What is your approach to using medications that can cause bone marrow suppression in SLE patients who have persistent leukopenia?
Answer from: at Academic Institution
I am so glad someone asked this question. I have heard some peers state that they are reluctant to use immunosuppressants in this situation.
However, I do not agree with this.
The whole reason our systemic lupus (SLE) patients have leukopenias is due to their autoimmunity (but make sure drug...
Comments
at Arthritis Clinic of Central Texas I do this with WBC 3000 and even upper 2000's, but...
at Uniformed Services University of the Health Sciences (USUHS) @Hassan Alissa: I used to be very nervous about it...
at Medstar Very helpful! Have you seen improvement in platele...
at Uniformed Services University of the Health Sciences (USUHS) @Jinan Al-Naqeeb: I have not used belimumab (BEL) ...
I agree with @Don’s approach. It helps to look for anti-neutrophil/granulocyte and anti-lymphocytes antibodies in some cases (some but not all labs offer this). The older method for testing this is to provide a 10-20 day trial of steroid with taper to see if the WBC count improves. Doses of pr...
Generally, people are afraid of pushing Imuran, MTX, etc., if a patient with lupus has leukopenia. However, more often than not, the leukopenia is from the underlying autoimmune disorder, not from the drugs. Unless the WBC is extremely low, say 1,000 or so, I usually continue the DMARD. What matters...
Comments
at Arthritis Clinic of Central Texas Thank you all for the comments. Circling back to u...
at Uniformed Services University of the Health Sciences (USUHS) @Hassan Alissa: I feel very fortunate practicing i...
at Arthritis Clinic of Central Texas Thank you for your reply!!
at Ascension St John What is your lower threshold for absolute lymphocy...
at Duke University Medical Center Agree with you, Dr. @Gonzalez. People, especially ...
I do this with WBC 3000 and even upper 2000's, but...
@Hassan Alissa: I used to be very nervous about it...
Very helpful! Have you seen improvement in platele...
@Jinan Al-Naqeeb: I have not used belimumab (BEL) ...