title: Features associated with hematologic abnormalities and their impact in patients with systemic lupus erythematosus: Data from a multiethnic Latin American cohort.
abstract: To examine hematological manifestations' correlates and their impact on damage accrual and mortality in SLE patients from the multiethnic, Latin American, GLADEL cohort.
  
  
  
  In patients with recent SLE diagnosis (≤2 years), the association between follow-up hematological manifestations (per ACR criteria) and socio-demographic and clinical variables was examined by univariable and multivariable logistic regressions; their impact on damage accrual and mortality was examined by Poisson and Cox proportional-hazards regression analyses, respectively.
  
  
  
  Of 1437 patients, 948 (66.0%) developed ≥1 hematological manifestation [5.5% hemolytic anemia (AHA), 16.3% thrombocytopenia, and 56.4% lymphopenia] over 4.3 (3.3) follow-up years. Younger age, Mestizo ethnicity, hematologic disorder (at/or before SLE diagnosis), and first damage recorded were associated with hematological manifestations while antimalarials were negatively associated. AHA (at/or before SLE diagnosis), anti-Sm, and anti-RNP antibodies were associated with subsequent AHA occurrence while musculoskeletal involvement was negatively associated. Thrombocytopenia (at/or before SLE diagnosis), AHA, anti-phospholipid antibodies (aPLs), anti-SSA/Ro, anti-SSB/La antibodies, and first damage recorded were associated with later thrombocytopenia occurrence. Lymphopenia (at/or before SLE diagnosis), younger age at diagnosis, Mestizo ethnicity, having medical insurance, and first damage recorded were associated with subsequent lymphopenia occurrence while antimalarials and azathioprine treatment were negatively associated. AHA was associated with damage accrual and mortality after adjusting for variables known to affect these outcomes.
  
  
  
  Mestizo ethnicity and early hematological manifestations are risk factors for their subsequent occurrence while antimalarials have a protective effect. The associations between AHA and aPLs and thrombocytopenia were corroborated. AHA contributes independently to damage accrual and diminished survival.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, School of Medicine, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Antioquia 229, Colombia. Electronic address: lagnvvn68@gmail.com.
authors.forename: Luis A
authors.initials: LA
authors.lastname: González-Naranjo
authors.affiliation: Department of Internal Medicine & Hematology, Universidad Nacional de Colombia, Bogotá, Colombia.
authors.forename: Octavio Martínez
authors.initials: OM
authors.lastname: Betancur
authors.affiliation: Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Graciela S
authors.initials: GS
authors.lastname: Alarcón
authors.affiliation: Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru; Universidad Científica del Sur, Lima, Peru.
authors.forename: Manuel F
authors.initials: MF
authors.lastname: Ugarte-Gil
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Jaramillo-Arroyave
authors.affiliation: Escuela de Estadística, Universidad Nacional de Rosario, Rosario, Argentina.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wojdyla
authors.affiliation: Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Spain.
authors.forename: Guillermo J
authors.initials: GJ
authors.lastname: Pons-Estel
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.
authors.forename: Federico
authors.initials: F
authors.lastname: Rondón-Herrera
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, School of Medicine, Universidad de Antioquia, Calle 70 No. 52-21, Medellin, Antioquia 229, Colombia.
authors.forename: Gloria M
authors.initials: GM
authors.lastname: Vásquez-Duque
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Quintana-López
authors.affiliation: Rheumatology Unit, Faculdade de Medicina da Universidade Federal de Goias, Goiania, Brazil.
authors.forename: Nilzio A
authors.initials: NA
authors.lastname: Da Silva
authors.affiliation: Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: João C
authors.initials: JC
authors.lastname: Tavares Brenol
authors.affiliation: Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), La Habana, Cuba.
authors.forename: Gil
authors.initials: G
authors.lastname: Reyes-Llerena
authors.affiliation: Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, Mexico.
authors.forename: Virginia
authors.initials: V
authors.lastname: Pascual-Ramos
authors.affiliation: Reumatología, Centro Médico ABC, Ciudad de México, Mexico.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Amigo
authors.affiliation: Department of Clinical Immunology and Rheumatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Loreto
authors.initials: L
authors.lastname: Massardo
authors.affiliation: Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru.
authors.forename: José
authors.initials: J
authors.lastname: Alfaro-Lozano
authors.affiliation: Hospital Nacional "Edgardo Rebagliatti Martins", Essalud, Lima, Peru.
authors.forename: María I
authors.initials: MI
authors.lastname: Segami
authors.affiliation: Servicio de Reumatología, Departamento de Medicina, Hospital Central de San Cristóbal, San Cristóbal, Venezuela.
authors.forename: María H
authors.initials: MH
authors.lastname: Esteva-Spinetti
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.
authors.forename: Antonio
authors.initials: A
authors.lastname: Iglesias-Gamarra
authors.affiliation: Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina.
authors.forename: Bernardo A
authors.initials: BA
authors.lastname: Pons-Estel
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000743:Anemia, Hemolytic / Q000097:blood* / Q000208:ethnology / Q000209:etiology; D000974:Antibodies, Antinuclear / Q000276:immunology; D017152:Antibodies, Antiphospholipid / Q000276:immunology; D000962:Antimalarials / Q000627:therapeutic use; D001323:Autoantibodies / Q000276:immunology; D001379:Azathioprine / Q000627:therapeutic use; D044383:Black People; D005006:Ethnicity; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007199:Indians, South American; D007348:Insurance, Health; D007843:Latin America; D016015:Logistic Models; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000097:blood* / Q000150:complications / Q000188:drug therapy / Q000276:immunology; D008231:Lymphopenia / Q000097:blood* / Q000208:ethnology / Q000209:etiology; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012261:Ribonucleoproteins / Q000276:immunology; D013921:Thrombocytopenia / Q000097:blood* / Q000208:ethnology / Q000209:etiology; D044465:White People; D055815:Young Adult
chemical_list: D000974:Antibodies, Antinuclear; D017152:Antibodies, Antiphospholipid; D000962:Antimalarials; D001323:Autoantibodies; D007166:Immunosuppressive Agents; D012261:Ribonucleoproteins; C035356:SS-A antibodies; C035357:SS-B antibodies; D001379:Azathioprine
keywords: Autoimmune hemolytic anemia; Hematologic manifestations; Lymphopenia; Systemic lupus erythematosus; Thrombocytopenia