Affiliations: Department of Pediatrics, Faculty of Medicine, King
Abdulaziz University, Jeddah, PO Box 80215, Jeddah 215 89, Saudi Arabia. Tel.:
+966 2 640 83 27; Fax: +966 2 6408353; E-mail: mmuzaffer@hotmail.com
Abstract: This research aimed to study the frequency and the long-term outcome
of initial hematological abnormalities in pediatric-Systemic Lupus
Erythematosus (p-SLE) among Saudi children. Thirty out of 36 children with SLE
(diagnosed according to the revised American College of Rheumatology criteria,
between 2000–2011) with hematological abnormalities were included in this
prospective study conducted at King Abdulaziz University Hospital, Jeddah,
Saudi Arabia. A frequency of 83% (30/36 patients) was estimated for
hematological abnormalities in p-SLE. This frequency is much higher than that
found in several other studies. Leukopenia occurred in 40% of the children
at presentation and in 13.3% during the course of the illness. Eighty
percent of patients (29/36) presented with a normochromic normocytic anemia.
Fifteen patients had iron deficiency with a hypochromic microcytic anemia
following disease remission at follow up. Other hematologic abnormalities
included a Coombs positive hemolytic anemia at presentation in 27%,
thrombocytopenia in 20%, and antiphospholipid antibodies in 9%. Most of
these hematological abnormalities improved significantly with systemic steroid
and immunosuppressive agents (azathioprine, cyclophosphamide, and
mycofenolate). One patient with a positive anticardiolipin antibody and lupus
anticoagulant experienced thrombotic events. Hematological abnormalities were
common in p-SLE, but the course was generally benign. Recurrent hemolysis and
steroid toxicity in patients with AIHA remain a challenge for rheumatologists.
An evaluation for SLE is critical in children presenting with unexplained
hematological abnormalities.