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Thrombocytopenia in SLE — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromeThrombocytopenia in SLESCE Rheumatology

A 42-year-old woman with SLE develops thrombocytopenia (platelets 28 x10^9/L). She has no bleeding symptoms. Anti-dsDNA is stable and complement is normal. She is on Mycophenolate. What is the most appropriate initial approach?

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Correct answer: C — Consider drug-induced thrombocytopenia and check for immune thrombocytopenic purpura (ITP)

Thrombocytopenia in SLE has multiple potential causes: active SLE, drug-induced (Mycophenolate can cause cytopenias), ITP, APS-related, and TTP. With stable serological markers (anti-dsDNA and complement), active SLE flare is less likely. Drug-induced thrombocytopenia should be considered and Mycophenolate dose reduction or cessation trialled. If platelets do not recover, ITP workup (anti-platelet antibodies, bone marrow examination) should be pursued. Treatment of lupus-associated ITP typically involves glucocorticoids, IVIg, and Rituximab for refractory cases.

Reference: EULAR 2023 SLE recommendations; Artim-Esen B et al 2014 thrombocytopenia in SLE