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Revista Paraguaya de Reumatología

On-line version ISSN 2413-4341


GALEANO, Luz; MOREL AYALA, Zoilo  and  CAMPUZANO DE ROLON, Ana. Juvenile Systemic Lupus Erythematosus and hematological compromise. Rev. parag. reumatol. [online]. 2020, vol.6, n.1, pp.5-10. ISSN 2413-4341.


Systemic Lupus Erythematosus (SLE) is a chronic inflammatory autoimmune disease of unknown cause without specificity for a particular organ. Juvenile SLE (jSLE) affects a greater number of organs and systems and presents a more aggressive clinical course than in adults. Hematological alterations could be presented as the only manifestation of SLE, so a detailed and systemic approach should be performed in these patients, once other causes such as infections and neoplasms have been excluded.


To determine the hematological compromise in patients diagnosed with jSLE in the Pediatric Service of the Faculty of Medical Sciences of the National University of Asunción; over a period of 5 years.

Materials and Methods:

Retrospective, observational, descriptive, cross-sectional study. Non-probability sampling of consecutive jSLE cases diagnosed or under follow-up from January 2012 to May 2017.


Of the 73 patients, 57 women (78%) and 16 (22%) men were found, with an F:M ratio of 3.5:1. Average age at diagnosis was 11.9 years (SD: 3.65, range between 2 and 17 years). Regarding origin, 39 patients (53%) came from the Capital and Central Department and 34 cases (46%) from rural areas. The mean time between onset of symptoms and clinical diagnosis was 2 months (SD 1.27 months). Symptoms at first consultation were: arthralgias in 38 patients (52%), fever in 14 cases (19.2%), cutaneous-mucosal manifestations in 10 patients (13.7%), neurological manifestations in 5 cases (6.8%), edema in 4 patients (5.5%) and constitutional manifestations in 2 patients (2.7%). Hematologic abnormalities were found in 62 patients (85%), with a single series affected in 25 cases (40.3%), bicytopenia in 33 patients (53.2%), and pancytopenia in 4 patients (6.5%). The most frequent alterations were: anemia in 58 patients (79.4%), lymphopenia in 27 cases (36.9%), thrombocytopenia in 21 patients (28.4%) and leukopenia in 17 cases (23.2%). 60% of patients had more than one affected series. On the subject of anemia (n=58), 16 patients (27.6%) had a direct positive Coombs test and 42 patients (72.4%) had a direct negative Coombs test.

Concerning hematimetric indices, 40 patients (69%) presented normochromic normocytic anemia and 18 patients (31%) hypochromic microcytic anemia.


Hematological alterations were a frequent finding as a initial manifestation of SLE. Most cases had involvement of two series, with non-hemolytic anemia being the predominant finding. Laboratory tests are of great value when evaluating a patient with suspected autoimmune disease, since the results can confirm the diagnosis, estimate the severity of the disease, assess the prognosis and monitor SLE activity.

Keywords : Juvenile Systemic Lupus; Erythematosus; children; pediatric; Hematologic; Autoimmune Hemolytic; Anemia; Leukopenia; Neutropenia; Thrombocytopenia.

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