Haemolytic anaemia in a multi-ethnic cohort of lupus patients: a clinical and serological perspective

Abstract

Systemic lupus erythematosus is a chronic autoimmune disease that can be associated with a variety of haematological manifestations. We identified 76 patients with haemolytic anaemia in a cohort of 1251 unrelated female lupus patients enrolled in our studies. The presence of the various American College of Rheumatology clinical criteria for lupus and serological specificities were determined in lupus patients with haemolytic anaemia and compared with a group of race-matched control lupus patients without haemolytic anaemia. Clinical data were obtained from medical records, and serological specificities were determined in our clinical immunology laboratory at OMRF. The presence of haemolytic anaemia in lupus patients was associated with a higher frequency of proteinuria (OR = 2.70, P = 0.000031), urinary cellular casts (OR = 2.83, P = 0.000062), seizures (OR = 2.96, P = 0.00024), pericarditis (OR = 2.21, P = 0.0019), pleuritis (OR = 1.72, P = 0.028) and lymphopenia (OR = 1.79, P = 0.015). These findings were independent of the presence of thrombocytopenia, which was approximately five times more common in lupus patients with haemolytic anaemia. Lupus patients with haemolytic anaemia were about 8 years younger than lupus patients without haemolytic anaemia at the time of disease onset (P = 0.000001). In the absence of thrombocytopenia, lupus patients with haemolytic anaemia were approximately two times more likely to have anti-dsDNA antibodies (P = 0.024). The presence of haemolytic anaemia is associated with a subset of lupus characterized by a younger age of disease onset, and a more severe disease with a higher likelihood of renal involvement, seizures, serositis and other cytopenias.

Warm Autoimmune Hemolytic Anemia: Clinical Profile and Management

“…Mean age of wAIHA onset was 51.7 ± 20.5 years in primary wAIHA group and 54.3 ± 25.7 years in secondary wAIHA, which is statistically not significant. Regarding clinical symptoms at the time of onset, 93.10% (27) in primary wAIHA group and 67.39% (31) in secondary wAIHA group reported it.…”

“…Diagnosis may be difficult in some patients with IgM warm antibodies, cold antibodies with low titers, DAT negativity, or Donath-Landsteiner antibodies. The type of antibodies and diseases underlying are represented in Table 1 [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38].…”

Associates and predictors of pleurisy or pericarditis in SLE

“…[1][2][3] Although not among the most common lupus manifestations, serositis is still frequent, seen in 12%-45%. [4][5][6][7][8][9][10] The frequency of pericarditis ranges from 10% to 24%, and of pleurisy ranges from 15% to 34%, [10][11][12][13][14][15] suggesting that these two types of serositis have similar frequencies. In one study, 24% of patients with SLE with serositis had relapsed during the follow-up period.…”

“…[11][12][13][14][15] The results from a few past studies have shown some potential associations of pleurisy or pericarditis in SLE, as summarised in table 1. [11][12][13][14][15] Feng et al found that male gender was associated with both serositis (p<0.05) and pleurisy (p<0.05). 11 In only one study, haemolytic anaemia was associated with pericarditis (p=0.0019) and pleurisy (p=0.028).…”

Genome-wide DNA methylation patterns in CD4+ T cells from patients with systemic lupus erythematosus

“…37 Imatinib, a specific PDGF receptor-targeting tyrosine kinase inhibitor initially developed to treat chronic myeloid leukemia, has been shown to significantly improve survival and delay the onset of proteinuria in lupus-prone mice. 38 …”