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Haemolytic anaemia in a multi-ethnic cohort of lupus patients: a clinical and serological perspective

College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Arthritis Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA

F Hamadeh

US Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA

T Aberle

Arthritis Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA

S Glenn

Arthritis Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA

DL Kamen

Department of Medicine, Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina, USA

JA Kelly

Arthritis Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA

M Reichlin

Arthritis Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA; US Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA; Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA

JB Harley

Arthritis Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA; US Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA; Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA

AH Sawalha

Arthritis Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA; US Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA; Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA, amr-sawalha{at}omrf.ouhsc.edu

Systemic lupus erythematosus is a chronic autoimmune disease that can be associated with a variety of haematological manifestations. We identified 76 patients with haemolytic anaemia in a cohort of 1251 unrelated female lupus patients enrolled in our studies. The presence of the various American College of Rheumatology clinical criteria for lupus and serological specificities were determined in lupus patients with haemolytic anaemia and compared with a group of race-matched control lupus patients without haemolytic anaemia. Clinical data were obtained from medical records, and serological specificities were determined in our clinical immunology laboratory at OMRF. The presence of haemolytic anaemia in lupus patients was associated with a higher frequency of proteinuria (OR = 2.70, P = 0.000031), urinary cellular casts (OR = 2.83, P = 0.000062), seizures (OR = 2.96, P = 0.00024), pericarditis (OR = 2.21, P = 0.0019), pleuritis (OR = 1.72, P = 0.028) and lymphopenia (OR = 1.79, P = 0.015). These findings were independent of the presence of thrombocytopenia, which was approximately five times more common in lupus patients with haemolytic anaemia. Lupus patients with haemolytic anaemia were about 8 years younger than lupus patients without haemolytic anaemia at the time of disease onset (P = 0.000001). In the absence of thrombocytopenia, lupus patients with haemolytic anaemia were approximately two times more likely to have anti-dsDNA antibodies (P = 0.024). The presence of haemolytic anaemia is associated with a subset of lupus characterized by a younger age of disease onset, and a more severe disease with a higher likelihood of renal involvement, seizures, serositis and other cytopenias.

Key Words: anaemia • haemolysis • haemolytic • lupus

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