The management of peripheral blood cytopenias in systemic lupus erythematosus.
Haematological complications are frequently seen in SLE. Anaemia, leucopenias and thrombocytopenia may result from bone marrow failure or excessive peripheral cell destruction, both of which may be immune mediated. Drugs and infection are other common causes. In this review, we will focus on the diagnosis and management of immune-mediated leucopenias and thrombocytopenia in SLE. The roles of bone marrow examination and the measurement of antibodies against leucocytes and platelets are discussed. Although many patients do not require specific treatment for cytopenias in SLE, CSs remain the mainstay of treatment. Other conventional therapies include AZA, CYC and human normal immunoglobulin. More recently, MMF has found a role as a CS and CYC-sparing agent. We also review B-cell depletion in the management of thrombocytopenia associated with SLE and other novel therapies including thrombopoeitin receptor agonists.
Hepburn
Alastair L
AL
Department of Rheumatology, Worthing Hospital, Lyndhurst Road, Worthing, West Sussex BN11 2DH, UK. alnhepburn@doctors.org.uk
Narat
Santosh
S
Mason
Justin C
JC
D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001402:B-Lymphocytes; D001792:Blood Platelets; D001853:Bone Marrow; D003520:Cyclophosphamide / Q000627:therapeutic use; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D008231:Lymphopenia / Q000188:drug therapy / Q000209:etiology*; D009503:Neutropenia / Q000188:drug therapy / Q000209:etiology*; D011961:Receptors, Fc / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D000069283:Rituximab; D013921:Thrombocytopenia / Q000188:drug therapy / Q000209:etiology*; D013926:Thrombopoietin / Q000627:therapeutic use
D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D011961:Receptors, Fc; D011993:Recombinant Fusion Proteins; D000069283:Rituximab; D003520:Cyclophosphamide; D013926:Thrombopoietin; C488777:romiplostim