia in systemic lupus erythematosus: association with thrombocytopenia. Clin Rheumatol 29, 1427–1431 (2010). https://doi.org/10.1007/s10067-010-1479-2
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DOI: https://doi.org/10.1007/s10067-010-1479-2