Bleeding as the Initial Manifestation of Systemic Lupus Erythematosus

Abstract

Systemic lupus erythematosus (SLE) is an immunologic disease that is multisystemic and as a result can manifest itself in various organs. In general, the hematologic manifestations of the disease consist of mild leukopenia (<4500 white blood cells [WBCs]/mm³), thrombocytopenia (100,000-150,000 cells/mm³), and anemia. Hemolytic anemia and marked thrombocytopenia are uncommon laboratory features of the disease. Additional hematologic abnormalities include thrombosis, which can occur in 10-15% of patients.⁽¹⁾ The thrombosis has been attributed to the presence of lupus anticoagulant. Bleeding is usually not seen in SLE since the hemolysis and thrombocytopenia seen in SLE generally are not severe enough to result in significant blood loss. However, when severe anemia secondary to bleeding is seen three causes should be investigated; thrombocytopenia, severe uremia, and the presence of lupus anticoagulant with prothrombin antibody. We report an adolescent girl who initially presented with menorrhagia and subsequently was found to have SLE.