Sir,Felty's syndrome (FS) designates a triad of findings including rheumatoid arthritis, splenomegaly and granulocytopenia with or without cutaneous ulcers (5). There are two possible types of mechanism responsible for the neutropenia: that at the peripheral circulating blood leukocyte level, and that acting at central bone marrow compartment level (1, 2, 6). There is considerable controversy over therapy; some authors favoring splenectomy when marked elevation is found in preoperative serum granulocyte binding IgG (3). Encouraged by the efficacy of plasmapheresis in the quantitative removal of circulating immune complexes and autoantibodies (9), we treated one patient with Felty's syndrome, presenting with severe granulocytopenia and high titre of antineutrophil antibodies with three courses of plasma exchange for three consecutive days, resulting in a significant improvement in granulocyte count.A 60-year-old-woman with classic Felty's syndrome (rheumatoid arthritis for the last 20 years, splenomegaly, leukopenia and a left leg ulcer) was admitted because of severe neutropenia. The leukocyte count was 900 and the total neutrophil count 144. Other analyses disclosed: rheumatoid factor + 1/80, Waaler-Rose + 115, antinuclear antibodies + 1/400, anti-DNAds 0, antigranulocyte antibodies + 11256, complement was normal.Scand J Rheumatol Downloaded from informahealthcare.com by UB Giessen on 11/01/14For personal use only.Scand J Rheumatology 14
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