Moderate and severe neutropenia in patients with systemic lupus erythematosus.
OBJECTIVE
Neutropenia is an uncommon albeit relevant finding in patients with systemic lupus erythematosus (SLE). It has been ascribed to several aetiologies and represents a challenging dilemma in which clinical findings, laboratory data and medication history must be carefully evaluated. The aim of this work was to review the cases of moderate and severe neutropenia in our cohort of SLE patients in order to identify predisposing factors, clinical outcomes and related prognostic implications.


METHODS
Thirty-three cases of neutropenia (neutrophil count <1000/microl) in patients with SLE were included. Sixty-five age- and sex-matched patients with SLE served as controls. Information was obtained by medical chart review. Statistical analyses included descriptive statistics, Student's t-test, paired t-test, chi 2 or Fisher's exact test, and logistic regression.


RESULTS
Baseline characteristics did not differ between groups. Use of concomitant medications and immunosuppressive drugs, as well as history of thrombocytopenia and central nervous system involvement, were associated with an increased risk for developing neutropenia. Along with neutropenia, cases had lower haemoglobin and platelet values and higher levels of liver enzymes. Moreover, disease activity was lower than in controls. One month after the neutropenia event, leucocyte and total granulocyte counts were still lower in patients than in controls. Mortality did not differ between patients with neutropenia and controls.


CONCLUSIONS
Most episodes of severe granulocytopenia in SLE patients occur as part of drug toxicity-induced medullar hypoplasia.
Martínez-Baños
D
D
Department of Haematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Crispín
J C
JC
Lazo-Langner
A
A
Sánchez-Guerrero
J
J
D000293:Adolescent; D000328:Adult; D001853:Bone Marrow / Q000473:pathology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007958:Leukocyte Count; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D020945:Lupus Vasculitis, Central Nervous System / Q000150:complications; D008297:Male; D009503:Neutropenia / Q000139:chemically induced / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013921:Thrombocytopenia / Q000150:complications; D016896:Treatment Outcome
D007166:Immunosuppressive Agents