Mittal Salony, Agarwal Preeti, Wakhlu Anupam, Kumar Ashutosh, Mehrotra Raj, Mittal Saumya
Assistant Professor, Department of Pathology, Kasturba Medical College , Mangalore, Karnataka, India .
Assistant Professor, DNB, Department of Pathology, King George Medical University , Lucknow, UP, India .
J Clin Diagn Res. 2016 Jun;10(6):EC08-11. doi: 10.7860/JCDR/2016/17930.7961. Epub 2016 Jun 1.
Haematological alterations such as anaemia, neutropenia and thrombocytopenia are frequent in Systemic Lupus Erythematosus (SLE). Ferritin being an acute phase reactant can be falsely elevated in lupus cases.
To evaluate the haematological alterations and to re-categorise the types of anemia by soluble transferrin receptor levels in diagnosed cases of SLE.
A sample of 30 newly diagnosed ANA positive SLE patients was taken. Complete blood counts, ESR, reticulocyte count, coagulation studies, diluted Russel Viper Venom Test (dRVVT), mixing studies, serological tests, high sensitivity CRP along with iron profile, transferrin saturation, soluble transferrin receptor (sol TFR) levels, anti-beta2 glycoprotein1, direct and indirect Coomb's test were estimated in cases diagnosed as SLE. Clinical symptoms were co-related with and Systemic Lupus Erythaematosus Disease Activity Index (SLEDAI) was estimated.
Anaemia was the most prevalent haematological alteration followed by thrombocytopenia. Further sub typing of anaemia was done by serum ferritin levels and using sol TFR assays. Ferritin is an acute phase reactant; it underestimated iron deficiency in patients of SLE. When sol TFR was used; patients with pure Anaemia of Chronic Disease (ACD) reduced from 68% to 26%, those with pure IDA reduced from 32% to 16% and a group with co-existing IDA & ACD (58%) was defined {Agreement=53%, p=0.09} by sol TFR which co-related with clinical response to Iron therapy in these patients. CRP was significantly raised in association with disease activity. Fever (p<0.0001), arthritis (p<0.03) were significantly related and CRP was elevated (p<0.04) in cases with high SLEDAI (severe flare).
Thus, in SLE, anaemia is the most frequent hematological alteration; iron deficiencies supercede in contrast to ACD and further autoimmune haemolytic anaemia. Sol TFR emerged as a better parameter to detect iron deficiency in patients of non- haemolytic anaemia in contrast to iron profile and ferritin levels.
血液学改变，如贫血、中性粒细胞减少和血小板减少，在系统性红斑狼疮（SLE）中很常见。铁蛋白作为一种急性期反应物，在狼疮病例中可能会出现假性升高。
评估血液学改变，并根据可溶性转铁蛋白受体水平对已确诊的SLE病例的贫血类型进行重新分类。
选取30例新确诊的ANA阳性SLE患者样本。对确诊为SLE的病例进行全血细胞计数、血沉、网织红细胞计数、凝血研究、稀释蝰蛇毒时间（dRVVT）、混合试验、血清学检查、高敏CRP以及铁代谢指标、转铁蛋白饱和度、可溶性转铁蛋白受体（sol TFR）水平、抗β2糖蛋白1、直接和间接抗人球蛋白试验。将临床症状与之相关联，并评估系统性红斑狼疮疾病活动指数（SLEDAI）。
贫血是最常见的血液学改变，其次是血小板减少。通过血清铁蛋白水平和使用sol TFR检测对贫血进行进一步亚型分类。铁蛋白是一种急性期反应物；它低估了SLE患者的缺铁情况。当使用sol TFR时；单纯慢性病贫血（ACD）患者从68%降至26%，单纯缺铁性贫血（IDA）患者从32%降至16%，并且通过sol TFR定义了一组IDA和ACD并存的患者（58%）{一致性=53%，p=0.09}，这与这些患者对铁治疗的临床反应相关。CRP与疾病活动显著相关。发热（p<0.0001）、关节炎（p<0.03）与之显著相关，并且在SLEDAI高（重度发作）的病例中CRP升高（p<0.04）。
因此，在SLE中，贫血是最常见的血液学改变；与ACD相比，缺铁更为常见，此外还有自身免疫性溶血性贫血。与铁代谢指标和铁蛋白水平相比，sol TFR成为检测非溶血性贫血患者缺铁的更好参数。
