Autoimmune haemolytic anaemia and thrombocytopaenia in a single-centre cohort of patients with systemic lupus erythematosus from Turkey: clinical associations and effect on disease damage and survival.
INTRODUCTION
Thrombocytopaenia and autoimmune haemolytic anaemia (AIHA) have considerable impact on prognosis in systemic lupus erythematosus (SLE). We investigated the frequencies of these haemocytopaenias, along with their associations and effect on outcome in a single-centre cohort of patients with SLE.


METHODS
Demographic characteristics, clinical features, autoantibody profiles, damage and mortality data were compared between patients with and without each haematological abnormality. Variables displaying significant differences between the groups were entered into logistic regression.


RESULTS
Ninety-three patients had AIHA and 215 had thrombocytopaenia. Both were associated with neuropsychiatric (NP) involvement, with each other, leucopaenia, antiphospholipid syndrome (APS) and antiphospholipid antibodies. More patients in both groups had organ damage, and their damage scores were higher. Association to NP damage was discernible. In addition, cardiovascular and renal damage and diabetes were more pronounced in patients with thrombocytopaenia. At logistic regression analysis, younger age, anticardiolipin antibody IgM positivity, leucopaenia and thrombocytopaenia were associated with AIHA whilst lupus anticoagulant activity, AIHA, leucopaenia, APS and NP involvement were associated with thrombocytopaenia. Among damage items, peripheral vascular damage, diabetes, NP damage, renal and ocular damage displayed significant associations with thrombocytopaenia, whereas none of the items did with AIHA. Patients with AIHA had significantly reduced survival rates at 10 and 20 years.


CONCLUSIONS
We observed that AIHA and thrombocytopaenia were associated with severe lupus, affecting major organs and causing end organ damage. Thus, they may be considered as prognostic markers. Furthermore, AIHA and especially thrombocytopaenia may also be a marker for a subgroup of lupus patients who have or may develop APS.
['Artım-Esen|B|B|https://orcid.org/0000-0002-5659-3955', 'Çene|E|E|', 'Şahinkaya|Y|Y|', 'Erdugan|M|M|', 'Oğuz|E|E|', 'Gül|A|A|', 'Öcal|L|L|', 'İnanç|M|M|']
D000293:Adolescent D000328:Adult D000744:Anemia, Hemolytic, Autoimmune D017153:Antibodies, Anticardiolipin D017152:Antibodies, Antiphospholipid D016736:Antiphospholipid Syndrome D001323:Autoantibodies D005260:Female D006801:Humans D007970:Leukopenia D016682:Lupus Coagulation Inhibitor D008180:Lupus Erythematosus, Systemic D020945:Lupus Vasculitis, Central Nervous System D008297:Male D009102:Multiple Organ Failure D011379:Prognosis D012720:Severity of Illness Index D015996:Survival Rate D013921:Thrombocytopenia D014421:Turkey D055815:Young Adult
autoimmune haemolytic anaemia thrombocytopaenia Systemic lupus erythematosus antiphospholipid syndrome haematological changes