| Objective:A study on the initial symptoms,laboratory examinations, diagnosis and treatment Of SLE patients with haematological presentations as the first symptom in order to decrease the misdiagnosis ratio and improve the level of diagnosis and treatment.Methods:Retrospective epidemiological survey was used on 30 SLE patients admitted to Qilu Hospital from 2004 Jan to 2009 Mar.All of them fell ill with haematological presentations as the first symptom.Their general conditions,initial symptoms,the first diagnosis,laboratory examinations and treatments were collected. Then a conclusion was drawn by statis.Results:1.Of them,27cases were female and 3cases were male. Their ages were from 12 to 70 years old.The mean±SD was 36.3±5.7 years.Their disease durations were from7 days to 29 years. The median was 24 months.2.Initial symptom and diagnosis:①Of the 30 patients,9 cases appeared anemic symptoms:AIHA was the first diagnosis of 5 cases;Iron deficient anemia was the first diagnosis of 2 cases; SLE was the first diagnosis of 2 cases;②19cases appeared idopathic hemorrhage:ITP was the first diagnosis of 7 cases;SLE was the first diagnosis of 4 cases;Thrombocytopenia was the first diagnosis of 3 cases;Evans syndrome was the firse diagnosis of 1 case;AA was the first diagnosis of 1 case;Pancytopenia was the first diagnosis of 3 cases;③2 cases fell ill with repetatus fever and lung infection,Leucopenia was the first diagnosis.3.Regular test of blood:23cases had anemia(The positive ratio was76.7%);13 cases had leucopenia(The positive ratio was 43.3%);25cases had thrombocytopenia(The positive ratio was 83.3%).4.Immune tests:(1)The positive ratio of ANA was 100%;The positive ratio of anti-ds-DNA antibody was 66.7%;The positive ratio of anti-Sm antibody was33.3%;(2) Coombs test was detected in 5 cases.4 of them were positive(The positive ratio was 80.0%).(3) ACA(anticardiolipin antibodies) was detected in 16 cases.6 of them were positive(The positive ratio was 37.5%).(4) Antiplatelet antibody was detected in 10 cases.7 of them were positive(The positive ratio was 70.0%).5.Bone marrow examination was detedted in 25 cases:①Bone marrow of 3 cases hyperplasied much more active;Bone marrow of 21cases hyperplasied active;Bone marrow of 1 case hyperplasied abaissemently.②Bone marrow of 18cases had normal cell shape and bone marrow of 6cases were in the state of abnormal hemopoiesis.③The appearance of bone marrow consistents with diverse diseases.6.Before the correct diagnosis,20casees were applied blood products.But their pathogenetic conditions were not improved after metachysis except lcase who was applied washed red cells.After the correct diagnosis,all cases were applied GC.6cases were combined immunodepressant.6cases were combined IvIg.The curative effect was significant.Conclusions:1.The pathogenesy of haematologica impairment is complex.The haematological presentations have diverse patterns of manifestation and they are not typical.Meanwhile several autoantibodies can be detected in serum.Doctors should pay more attention to SLE patients with haematological impairment as the first symptom in order to decrease the misdiagonsis ratio.2.Bone marrow ususlly hyperplasy actively.It has not typical appearance.While it appears pathologic hemopoiesis at some times.Bone marrow dose not comply with peripheral blood.3.Glucocorticoid plays a fundamental role in treatments.It has significiant effects in most of SLE patients with haematological impairment.Immunosuppressant does not inhibit bone marrow.Meanwhile,it can improve patients' conditions.4.Platelet transfusion can not improve pathogenetic conditions.The use of blood products should be more careful. Metachysis should be obeyed strict standards.5.The curative effect of IvIg is significant and it's side effect is rare.It is worth of recommending in severe cases.
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