Bone marrow abnormalities common among lupus patients with peripheral cytopenia

Incidence of bone marrow abnormality was high among patients with systemic lupus erythematosus and peripheral cytopenia, according to study results.

Researchers in Thailand conducted the prospective, cross-sectional, analytic study of 41 patients (median age, 30 years; 95.1% women) who had systemic lupus erythematosus (SLE) plus the presence of cytopenia, defined by at least two of the following criteria: hemoglobin levels less than 10 g/dL, white blood cell counts less than 4 x 109 cells/L, or platelets less than 100 x 109L. Median disease duration was 5 years. Patients underwent bone marrow aspiration and biopsy, and researchers studied the marrow to determine abnormalities and which clinical factors predicted the need for bone marrow examination.

Twenty patients (48.8%) had abnormal bone marrow; disorders were classified into six groups: hypercellularity (50%), plasmacytosis (35%), hemophagocytosis (30%), dyserythropoiesis (10%), aplastic marrow (10%) and myelofibrosis (5%). Moderate to severe active disease was experienced by 75.6% of patients. Fourteen (34.14%) of the 41 patients experienced a moderate degree and 19 (43.34%) experienced a severe degree of cytopenia. Recovery from cytopenia occurred after SLE treatment.

Univariate analysis showed that clinical factors were not associated with bone marrow disorders. When all three factors indicating active disease were present (Systemic Lupus Erythematosus Disease Activity Index score, the number of organs involved and previous immunosuppressive drug therapy), bone marrow abnormalities were potentially predicted.

“Most of the abnormalities were found in active SLE patients and the cytopenia improved after treatment of SLE,” the researchers concluded. “Bone marrow may be one of the common target organs affected by immune mechanisms, resulting in peripheral cytopenia. Standard treatment of the underlying disease should therefore be given before doing bone marrow studies, but a bone marrow examination should be recommended when peripheral cytopenias do not recover following conventional therapy.”