title: Anaemia in Systemic Lupus Erythematosus Based on Iron Studies and Soluble Transferrin Receptor Levels.
abstract: BACKGROUND
  Haematological alterations such as anaemia, neutropenia and thrombocytopenia are frequent in Systemic Lupus Erythematosus (SLE). Ferritin being an acute phase reactant can be falsely elevated in lupus cases.
  
  
  OBJECTIVE
  To evaluate the haematological alterations and to re-categorise the types of anemia by soluble transferrin receptor levels in diagnosed cases of SLE.
  
  
  METHODS
  A sample of 30 newly diagnosed ANA positive SLE patients was taken. Complete blood counts, ESR, reticulocyte count, coagulation studies, diluted Russel Viper Venom Test (dRVVT), mixing studies, serological tests, high sensitivity CRP along with iron profile, transferrin saturation, soluble transferrin receptor (sol TFR) levels, anti-beta2 glycoprotein1, direct and indirect Coomb's test were estimated in cases diagnosed as SLE. Clinical symptoms were co-related with and Systemic Lupus Erythaematosus Disease Activity Index (SLEDAI) was estimated.
  
  
  RESULTS
  Anaemia was the most prevalent haematological alteration followed by thrombocytopenia. Further sub typing of anaemia was done by serum ferritin levels and using sol TFR assays. Ferritin is an acute phase reactant; it underestimated iron deficiency in patients of SLE. When sol TFR was used; patients with pure Anaemia of Chronic Disease (ACD) reduced from 68% to 26%, those with pure IDA reduced from 32% to 16% and a group with co-existing IDA & ACD (58%) was defined {Agreement=53%, p=0.09} by sol TFR which co-related with clinical response to Iron therapy in these patients. CRP was significantly raised in association with disease activity. Fever (p<0.0001), arthritis (p<0.03) were significantly related and CRP was elevated (p<0.04) in cases with high SLEDAI (severe flare).
  
  
  CONCLUSIONS
  Thus, in SLE, anaemia is the most frequent hematological alteration; iron deficiencies supercede in contrast to ACD and further autoimmune haemolytic anaemia. Sol TFR emerged as a better parameter to detect iron deficiency in patients of non- haemolytic anaemia in contrast to iron profile and ferritin levels.
authors: Assistant Professor, Department of Pathology, Kasturba Medical College , Mangalore, Karnataka, India .
authors: Salony
authors: S
authors: Mittal
authors: Assistant Professor, DNB, Department of Pathology, King George Medical University , Lucknow, UP, India .
authors: Preeti
authors: P
authors: Agarwal
authors: Assistant Professor, Department of Rheumatology, King George Medical University , Lucknow, UP, India .
authors: Anupam
authors: A
authors: Wakhlu
authors: Professor, Department of Pathology, King George Medical University , Lucknow, UP, India .
authors: Ashutosh
authors: A
authors: Kumar
authors: Professor, Department of Pathology, Kasturba Medical College , Mangalore, Karnataka, India .
authors: Raj
authors: R
authors: Mehrotra
authors: Registrar, Department of Medicine, Indraprastha Apollo Hospital , New Delhi , India.
authors: Saumya
authors: S
authors: Mittal
keywords: Anaemia of chronic disease; Arthritis; C-reactive protein; Coagulation test; Ferritin; Fever; Iron deficiency anaemia; Iron profile; Soluble transferrin receptor