Bone marrow findings in systemic lupus erythematosus patients with peripheral cytopenias

Abstract

We studied 21 bone marrow specimens from 21 patients with systemic lupus erythematosus (SLE) and peripheral cytopenias: anaemia (Hb < 10 g/dl), and/or leucopenia (white blood cell count < 4 x 10(9)/l), and/or thrombocytopenia (platelets < 150 x 10(9)/l). None of the patients had used immunosuppressive drugs in the 2 months before the study, and 11 (52.4%) had never used these drugs. The global and specific series cellularity, degree of fibrosis and necrosis were evaluated by bone marrow trephine; morphological abnormalities and iron stores were evaluated by cytological smears. The most important abnormalities viewed in bone marrow biopsies were: global hypocellularity (47.6%), increased reticulin proliferation (76.2%) with myelofibrosis in one patient, and necrosis (19.0%). The marrow aspirates were difficult to obtain in four patients, who showed an increased reticulin proliferation on histological analysis. Plasmocytosis was present in 26.7% of cases and in one there was a serum monoclonal component (IgG kappa). Iron stores were normal or increased in 26.7% of specimens and decreased or absent in 73.3%. The most frequent peripheral abnormality was leucopenia in 90.4% (19/21) and granulocytic hypoplasia was observed in 47.3% (9/19) of these patients. We conclude that the bone marrow may be a target organ in SLE with cytopenias.

Pediatric Lupus: Varied Haematological Picture and Presentation

“…At onset, 40-90 % of children will present with constitutional symptoms (fever, fatigue or weight loss), 20-82 %will have renal involvement, 20-74 % musculoskeletal symptoms, 22-74 % malar rash, 15-45 % lymphadenopathies and 15-74 % visceromegaly Thirty-nine percent of children with SLE will develop hematological abnormalities, one of the ACR diagnostic criteria for SLE, during the course of the disease. [3] During the course of their illness, 70 % of patients with SLE will have anemia, 65 % will have leukopenia, [4] and 25 % will have thrombocytopenia. [5] The majority of the anemia in SLE is thought to be secondary to the underlying chronic inflammatory disease, with only 2-3 % of the cases caused by autoimmune hemolytic anemia.…”

Bone marrow histological findings in systemic lupus erythematosus with hematologic abnormalities: A clinicopathological study

“…However, the histopathologic features characterizing the primary involvement of BM in SLE have not been systematically analyzed to date. Nonspecific abnormalities, such as BM hypocellularity, vasculitis, increased reticulin, and necrosis were underscored as the most prominent features of BM histology in two published series of 23 and 21 SLE patients, respectively [12][13]; contradictory data were obtained by another study, in which BM findings were apparently normal [14]. Hence, we performed a prospective, elaborate analysis of BM examination in a series of 40 SLE patients with peripheral hemocytopenias that were exclusively attributed to the disease's primary pathogenic process.…”

Necrose de medula óssea em paciente portadora de lúpus eritematoso sistêmico

“…No contexto da SAF, também pode ocorrer plaquetopenia. [1][2][3][4][5] Os três componentes do sangue podem ser afetados, isolada ou globalmente. A anemia é a alteração mais comum, embora a leucopenia, a neutropenia, a linfopenia e a trombocitopenia também sejam frequentes.…”

“…Pereira et al 4 estudaram amostras de MO de 21 pacientes lúpicos com citopenia periférica (anemia e/ou leucopenia e/ou plaquetopenia), sem uso de imunossupressores por no mínimo dois meses. Dentre os achados, descreveram necrose de MO em 19%.…”

“…Dentre os achados, descreveram necrose de MO em 19%. 4 Na literatura, há relatos de casos de necrose de MO associados à SAF e/ou ao LES. Moore descreveu o caso de uma paciente portadora de SAF e anormalidade do fator V de Leiden, que apresentou quadro de SAF catastrófica, e foi documentada necrose de MO em múltiplos sítios.…”