🩸 Cytopenias in #lupus 🦋
I started off with leukopenia in lupus
& suggested @nihardesai7 to make 🧵 s on anemia & thrombocytopenia (TCP) but well!
So here's a short 🧵on TCP in lupus
#MedEd #MedTwitter #RheumTwitter
(1/9)
I started off with leukopenia in lupus
& suggested @nihardesai7 to make 🧵 s on anemia & thrombocytopenia (TCP) but well!
So here's a short 🧵on TCP in lupus
#MedEd #MedTwitter #RheumTwitter
(1/9)
🧐First, is it really TCP?
Always confirm with a manual platelet count!
(2/9)
Always confirm with a manual platelet count!
(2/9)
If it's true TCP, the most common cause is immune TCP
1️⃣ ITP
🔹Seen in 10-40% of patients
🔹ITP can be present more than 10 years prior to development of lupus! ard.bmj.com
(3/9)
1️⃣ ITP
🔹Seen in 10-40% of patients
🔹ITP can be present more than 10 years prior to development of lupus! ard.bmj.com
(3/9)
🔹Pathogenesis
⏫ Destruction due to antibodies against
🎯 GP IIb/IIIa (most common)
🎯 GP Ib/IX
🎯 CD40L
🎯 Antiphospholipid Ab (non specific binding)
⏬ production due to antibodies against
🎯TPO
(4/9)
⏫ Destruction due to antibodies against
🎯 GP IIb/IIIa (most common)
🎯 GP Ib/IX
🎯 CD40L
🎯 Antiphospholipid Ab (non specific binding)
⏬ production due to antibodies against
🎯TPO
(4/9)
🔹It's associated with high overall disease activity & mortality ☹️
🔹Treatment is needed when platelets <30000/cmm💊
🔹A nice algorithm 👇
sciencedirect.com
(5/9)
🔹Treatment is needed when platelets <30000/cmm💊
🔹A nice algorithm 👇
sciencedirect.com
(5/9)
2️⃣ Thrombotic microangiopathy(aHUS/TTP/CAPS)
Another important cause of TCP in lupus with ⏫⏫⏫ mortality!
🔹TTP
🎯 Anti- ADAMTS13 antibodies
💊High dose steroids+plasma exchange+ immunosuppression (CYC or RTX)
onlinelibrary.wiley.com
(6/9)
Another important cause of TCP in lupus with ⏫⏫⏫ mortality!
🔹TTP
🎯 Anti- ADAMTS13 antibodies
💊High dose steroids+plasma exchange+ immunosuppression (CYC or RTX)
onlinelibrary.wiley.com
(6/9)
🔹Catastrophic APS
Think of CAPS in a known case of APS who is acutely ill or as a differential for TMA !
📸 from uptodate 👇
(7/9)
Think of CAPS in a known case of APS who is acutely ill or as a differential for TMA !
📸 from uptodate 👇
(7/9)
A useful algorithm for CAPS + another similar entity called microvascular APS (DAH, APS nephropathy)
👉Microvascular APS⏩ steroids + immunosuppression
👉CAPS
💊Steorids+ IVIG +/- plasma exchange
⬇️
Prominent TMA⏩Eculizumab
Prominent MAPS⏩ RTX
onlinelibrary.wiley.com
(8/9)
👉Microvascular APS⏩ steroids + immunosuppression
👉CAPS
💊Steorids+ IVIG +/- plasma exchange
⬇️
Prominent TMA⏩Eculizumab
Prominent MAPS⏩ RTX
onlinelibrary.wiley.com
(8/9)
Think of other causes not specific to lupus which are as or probably even more common!
🔹Nutritional
🔹Drugs (MTX, AZA, MMF etc)
🔹MAS
🔹Infection/Sepsis
🔹Hypersplenism
🔹DIC
(9/9)
🔹Nutritional
🔹Drugs (MTX, AZA, MMF etc)
🔹MAS
🔹Infection/Sepsis
🔹Hypersplenism
🔹DIC
(9/9)
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