Letter to the Editor regarding the review of literature about aplastic anaemia complicating systemic lupus rythematosus
Reza Karbasi-Afshar, Ehsan Saburi , Amin Saburi
1. Faculty of medicine, Baqiyatallah University of Medical Sciences,
Tehran, IR. Iran.
2. Master of Science in laboratory medicine, Shahid Beheshti
University of Medical Sciences, Tehran, Islamic Republic of
3. Chemical Injuries Research Center, Baqiyatallah University
of Medical Sciences, Tehran, IR. Iran.
Dr. Amin Saburi, Chemical Injuries Research Center, Baqiyatallah university of medical sciences, Mollasadra St, Vanak Sq, Tehran, IR. Iran. Tel/Fax: +98-2188600067, E-mail: email@example.com
cite this article :
Reza Karbasi-Afshar, Ehsan Saburi , Amin Saburi. LETTER TO THE EDITOR REGARDING THE REVIEW OF LITERATURE ABOUT APLASTIC ANAEMIA COMPLICATING SYSTEMIC LUPUS RYTHEMATOSUS. Journal of Clinical and Diagnostic Research [serial online] 2012 April [cited: 2013 May 25 ]; 6:-325. Available from http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=April&volume=6&issue=2&page=-325&id=2026
Dear Editor We read with interest, Dr. Wesley Jose et al.’s paper, ‘‘Aplastic anaemia complicating systemic lupus erythematosus (SLE) at a presentation: a clinical vignette and review of literature”, Journal of Clinical and Diagnostic Research 2011 June, 5(3): 637-639 (1). They skillfully reported an interesting case of Systemic Lupus Erythematosus (SLE) who initially presented with pancytopaenia, with the diagnosis of secondary Aplastic Anaemia (AA) and also she had responded to high dose Dexamethasone for four days, dramatically. Also, they asserted that they had reviewed the literature and had found only 16 reports for a total number of 19 patients. But, it seems that their review was not proper and that they had missed some reports. We reviewed the English literature exactly and found 6 reports which were missed until Jan 2011 (when Wesley et al.’s manuscript was submitted) (2),(3),(4),(5),(6),(7).
Various treatment protocols were used for these patients, but it seemed that some of these patients hadn’t responded to the treatment well. In the six previous studies that had been ignored, anti-thymocyte globulin (ATG), granulocyte colony-stimulating factors (G-CSF) and cyclosporine had been used and they had been relatively effective. They revealed that a short course of high dose Dexamethasone was effective for acquire AA which was secondary to SLE. Plasmapheresis, cyclophosphamide, oxymethalone, prednisolone, methylprednisolone, androgens, plaquenil and antithymocyte globulin also had been used to treat these patients, but it appeared that this was the first time that Dexamethasone was successfully used for the treatment.
Recently, new biologic medications such as Rituximab (a CD20 positive B cell lymphocyte suppressor) were recommended for the lupus patients who were complicated with severe and refractory haematologic disorders (8). Regarding the aetiological mechanism of AA which is secondary to SLE (dysregulation of the T and B lymphocyte cells or the auto-antibodies that results in the destruction of the multi potential bone marrow stem cells), it is expected that the role of new biologic drugs will be bolder in these patients. Finally, the cases with SLE and acquired AA can benefit by a new biologic treatment. However, at the first step, the use of classic immunosuppressive drugs is safer and cheaper. Sincerely,
Jose W, Unnikrishnan A, Muthu Pn, Kumar K, Pavithran K. Aplastic anemia complicating systemic lupus erythematosus (SLE) at presentation: a clinical vignette and review of literature. Journal of Clinical and Diagnostic Research 2011;5(3):637-9.
Hepburn AL, Lampert IA, Boyle JJ, Horncastle D, Ng WF, Layton M, et al. In vivo evidence for apoptosis in the bone marrow in systemic lupus erythematosus. Ann Rheum Dis. [Case Reports]. 2007 Aug;66(8):1106-9.
Ideguchi H, Ohno S, Ishigatsubo Y. A case of pure red cell aplasia and systemic lupus erythematosus which was caused by the human parvovirus B19 infection. Rheumatol Int. [Case Reports]. 2007 Feb;27(4):411-4.
Lee JH, Lee SG, Kim JR, et al. A case of aplastic anemia which was associated with systemic lupus erythematosus: successful treatment with cyclosporine. [Article in Korean]. J Rheumatol. 2007;14:384-9.
Morishita Y, Matsukawa Y, Kura Y, Takei M, Tomita Y, Nishinarita S, et al. Anti-thymocyte globulin for a patient with systemic lupus erythematosus which was complicated by severe pancytopenia. J Int Med Res. [Case Reports]. 1997 Jul-Aug;25(4): 219-23.
Alishiri GH, Saburi A, Bayat N, Saadat AR, Saburi E. The initial presentation of systemic lupus erythematosis with aplastic anemia which was successfully treated with rituximab. Clin Rheumatol. 2011 Oct 21; Clin Rheumatol. 2012 Feb; 31(2):381-4.
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Financial OR OTHER COMPETING INTERESTS: None.
Date of Submission: Nov 11, 2011 Date of Peer Review: Feb 05, 2012 Date of Acceptance: Mar 14, 2012 Date of Publishing: Apr 20, 2012