• Anemia of chronic illness (normocytic, normochromic)
• High incidence of iron deficiency
• Leukocytosis and neutropenia common in exacerbations of juvenile rheumatoid arthritis (JRA)
• Thrombocytosis associated with a high level of interleukin 6 (IL-6) occurs in many patients, although there may be transient episodes of thrombocytopenia
• Triad of rheumatoid arthritis, splenomegaly, and neutropenia
• Granulocyte colony-stimulating factor (G-CSF) is effective treatment in some cases
Systemic Lupus Erythematosus
• Two types of anemia are common: anemia of chronic illness (normocytic, normochromic) and acquired autoimmune hemolytic anemia (Coombs' positive).
• Neutropenia is common as a result of decreased marrow production and immune mediated destruction.
• Lymphopenia with abnormalities of T-cell function occurs.
• Immune thrombocytopenia occurs.
• A circulating anticoagulant (antiphospholipid antibody) may be present and is associated with thrombosis.
• Microangiopathic hemolytic anemia, possibly associated with renal disease or hypertensive crises
• Prominent eosinophilia.
This autoimmune disorder is rare in children. Hematologic features include:
• Anemia: normocytic; RBC fragmentation with microangiopathic hemolytic anemia
• Leukocytosis with neutrophilia
• Mild normochromic, normocytic anemia with reticulocytopenia
• Leukocytosis with neutrophilia and toxic granulation of neutrophils and vacuoles
• Decreased T-suppressor cells
• Increased cytokines IL-1, IL-6, IL-8, interferon-a, and tumor necrosis factor (TNF)
• Marked thrombocytosis (mean platelet count of 700,000/mm3)
Henoch-Schonlein purpura (HSP) is called anaphylactoid purpura, which is associated with systemic vasculitis characterized by unique purpuric lesions, transient arthralgias or arthritis (especially affecting knees and ankles), colicky abdominal pain, and nephritis (see page 293).
• Anemia occasionally occurs as a result of GI bleeding or decreased RBC production caused by renal failure.
• Transient decreased F XIII activity may occur.
• Vitamin K deficiency from severe vasculitis-induced intestinal malabsorption has been reported.
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