Hematological Manifestations of SLE at Initial Presentation: Is It Underestimated?

Pk, Srivastava; Bindya, M.; Kumar, K. G. Sajeeth

doi:10.5402/2012/961872

Cited by 27 publications

(38 citation statements)

References 10 publications

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“…The mean age of the patients was found to be 33 years which is in accordance with the findings of Sasidharan et al and Shaikh MA et al 4,5 In the present study, the common clinical manifestation noted was constitutional and hematological symptoms (100%) followed by mucocutaneous symptoms (92.3%). Renal symptoms were also common.…”

Section: Discussionsupporting

confidence: 80%

“…This was lower than the previous findings of Sasidharan et al where as in study done by Saigal et al the mean haemoglobin level was 6.7 mg/dl. 4,6 In the present study, most common cause of anemia is AIHA (38.46%) which is comparable with Domiciano et al, Oliveira et al 7,8 Second most common cause was nutritional anemia (30.80%) followed by ACD (17.30%). In the present study, microcytic anemia was more common.…”

Section: Discussionsupporting

confidence: 80%

“…This female preponderance was almost similar with the studies of Sasidharan et al and Shaikh MA et al in which the male:female ratio was 9:1. 4,5 The increased frequency of SLE among females is thought to be due to hormonal effects.…”

Section: Discussionmentioning

confidence: 99%

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Aetiology and outcome of anemia in patients with systemic lupus erythematosus

Sonawale¹,

Pasiddhi²,

Sabnis³

2017

Int J Adv Med

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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.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 80%

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Aetiology and outcome of anemia in patients with systemic lupus erythematosus

Sonawale¹,

Pasiddhi²,

Sabnis³

2017

Int J Adv Med

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“…In the American College of Rheumatology (ACR) criteria for diagnosis of SLE, hematological changes, though very commonly seen, are not properly evaluated or estimated and are not given enough representation [6].…”

Section: Discussionmentioning

confidence: 99%

Autoimmune hemolytic anemia- an initial presentation in childhood systemic lupus erythematosus

Giriyan

Priya

Reddy

2019

Trop J Pathol Microbiol

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Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that can involve any organ system. It predominantly affects women aged 20 to 40 years. In 10% to 15% of patients, the diagnosis is first established during childhood. Childhood SLE is greater in severity, abrupt with atypical presentation at onset. A 12-year-old girl presented with fever of 8 days and vomiting of 2 days duration. On examination there was pallor and hepatospleenomegaly. Hematologic investigations showed picture of hemolytic anemia. RBCs showed auto-agglutination. Suspecting autoimmune hemolytic anemia, Direct Coombs test was done and was positive. Patient later developed malar rash and hematuria. Suspecting the cause of autoimmune hemolytic anemia to be SLE, Antinuclear antibody, Anti double stranded DNA antibody, Anti Smith antibody were done and showed positive result. Hence the diagnosis was confirmed to be Autoimmune Hemolytic Anemia Due to Systemic Lupus Erythematosus.

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“…As Evans syndrome is a diagnosis of exclusion, other confounding factors have to be ruled out by performing different tests such as ELISA for HIV I and II, malarial antigen, urine examination, ultrasonography, chest X-ray, antinuclear antibody and Ham's test, ANA and dsDNA (to rule out SLE). 3 Bone marrow examination if the patient is presenting with pancytopenia to exclude infiltrative process or an aplastic marrow.…”

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confidence: 99%

Maternal and perinatal outcome of Evan’s syndrome: a 5 years study in a tertiary care centre

Manjula

Selvi

Priya

2019

Int J Reprod Contracept Obstet Gynecol

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Background: Evans syndrome is a rare autoimmune disorder characterized by simultaneous or sequential presence of a positive antiglobulin test, autoimmune haemolytic anemia (AIHA), and immune thrombocytopenia (ITP). It is characterised by frequent exacerbations and remissions within a chronic course. It was first described by Robert Evans in 1951. Incidence of AIHA is 1 per 75 - 80,000 and ITP is 5.5 /100000 per general adult population. Incidence of Evans syndrome is 1.8% to 10% of patients with ITP. Objective was to study the maternal and perinatal outcome of women with Evans syndrome (E).Methods: About 4 antenatal mothers were identified with Evans syndrome at St. Johns medical college and hospital, Bengaluru during the study period of 5 years from July 2013-July 2017. They were followed up during their antenatal, intra natal and postnatal period and outcomes were studied. All patients included in the study fulfilled the criteria for Evans syndrome.Results: There were 4 cases of Evans syndrome, with a total number of deliveries of 11859, during this 5 year study. Incidence was 0.09 per 1000 births. All patients presented with bleeding manifestations ranging from mucosal haemorrhage to subarachnoid haemorrhage (SAH) at the time of diagnosis. All patients were on treatment with either 1st or 2nd line of management with corticosteroids/ azathioprine. None had bleeding during pregnancy after the initiation of treatment. Patients had antenatal complications like preeclampsia 25%, IUGR 25%, oligohydraminos 50%, IUD 25%. 2 patients received platelet transfusions intrapartum. None had intrapartum or postpartum haemorrhage. There were no maternal and neonatal mortality.Conclusions: Evans syndrome in pregnancy is a rare condition and requires multi disciplinary approach involving specialists from obstetrics, neonatology, and hematology. Close maternal and fetal surveillance and management during pregnancy is essential to increase the possibility of a favourable pregnancy outcome in these women.

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Hematological Manifestations of SLE at Initial Presentation: Is It Underestimated?

Cited by 27 publications

References 10 publications

Aetiology and outcome of anemia in patients with systemic lupus erythematosus

Aetiology and outcome of anemia in patients with systemic lupus erythematosus

Autoimmune hemolytic anemia- an initial presentation in childhood systemic lupus erythematosus

Maternal and perinatal outcome of Evan’s syndrome: a 5 years study in a tertiary care centre

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