title: Clinical assessment and management of cytopenias in lupus patients.
abstract: Anemia, leukopenia, and/or thrombocytopenia can occur as a result of non-immune- and immune-mediated mechanisms in patients with systemic lupus erythematosus. Although the differential diagnosis of these cytopenias is broad and warrants a thorough evaluation, lupus disease activity and medications are common etiologic factors. Corticosteroids are the mainstay of initial treatment for immune-mediated hemolytic anemia and severe thrombocytopenia; immunosuppressive agents such as mycophenolate mofetil or azathioprine are often added for their steroid-sparing effects. Rituximab and intravenous immunoglobulin can be considered for refractory cytopenias based on a large body of anecdotal evidence and case series. Newer biologic agents such as belimumab or epratuzumab have yet to be studied specifically in systemic lupus erythematosus-mediated hematologic disorders.
authors.affiliation: Division of Rheumatology, Hospital for Special Surgery, Weill Medical College of Cornell University, NY 10021, USA. levinea@hss.edu
authors.forename: Alana B
authors.initials: AB
authors.lastname: Levine
authors.forename: Doruk
authors.initials: D
authors.lastname: Erkan
mesh_terms: D000740:Anemia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007970:Leukopenia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010198:Pancytopenia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D000069283:Rituximab; D013921:Thrombocytopenia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D000069283:Rituximab; D009173:Mycophenolic Acid; D001379:Azathioprine