Aetiology and outcome of anemia in patients with systemic lupus erythematosus
DOI:
https://doi.org/10.18203/2349-3933.ijam20172536Keywords:
Anemia, Systemic lupus erythematosus, SLEDAI scores, SLICC/ACR damage index, Serum complement levelsAbstract
Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder that is greatly subject to the combined effect of genetic, environmental, demographic and geographical factors. Hematological manifestations are very common in SLE, with many patients presenting with anemia. The cause of Anemia could be varied, with Autoimmune hemolytic anemia, anemia of chronic disease, iron deficiency being the common causes. The aim of the present study was to estimate the proportion of patients with prevalence of different causes of anemia in SLE and it‘s association between immunological and clinical parameters and to correlate the severity of anemia with SLEDAI score and SLICC/ACR score.
Methods: This was an observational and prospective study conducted on 52 patients satisfying ACR criteria for SLE and WHO definition of anemia. All patients underwent baseline investigations for hematological, biochemical parameters and immunological investigations for C3 and C4. Other special investigations were done as per the treating rheumatologists’ opinion. Patients were followed up after three months to evaluate the response to therapy.
Results: In this study, most of the patients were in the age group between 20-50 years (94.22%) and female:male ratio was 13:1. At presentation 55.76% patients had severe anemia, 38.46% had moderate anemia and 5.78% had mild anemia. After therapy (three months) only 3.84% patients had severe anemia. The most common cause of anemia was AIHA (38.46%). Mean SLEDAI score at presentation was >20 but after three months therapy the score was reduced to 4. There was no correlation between aneamia and SLICC/ACR damage index.
Conclusions: Anaemia usually occurs at the onset of SLE and its recurrence rate will become low after three months of therapy. SLEDAI scores, SLICC/ACR damage index and serum complement levels (C3 and C4) acts as good indices for assessment and follow up of SLE.
References
Sasidharan PK. SLE as a hematological disease, in Hematolgy Today. In: Agarwal MB, editor. Mumbai, India: Vikas Publications; 2010:953-966.
Singh S, Kumar L, Khetarpal R, Aggarwal P, Marwaha RK, Minz RW, et al. Clinical and immunological profile of SLE: some unusual features. Indian Ped. 1997;34(11):979-86.
Bennett JC, Claybrook J, Kinsey H, Holley HL. The clinical manifestations of systemic lupus erythematosus. A study of forty-five patients. J Chronic Dis. 1961;13(5):411-25.
Sasidharan PK, Bindya M, Sajeeth Kumar KG. Hematological Manifestations of SLE at Initial Presentation: Is It Underestimated? ISRN Hematology. 2012:doi:10.5402/2012/961872
Shaikh MA, Memon I, Ghori RA. Frequency of anaemia in patients with systemic lupus erythematosus at tertiary care hospitals. J Pak Med Assoc. 2010;60(10):822-5.
Saigal R, Kansal A, Mittal M, Singh Y, Maharia HR, Juneja M. Clinical profile of systemic lupus erythematosus patients at a tertiary care centre in Western India. JIACM. 2011;13(1):27-32.
Domiciano D, Shinjo SK. Autoimmune hemolytic anemia in systemic lupus erythematosus: Association with thrombocytopenia. Clinical Rheumatol. 2010;29(12):1427-31.
Oliveira MCLA, Oliveira BM, Murao M, Vieira ZM, Gresta LT, Viana MB. Clinical course of autoimmune hemolytic anemia: an observational study. J Pediatr (Rio J). 2006;82(1):58-62.
Katz RS. Lupus update. Available at http://www.lupusil.org/what-are-the-sledai-and-bilag-evaluations.html. Accessed on 10 January 2017.
Bombardier C, Gladman DD, Hurwitz MB, Caron D, Chang CH. The committee on prognosis studies in SLE. Arthritis Rheum. 1992;35:630-40.
Mirzayan MJ, Schmidt RE, Witte T. Prognostic parameters for flare in systemic lupus erythematosus. Rheumatol. 2000;39:1316-9.
Gladman D, Ginzler E, Goldsmith C, Fortin P, Liang M, Urowitz M, et al. The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum. 1996;39:363-9.
Davis P, Cumming RH, Verri Jones J. Relationship between anti-DNA antibodies, complement consumption and circulating immune complexes in systemic lupus erythematosus. Clini Exp Immunol. 1977;28:226-32.
Narayanan K, Marwaha V, Shanmuganandan K, Shankar S. Correlation between Systemic Lupus Erythematosus Disease Activity Index, C3, C4 and Anti-dsDNA Antibodies. Med J Armed Forces India. 2010;66(2):102-7.
