African Journal of Rheumatology. 4(2):57-62.
Systemic lupus erthematosus (SLE) is a multisystem, autoimmune and often severe disease. Its aetiology is still poorly understood. Factors such as genetic, environmental, hormonal and immunological have been implicated in its pathogenesis. Patients with SLE are subject to myriad symptoms, complaints, and inflammatory involvement that can affect virtually every organ including the hemopoietic system.
Hematological abnormalities are common among patients with SLE. The most frequent hematological abnormalities include anemia, leucopenia and thrombocytopenia. These abnormalities are markers of disease activity and have been found to be independent determinants of mortality therefore understanding their prevalence is important in patient evaluation.
While these abnormalities have been widely studied in other parts of the world, no study has been conducted on Kenyan patients afflicted by SLE thus there exist a gap regarding hematological parameters in SLE patients and hence the need for this study. We performed this study to understand hematological parameters in a tertiary hospital in Nairobi, Kenya.
The main objective of this study was to determine the prevalence of hematological parameters abnormalities, among SLE patients on follow up at Rheumatology and Renal Outpatient clinics at Kenyatta National Hospital. Specifically, the study aimed to describe the prevalence of anemia, leucopenia, and thrombocytopenia and identify patient factors associated with these abnormalities.
A cross-sectional descriptive study was carried out on SLE patients attending the Rheumatology and Renal outpatient clinics at KNH. Seventy one consecutive SLE patients were screened for eligibility between 5th March 2015 and 5th of June 2015, of these sixty five were recruited and enrolled into the study. Clinical and social demographic data was captured and recorded in a pre-designed questionnaire. Subsequently, four millilitres of blood was collected for measurement of a complete blood count, reticulocyte count, erythrocyte sedimentation rate and peripheral blood film examination. The tests were undertaken at the KNH Department of Human Pathology, Unit of Haematology and blood transfusion using a CELL-DYN 3700 automated blood counter. ESR interpretation was undertaken at the same laboratory by the Wintrobe method and a PBF was reported after staining with maygrunwald / giemsa stain by direct visualization on a microscope at various powers of magnification by hematologists who were supervisors for this study and the PI
Sixty five eligible SLE patients were recruited into the study. The mean (SD) age was 36. 5(± 12) years. There were 3 (5%) males and 62 (95%) females. Forty nine (75%) patients had at least one abnormality. The abnormalities involved all the three cell lines. The prevalence of abnormalities were; anemia 43%, leucopenia 26% and thrombocytopenia 20%. Disease duration less than one year was significantly associated with anemia, p=0.035, OR = 3.5 (95% CI 0.9-15.1).
Hematological abnormalities are the second most common manifestation of the disease after arthritis and arthralgia among SLE patients on follow up at Kenyatta National Hospital Rheumatology and Renal clinic. Though majority of these abnormalities were mild to moderate and clinically asymptomatic, the proportions of anemia, leucopenia and thrombocytopenia were substantially high. There was a significant association between anemia and duration of disease.
I. A larger longitudinal study to correlate thrombocytopenia and leucopenia with demographics and drugs. . This may require a multicenter approach to avail sufficient number of patients.
II. Routine screening for hematological abnormalities, careful long-term monitoring and prompt therapeutic intervention.
III. Multidisplinary approach in management of SLE patients and input from a hematologist.
IV. Need to review the current treatment regimens of our patients to a steroid sparing regimen.
V. Lastly a study to correlate these hematological abnormalities with disease activity in patients with SLE.