Hematology: Cytopenias

Cytopenias are frequently encountered in patients with systemic lupus erythematosus (SLE), and leukopenia (white blood cell count <4000/mm3), thrombocytopenia (platelet count <100, 000/mm3), and autoimmune hemolytic anemia (defined by evidence for active hemolysis and a positive Coombs test) are included in the classification criteria for SLE. Leukopenia is primarily due to decreases in the neutrophil and/or lymphocyte counts. Mild to moderate neutropenia occurs in 20%-40% of patients with SLE but specific treatment targeted to increase the neutrophil count is typically not needed. Severe neutropenia occurs infrequently. Mild thrombocytopenia is observed in 10%-40% of patients with SLE, most commonly reflecting immune-mediated destruction of platelets. Specific treatment for thrombocytopenia is generally not required unless the platelet count drops below 30, 000/mm3. Anemia is common in patients with SLE, but the most common causes of anemia, such as iron deficiency and anemia of inflammation, are also seen in patients with nonrheumatologic conditions.

Duke Scholars

Author Thomas Lee Ortel Medicine, Hematology