RESEARCH - Features associated with, and the impact of, hemolytic anemia in patients with SLE

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Arthritis Rheum. 2008 Sep 15;59(9):1332-40.

Features associated with, and the impact of, hemolytic anemia in

patients with systemic lupus erythematosus: LX, results from a

multiethnic cohort.

Durán S, Apte M, Alarcón GS, n MC, Edberg JC, RP, Zhang

J, Langefeld CD, Vilá LM, Reveille JD; Lumina Study Group.

University of Alabama at Birmingham.

OBJECTIVE: To examine the clinical and genetic correlates of hemolytic

anemia and its impact on damage accrual and mortality in systemic

lupus erythematosus (SLE) patients.

METHODS: SLE patients (American College of Rheumatology [ACR]

criteria) of Hispanic (Texan or Puerto Rican), African American, and

Caucasian ethnicity from the LUMINA (LUpus in MInorities, NAture

versus nurture) cohort were studied. Hemolytic anemia was defined as

anemia with reticulocytosis (ACR criterion). The association between

degrees of hemolytic anemia and socioeconomic/demographic, clinical,

pharmacologic, immunologic, psychological, and behavioral variables

was examined by univariable and multivariable (proportional odds

model) analyses. Genetic variables (FCGR and Fas/Fas ligand

polymorphisms) were examined by 2 degrees of freedom test of

association and Cochran-Armitage trend tests. The impact of hemolytic

anemia on damage accrual and mortality was examined by multivariable

linear and regression analyses, respectively.

RESULTS: Of 628 patients studied, 90% were women, 19% were Texan

Hispanic, 16% were Puerto Rican Hispanic, 37% were African American,

and 28% were Caucasian. Sixty-five (10%) patients developed hemolytic

anemia at some time during the disease course, 83% at or before

diagnosis. Variables independently associated with degrees of

hemolytic anemia were African American ethnicity, thrombocytopenia,

and the use of azathioprine. Hemolytic anemia was associated with

damage accrual after adjusting for variables known to affect this

outcome; however, hemolytic anemia was not associated with mortality.

CONCLUSION: The association of hemolytic anemia with thrombocytopenia

suggests a common mechanism in their pathophysiology. Hemolytic anemia

is an early disease manifestation and is associated with African

American ethnicity and the use of azathioprine; it appears to exert an

impact on damage but not on mortality.

PMID: 18759263

http://www.ncbi.nlm.nih.gov/pubmed/18759263

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