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Rheumatology Advance Access originally published online on February 16, 2006
Rheumatology 2006 45(8):994-998; doi:10.1093/rheumatology/kel016
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Moderate and severe neutropenia in patients with systemic lupus erythematosus

D. Martínez-Baños, J. C. Crispín1, A. Lazo-Langner and J. Sánchez-Guerrero1

Departments of Haematology and Oncology and 1 Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.

Correspondence to: J. Sánchez-Guerrero, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México 14000, Tlalpan D.F. Mexico City. E-mail: jsanchez{at}quetzal.innsz.mx

Objectives. Neutropenia is an uncommon albeit relevant finding in patients with systemic lupus erythematosus (SLE). It has been ascribed to several aetiologies and represents a challenging dilemma in which clinical findings, laboratory data and medication history must be carefully evaluated. The aim of this work was to review the cases of moderate and severe neutropenia in our cohort of SLE patients in order to identify predisposing factors, clinical outcomes and related prognostic implications.

Methods. Thirty-three cases of neutropenia (neutrophil count <1000/µl) in patients with SLE were included. Sixty-five age- and sex-matched patients with SLE served as controls. Information was obtained by medical chart review. Statistical analyses included descriptive statistics, Student's t-test, paired t-test, {chi}2 or Fisher's exact test, and logistic regression.

Results. Baseline characteristics did not differ between groups. Use of concomitant medications and immunosuppressive drugs, as well as history of thrombocytopenia and central nervous system involvement, were associated with an increased risk for developing neutropenia. Along with neutropenia, cases had lower haemoglobin and platelet values and higher levels of liver enzymes. Moreover, disease activity was lower than in controls. One month after the neutropenia event, leucocyte and total granulocyte counts were still lower in patients than in controls. Mortality did not differ between patients with neutropenia and controls.

Conclusions. Most episodes of severe granulocytopenia in SLE patients occur as part of drug toxicity-induced medullar hypoplasia.

KEY WORDS: Granulocytopenia, Neutropenia, Systemic lupus erythematosus


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