SLE haematology — SCE Rheumatology MCQ

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ModerateConnective Tissue DiseasesSLE haematologySCE Rheumatology

A 27-year-old woman with SLE presents with petechiae and menorrhagia. Platelets are 8 × 10⁹/L, Hb is normal and blood film shows no schistocytes. Creatinine is normal and she has no infection. She takes hydroxychloroquine only. What is the most appropriate management?

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Reveal the answer and explanation

Correct answer: A — High-dose glucocorticoid therapy

Explanation lettering: C = shown as A · E = shown as B · A = shown as C · B = shown as E

High-dose glucocorticoid therapy is best because severe immune thrombocytopenia in SLE with bleeding features requires urgent immunosuppression, typically high-dose glucocorticoids with haematology input. A is less suitable because allopurinol does not treat immune thrombocytopenia; B is less suitable because phlebotomy is used for iron overload or polycythaemia, not thrombocytopenia; D is less suitable because aspirin would worsen bleeding risk; E is less suitable because methotrexate escalation is not the acute treatment for platelets of 8. Clinical pearl: check the blood film in lupus cytopenias to avoid missing thrombotic microangiopathy.

Reference: EULAR SLE recommendations 2023; BSR lupus guideline