Hematologic Aspects of Systemic Lupus Erythematosus

Abstract

Anemia occurs in more than 1/2 of patients with systemic lupus erythematosus and is usually attributed to chronic disease. Approximately 10% of patients with a positive Coombs'' test manifest clinically significant hemolysis. Leukopenia affects granulocytic and lymphocytic lines and may be caused by autoantibodies. Nevertheless, enhancement of B [bone marrow-derived] lymphocyte function occurs in active disease, perhaps due to a loss of regulatory T [thymus-derived] cells. Most patients have increased production and increased peripheral destruction of thrombocytes, with a normal circulation platelet count. Thrombocytopenia is usually caused by increased destruction. Qualitative abnormalities of platelet aggregation occur. Circulation anticoagulants are not rare; spontaneous bleeding is uncommon. The anticoagulants, immunoglobulins directed against clotting factors, assume importance for invasive procedures. Most clinically significant hematopoietic abnormalities can be suppressed by corticosteroids; splenectomy, immunosuppressive agents or both may be indicated for patients who respond inadequately to corticosteroids.