Severe Hematologic Manifestations Among Filipino Patients With Systemic Lupus Erythematosus: a 5-Year Retrospective Cohort Study
Rodeo V. Navarroza, Sandra V. Navarra
Apr 2022 DOI 10.35460/2546-1621.2019-0045 Access
Abstract
Objective: Determination of the prevalence of severe hematologic manifestations among Filipino patients with systemic lupus erythematosus (SLE) and analysis of any association with organ involvement and serology.
Methods: This cross-sectional study included SLE patients 19 years old and above seen at the UST Hospital from 2012 to 2017. Patients with severe hematologic manifestations (severe hemolytic anemia, severe thrombocytopenia, and ES[ES]) were identified and their prevalence determined. Independent t-test was used to compare continuous variables. Categorical variables were measured using the chi-square test; odds ratios (OR) with their corresponding 95% confidence interval were calculated using the SPSS software version 21. This study has been approved by the Institutional Review Board.
Results: Of the 253 patients (238 females, 94.07%), the mean age at diagnosis was 27.04 (SD 9.96) years. Severe hematologic involvement was noted in 12.26% (n=31); severe hemolytic anemia was the most prevalent (14, 5.53%), followed by severe thrombocytopenia (13, 5.14%) and ES (4, 1.58%). Higher prevalence of major organ involvement was observed among patients who manifest with severe hematologic disease. Severe thrombocytopenia was more likely to have cardiac involvement (OR 7.39, 95% CI 1.90 to 28.81, p=0.004). A higher prevalence of negative baseline anti-dsDNA serology was seen among patients who developed ES.
Conclusion: Severe hematologic involvement was noted in 12.26% of Filipino SLE patients, with hemolytic anemia as the most frequently recorded. Severe thrombocytopenia was associated with cardiac involvement among these patients. Patients developing ES tend to have a negative anti-dsDNA serology.
Keywords: systemic lupus erythematosus, severe hematologic manifestations, hemolytic anemia, thrombocytopenia
- Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40:1725.
- Sultan SM, Begum S, Isenberg DA. Prevalence, patterns of disease and outcome in patients with systemic lupus erythematosus who develop severe haematological problems. Rheumatol Oxf Engl. 2003;42:230–34.
- Miranda-Hernández D, Cruz-Reyes C, Monsebaiz-Mora C, Gómez-Bañuelos E, Ángeles U, Jara LJ, et al. Active haematological manifestations of systemic lupus erythematosus lupus are associated with a high rate of in-hospital mortality. Lupus [Internet]. 2017;26(6):640–5. Available from: http://dx.doi.org/10.1177/0961203316672926
- Nossent JC, Swaak AJ. Prevalence and significance of haematological abnormalities in patients with systemic lupus erythematosus. Q J Med. 1991;80:605–12.
- Skare T, Damin R, Hofius R. Prevalence of the American College of Rheumatology hematological classification criteria and associations with serological and clinical variables in 460 systemic lupus erythematosus patients. Rev Bras Hematol E Hemoter. 2015;37:115–9.
- Costallat GL, Appenzeller S, Costallat LTL. ES and systemic lupus erythematosus: clinical presentation and outcome. Jt Bone Spine Rev Rhum. 2012;79:362–4.
- Zhang L, Wu X, Wang L, Li J, Chen H, Zhao Y, et al. Clinical features of systemic lupus erythematosus patients complicated with ES: A case-control, single center study. Medicine (Baltimore) [Internet]. 2016;95(15):e3279. Available from: http://dx.doi.org/10.1097/md.0000000000003279
- Aleem A, Al Arfaj AS, Khalil N, Alarfaj H. Haematological abnormalities in systemic lupus erythematosus. Acta Reumatol Port. 2014;39:236–41.
- Chock YP, Wahl D, Zuily S. Increased risk of thrombocytopenia associated with antiphospholipid antibodies in patients with systemic lupus erythematosus: a systematic review and meta-analysis - ACR Meeting Abstracts. Available from: http://acrabstracts.org/abstract/increased-risk-of-thrombocytopenia-associated-with-antiphospholipid-antibodies-in-patients-with-systemic-lupus-erythematosus-a-systematic-review-and-meta-analysis/. Accessed January 31, 2018.
- Zuily S, Domingues V, Suty-Selton C, Eschwège V, Bertoletti L, Chaouat A, et al. Antiphospholipid antibodies can identify lupus patients at risk of pulmonary hypertension: A systematic review and meta-analysis. Autoimmun Rev [Internet]. 2017;16(6):576–86. Available from: http://dx.doi.org/10.1016/j.autrev.2017.04.003
- Toloza SMA, Uribe AG, McGwin G Jr, Alarcón GS, Fessler BJ, Bastian HM, et al. Systemic lupus erythematosus in a multiethnic US cohort (LUMINA). XXIII. Baseline predictors of vascular events: Predictors of Vascular Events in SLE. Arthritis Rheum [Internet]. 2004;50(12):3947–57. Available from: http://dx.doi.org/10.1002/art.20622
- Petri M. The lupus anticoagulant is a risk factor for myocardial infarction (but not atherosclerosis): Hopkins Lupus Cohort. Thromb Res. 2004;114:593–5.
- Ziakas PD, Giannouli S, Zintzaras E, Tzioufas AG, Voulgarelis M. Lupus thrombocytopenia: clinical implications and prognostic significance. Ann Rheum Dis. 2005;64:1366–9.
- Mok CC, Lee KW, Ho CT, Lau CS, Wong RW. A prospective study of survival and prognostic indicators of systemic lupus erythematosus in a southern Chinese population. Rheumatol Oxf Engl. 2000;39:399–406.
- Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, et al. Morbidity and mortality in systemic lupus erythematosus during a 5-year period: A multicenter prospective study of 1,000 patients. Medicine (Baltimore) [Internet]. 1999;78(3):167–75. Available from: http://dx.doi.org/10.1097/00005792-199905000-00003
- González-Naranjo LA, Betancur OM, Alarcón GS, Ugarte-Gil MF, Jaramillo-Arroyave D, Wojdyla D, et al. Features associated with hematologic abnormalities and their impact in patients with systemic lupus erythematosus: Data from a multiethnic Latin American cohort. Semin Arthritis Rheum [Internet]. 2016;45(6):675–83. Available from: http://dx.doi.org/10.1016/j.semarthrit.2015.11.003
Articles related to the one you are viewing
There are currently no results to show, please try again later
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/.