Article Text

Download PDFPDF

LP-061 Male sex and disease activity at diagnosis are predictors of severe hemolytic anemia in patients with systemic lupus erythematosus: data from a multiethnic Latin American cohort
  1. Luis A González1,
  2. Graciela S Alarcón2,3,
  3. Guillermina B Harvey4,
  4. Rosana Quintana5,
  5. Guillermo J Pons-estel5,
  6. Manuel F Ugarte-gil6,7,
  7. Gloria Vásquez1,
  8. Luis J Catoggio8,
  9. Mercedes A García9,
  10. Eduardo F Borba10,
  11. Nilzio A Da silva11,
  12. C João12,13,
  13. Marlene Guibert toledano14,
  14. Loreto Massardo15,
  15. Oscar Neira16,
  16. Virginia Pascual-ramos17,
  17. Mary-Carmen Amigo18,
  18. Leonor A Barile-fabris19,
  19. Ignacio García de la torre20,
  20. José Alfaro-lozano6,
  21. María I Segami21,
  22. Rosa Chacón-díaz22,
  23. María H Esteva-spinetti23,
  24. Antonio Iglesias-gamarra24 and
  25. Bernardo A Pons-estel5
  1. 1Division of Rheumatology, Department of Internal Medicine, Universidad de Antioquia, Medellín, Colombia
  2. 2Division of Clinical Immunology and Rheumatology, Department of Medicine, Marnix E. Heersink School, The University of Alabama at Birmingham, Birmingham, AL, USA
  3. 3Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
  4. 4Escuela de Estadística, Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Rosario, Argentina
  5. 5Rheumatology, Grupo Oroño – Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
  6. 6Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
  7. 7Rheumatology Department, Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas,Universidad Científica del Sur, Lima, Peru
  8. 8Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
  9. 9Servicio de Reumatología, HIGA San Martin de La Plata, Argentina
  10. 10Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
  11. 11Rheumatology Unit, Faculdade de Medicina da Universidad e Federal de Goias, Goiania, Brazil
  12. 12Rheumatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
  13. 13Rheumatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
  14. 14Rheumatology, Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), La Habana, Cuba
  15. 15Rheumatology, Centro de Biología Celular y Biomedicina, Facultad de Medicina y Ciencia, Universidad San Sebastián, Chile
  16. 16Rheumatology, Hospital del Salvador, Universidad de Chile, Santiago, Chile
  17. 17Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición ‘Salvador Zubirán’, Ciudad de México, Mexico
  18. 18Rheumatology, Centro Médico ABC, Ciudad de México, Mexico
  19. 19Rheumatology, Hospital Ángeles del Pedregal, Ciudad de México, Mexico
  20. 20Departamento de Inmunología y Reumatología, Hospital General de Occidente de la S.S. y Universidad de Guadalajara, Zapopan, Jalisco, Mexico
  21. 21Rheumatology, Hospital Nacional ‘Edgardo Rebagliati Martins’, Essalud, Lima, Peru
  22. 22Rheumatology, Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas,, Venezuela
  23. 23Rheumatology, Servicio de Reumatología, Departamento de Medicina, Hospital Central de San Cristóbal, Venezuela
  24. 24Unidad de Reumatología, Departamento de Medicina Interna, Universidad Nacional de Colombia, Bogotá, Colombia


Background Systemic lupus erythematosus (SLE) is an important cause of secondary warm-antibody autoimmune hemolytic anemia (AIHA). The prevalence of AIHA has been estimated to range from 5% to 30%, but severe AIHA is comparatively less frequent in SLE patients. The severity of AIHA has rarely been studied in SLE patients;1–3 we thus have examined the predictors of severe AIHA using the extensive database of a large Latin American inception cohort.

Methods In patients with a recent diagnosis of SLE (≤ 2 years), factors associated with the occurrence of severe AIHA (hemoglobin level <7 g/dl) were examined by Cox proportional univariable and multivariable hazards regression analyses.

Results Of 1,349 patients, 103 (7.6%) developed AIHA over 5.4 (3.8) years. Of them, 49 (47.6%) patients were classified as having severe AIHA (Mestizos 44.9%, Caucasians 40.8%, and African-Latin American 14.3%). The median time from the first clinical SLE manifestation to the occurrence of severe AIHA was 3.7 months (IQR 1.4–15). In the univariable analyses, male sex and disease activity at diagnosis were associated with a shorter time to severe AIHA occurrence while malar rash and photosensitivity were associated with a longer time. By multivariable analysis and after adjusting for age at SLE diagnosis, gender, and ethnicity, male sex, and higher disease activity at diagnosis remained associated with a shorter time to the occurrence of severe AIHA. The results are shown in the Table below.

Conclusions Severe AIHA occurred in 3.6% of our cohort and it is an early manifestation of lupus. In Latin American patients with SLE, male sex represents more than a two-fold higher risk of experiencing severe AIHA at a faster pace. A higher level of disease activity at SLE diagnosis is also an independent predictor of the occurrence of severe AIHA in a shorter time.


  1. Durán S, Apte M, Alarcón GS, et al. Features associated with, and the impact of, hemolytic anemia in patients with systemic lupus erythematosus: LX, results from a multiethnic cohort. Arthritis Rheum 2008; 59:1332–1340.6.

  2. Sultan SM, Begum S, Isenberg DA. Prevalence, patterns of disease, and outcome in patients with systemic lupus erythematosus who develop severe hematological problems. Rheumatology (Oxford) 2003;42:230–234. 28.

  3. Moysidou GS, Garantziotis P, Nikolopoulos D, Katsimbri P, Fanouriakis A, Boumpas DT. Relapses are common in severe hematologic systemic lupus erythematosus and may be prevented by early institution of immunosuppressive agents: Α real-life single-center study. Lupus 2022 Dec 9:9612033221144425. DOI: 10.1177/09612033221144425. Epub ahead of print. PMID: 36490217.

  • Systemic lupus erythematosus
  • Autoimmune hemolytic anemia
  • Disease activity

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.