The management of peripheral blood cytopenias in systemic lupus erythematosus

Haematological complications are frequently seen in SLE. Anaemia, leucopenias and thrombocytopenia may result from bone marrow failure or excessive peripheral cell destruction, both of which may be immune mediated. Drugs and infection are other common causes. In this review, we will focus on the diagnosis and management of immune-mediated leucopenias and thrombocytopenia in SLE. The roles of bone marrow examination and the measurement of antibodies against leucocytes and platelets are discussed. Although many patients do not require specific treatment for cytopenias in SLE, CSs remain the mainstay of treatment. Other conventional therapies include AZA, CYC and human normal immunoglobulin. More recently, MMF has found a role as a CS and CYC-sparing agent. We also review B-cell depletion in the management of thrombocytopenia associated with SLE and other novel therapies including thrombopoeitin receptor agonists.