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Topics:
Internal Medicine • Rheumatology • Hematology • Systemic lupus erythematosus • Benign Hematology • General Rheumatology • SLE
For patients with SLE, is there an ANC level for which you would hold or adjust hydroxychloroquine in an asymptomatic patient?
UpToDate recommends Hydroxychloroquine for all SLE patients, but neutropenia is sometimes ascribed to HCQ rather than the underlying disease. What level/grade of neutropenia would you be inclined to hold and/or modify the drug? Would you be more likely to hold/adjust if the patient has fever/systemic infection?
Answer from: at Academic Institution
Leukopenia most often as lymphocytopenia, of course, is not unusual in lupus. Total WBC less than 4000 is an ACR classification criteria for the disease as is ALC less than 1500 on two occasions. SLICC disease classification requires ALC less than 1000. Total WBC < 3000 generates SLEDAI points. O...
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Answer from: at Community Practice
While one can never completely exclude any drug as a potential cause of neutropenia, in 36 years of practice managing SLE patients, I have never encountered a bona fide case of HCQ-induced neutropenia (i.e. resolution with holding the drug and recurrence following re-introduction). As such, when neu...