Haemolytic anaemia in a multi-ethnic cohort of lupus patients: a clinical and serological perspective

Abstract

Systemic lupus erythematosus is a chronic autoimmune disease that can be associated with a variety of haematological manifestations. We identified 76 patients with haemolytic anaemia in a cohort of 1251 unrelated female lupus patients enrolled in our studies. The presence of the various American College of Rheumatology clinical criteria for lupus and serological specificities were determined in lupus patients with haemolytic anaemia and compared with a group of race-matched control lupus patients without haemolytic anaemia. Clinical data were obtained from medical records, and serological specificities were determined in our clinical immunology laboratory at OMRF. The presence of haemolytic anaemia in lupus patients was associated with a higher frequency of proteinuria (OR = 2.70, P = 0.000031), urinary cellular casts (OR = 2.83, P = 0.000062), seizures (OR = 2.96, P = 0.00024), pericarditis (OR = 2.21, P = 0.0019), pleuritis (OR = 1.72, P = 0.028) and lymphopenia (OR = 1.79, P = 0.015). These findings were independent of the presence of thrombocytopenia, which was approximately five times more common in lupus patients with haemolytic anaemia. Lupus patients with haemolytic anaemia were about 8 years younger than lupus patients without haemolytic anaemia at the time of disease onset (P = 0.000001). In the absence of thrombocytopenia, lupus patients with haemolytic anaemia were approximately two times more likely to have anti-dsDNA antibodies (P = 0.024). The presence of haemolytic anaemia is associated with a subset of lupus characterized by a younger age of disease onset, and a more severe disease with a higher likelihood of renal involvement, seizures, serositis and other cytopenias.

Keywords

anaemia haemolysis haemolytic lupus

Get full access to this article

View all access options for this article.

References

1 Sawalha AH Harley JB . Antinuclear autoantibodies in systemic lupus erythematosus. Curr Opin Rheumatol 2004; 16: 534 – 540 .

2 Giannouli S Voulgarelis M Ziakas PD Tzioufas AG . Anaemia in systemic lupus erythematosus: from pathophysiology to clinical assessment. Ann Rheum Dis 2006; 65: 144 – 148 .

3 Bertoli AM Vila LM Apte M . Systemic lupus erythematosus in a multiethnic US cohort LUMINA LI: anaemia as a predictor of disease activity and damage accrual. Rheumatology (Oxford) 2007; 46: 1471 – 1476 .

4 Tan EM Cohen AS Fries JF . The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25: 1271 – 1277 .

5 Hochberg MC . Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997; 40: 1725 .

6 Font J Cervera R Ramos-Casals M . Clusters of clinical and immunologic features in systemic lupus erythematosus: analysis of 600 patients from a single center. Semin Arthritis Rheum 2004; 33: 217 – 230 .

7 Beyan E Beyan C Turan M . Hematological presentation in systemic lupus erythematosus and its relationship with disease activity. Hematology 2007; 12: 257 – 261 .

8 Packman CH . Hemolytic anemia due to warm autoantibodies. Blood Rev 2008; 22: 17 – 31 .

9 Videbaek A . Auto-immune haemolytic anaemia in systemic lupus erythematosus. Acta Med Scand 1962; 171: 187 – 194 .

10.

10 Kokori SI Ioannidis JP Voulgarelis M Tzioufas AG Moutsopoulos HM . Autoimmune hemolytic anemia in patients with systemic lupus erythematosus. Am J Med 2000; 108: 198 – 204 .

11.

11 Clark G Reichlin M Tomasi TB . Characterization of a soluble cytoplasmic antigen reactive with sera from patients with systemic lupus erythmatosus. J Immunol 1969; 102: 117 – 122 .

12.

13.

13 Scofield RH Bruner GR Kelly JA . Thrombocytopenia identifies a severe familial phenotype of systemic lupus erythematosus and reveals genetic linkages at 1q22 and 11p13. Blood 2003; 101: 992 – 997 .

14.

14 Sultan SM Begum S Isenberg DA . Prevalence, patterns of disease and outcome in patients with systemic lupus erythematosus who develop severe haematological problems. Rheumatology (Oxford) 2003; 42: 230 – 234 .