Background/Purpose: To characterize the frequency of thrombocytopenia in SLE and determine its time of onset during the course of the disease, severity and impact on mortality.

Methods: This was a single centre cohort analysis of 708 patients with SLE (fulfilling the revised ACR criteria) followed for a period of 5 to 40 years (January 1979 – December 2018). We reviewed the patients’ clinical notes identifying the presence of thrombocytopenia, and ascertained other clinical and serological features of the disease. Thrombocytopenia was classified as mild (100-149×10⁹/L), moderate (31-99×10⁹/L) or severe (≤30×10⁹/L platelets). It was also classified as asymptomatic (no relation to any bleeding event), with minor bleeding or with major bleeding. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software.

Results: A total of 163 patients (23.0%) were identified as having developed thrombocytopenia sometime during the course of SLE. Mean age at diagnosis of SLE was 28.37 (SD=13.33 years), ranging from 7 to 77 years; 149 (91.4%) patients were female and 14 (8.6%) male. Twenty two patients (13.5%) had isolated ITP before the diagnosis of SLE. Median follow-up time was 19 years (IQR=13). The median time from diagnosis of SLE to development of thrombocytopenia was 8 years (IQR=14). Most patients (N=65, 39.9%) had mild thrombocytopenia, 38 (23.3%) moderate and 31 (19.9%) severe thrombocytopenia. More than half the patients (N=90, 55.2%) developed asymptomatic thrombocytopenia, while 27 (16.6%) presented with minor bleeding but only 5 patients (3.1%) had major bleeding events in the context of thrombocytopenia. The development of severe thrombocytopenia anytime during the course of SLE was associated with an increased risk of death (HR=3.57, p=.025). When considering the survival rates after the development of thrombocytopenia it was found that there is an increased risk of death for male patients (HR=3.41, p=.036) and for those who present with concomitant haemolytic anaemia (HR=3.07, p=.027). There was no statistical correlation found between the presence of bleeding events and mortality.

Conclusion: The presence of severe thrombocytopenia (platelets ≤30×10⁹) in patients with SLE is associated with an increased risk of death, regardless of bleeding events. Male patients with SLE and thrombocytopenia (any degree) have an increased mortality risk, as have those who develop concomitant thrombocytopenia and haemolytic anaemia.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-and-outcome-of-thrombocytopenia-in-systemic-lupus-erythematosus-single-centre-cohort-analysis/