The Prevalence of the following with its degree may correlate with Disease activity in SLE
(B) Lymphopenia # Autoimmune Hemolytic Anemia (AIHA) It is characterized by elevated reticulocyte counts, low haptoglobin levels, increased indirect bilirubin concentration and a positive direct Coombs' test. It has been noted in up to 10% of patients with SLE. Presence of hemolytic anemia may associate with manifestations of severe disease such as renal disease, seizures and serositis. Presence of both immunoglobulin and complements on red blood cells is usually associated with some degree of hemolysis, while presence of complements alone (C3 and /or C4) is often not associated with hemolysis AIHA responds to steroids (1 mg/kg per day prednisone or its equivalent in divided doses) in 75 to 96% of patients. Once the hematocrit begins to rise and the reticulocyte count falls, steroids can be rapidly tapered.SLICC CLASSIFICATION CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUSRequirements: > criteria (at least 1 clinical and 1 laboratory criteria. Or Biopsy-proven lupus nephritis with positive ANA or Anti-DNAClinical CriteriaImmunologic Criteria* Acute Cutaneous Lupus* ANA* Chronic cutaneous Lupus* Anti-DNA* Oral or nasal ulcers* Ant-Sm* Non-Scarring alopecia* Antiphospholipid Ab* Arthritis* Low complement (C3, C4, CH50)* Serositis* Direct Coomb's test* Renal * Neurologic* Hemolytic anemia* Leukopenia* Thrombocytopenia (<100,000/mm3)> Leucopenia It is a typical feature of SLE which may occur as a result of lymphopenia, neutropenia or a combination of both. Prevalence of lymphopenia in SLE ranges from 20 to 81% and its degree may correlate with disease activity. Both T and B lymphocytes are reduced, while natural killer cells are typically increased. Reduced surface expression of complement regulatory proteins CD55 and CD59 has been found in leucopenic patients with SLE. Deficiency of these proteins may make these cells susceptible to complement-mediated lysis. There is increasing evidence that endogenous production of type 1 interferons (IFNs) is implicated in the pathogenesis of neutropenia and lymphopenia in SLE. Elevated serum levels of IFN-a in SLE correlate inversely with leucocyte numbers# Neutropenia It is a common feature of SLE, with a prevalence rate of 47%, it may be mediated by anti-neutrophil antibodies. Increased levels of TNF-related apoptosis-inducing ligand (TRAIL) in SLE and may contribute to Neutropenia (through excessive neutrophil apoptosis mediated neutropenia).# Thrombocytopenia It has a reported prevalence ranging from 7 to 30% in large series of patients with SLE. Increased peripheral destruction of platelets and presence of anti-platelet antibodies, is the most likely pathogenic mechanism. Thrombocytopenia is an independent risk factor for increased mortality in SLE.
Autoimmune Hemolytic anemia
Lymphopenia
Neutropenia
Thrombocytopenia
Miscellaneous