Calcinose em área de queimadura tardia: relato de caso e discussão da conduta / Calcinosis in an area of late burn: a case report and management discussion

Introdução: Calcinose cutânea é uma doença rara caracterizada por precipitações de cristais de cálcio no tecido cutâneo. Pode ser localizada ou generalizada, distrófica, metastática, iatrogênica ou idiopática. Relato do Caso: Paciente feminina, 66 anos, vítima de queimaduras de segundo e terceiro graus por fogo em abdome inferior e coxas aos 8 anos de idade atingindo 25% de superfície corpórea. Após 58 anos, recebeu o diagnóstico de calcinose distrófica na cicatriz da queimadura, contemplado através de biópsia e análise histopatológica. Submetida a exérese cirúrgica associada a rotação de retalho dermogorduroso de abdome superior e enxertia de pele total para correção de cicatrizes. Conclusão: Embora a melhor escolha terapêutica ainda não seja clara, o tratamento de complicações que podem culminar em incapacidade funcional é fundamental para reduzir a morbidade e aumentar a qualidade de vida do paciente.

Introduction: Cutaneous calcinosis is a rare disease characterized by the precipitation of calcium crystals in the skin tissue. It can be localized, generalized, dystrophic, metastatic, iatrogenic, or idiopathic. Case Report: Female patient, 66 years old, victim of second and third-degree burns by fire in the lower abdomen and thighs at 8 years old, reaching 25% of the body surface. After 58 years, she was diagnosed with dystrophic calcinosis in the burn scar, which was confirmed through biopsy and histopathological analysis. She underwent surgical excision associated with rotation of the upper abdomen dermal-fat flap and total skin graft for scar correction. Conclusion: Although the best therapeutic choice is still unclear, treating complications leading to functional disability is essential to reduce morbidity and increase the patient's quality of life.

The impact of social isolation by COVID-19 on the epidemiological and clinical profiles of the burn patients. A retrospective study.

BACKGROUND: Social isolation, imposed by the COVID-19 pandemic, may imply changes in the clinical-demographic and epidemiological profiles of burn trauma victims. OBJECTIVE: Evaluate the changes in the epidemiological profile of patients with burns that resulted in hospitalization during the social isolation period due to the COVID-19 pandemic, comparing with the same period in the previous year. METHODS: The medical records of burn patients who were hospitalized in our Burn Center during the local confinement period (March 18th to August 31st, 2020) and during the same period in 2019 were analyzed. Data on demographic, clinical and hospitalization aspects were studied. RESULTS: 470 patients were evaluated. In the pediatric population, a significant increase in the number of cases up to 2 years old (P = 0.0003), median of %TBSA (P = 0.037), full-thickness burns (P < 0.0001), involvement of hands (P = 0.024), debridement (P = 0.046) and grafting (P = 0.032) procedures, and higher scores of severity (P < 0.0001) were noted. In the adult population, it was only observed an increase in the burn-hospitalization interval (P = 0.029). CONCLUSION: The pediatric population was heavily impacted by the imposed period of social isolation, presenting a greater severity of burns. In contrast, the epidemiology of burns for the adult population was slightly altered during the pandemic period.

Banco de pele de Curitiba, Brasil: epidemiologia de doadores e receptores / Skin bank of Curitiba, Brazil: epidemiology of donors and recipients

Introdução: A enxertia homóloga de pele pode representar a diferença entre a vida e a morte de pacientes grandes queimados. Sua utilização consiste em um tratamento precioso quando não há a disponibilidade do enxerto autólogo. Os bancos de tecidos foram criados para realizar o processamento e armazenamento da pele alógena. O objetivo é analisar o perfil epidemiológico de doadores e receptores de pele do banco de pele do Hospital Universitário Evangélico Mackenzie (HUEM) e a sua produtividade, desde a inauguração em 2013 até 2019. Métodos: Consulta aos relatórios anuais do período de sete anos. Resultados: Captou-se a pele de 187 doadores, dos quais 61% eram homens e 39%, mulheres. A idade média foi de 41,07 anos. O número de doadores atingiu a média de 21,3 por ano. Foram coletados, no total, 201.000cm2 de tecido viável, que resultaram na produção de 3.770 lâminas de pele. Desde 2013, foram realizados no HUEM, 325 enxertos alógenos que beneficiaram 194 pessoas. A idade média dos pacientes que receberam a pele foi de 34,67 anos. A maior parte da pele captada, processada e armazenada pelo banco do HUEM (cerca 91%) foi utilizada em enxertias realizadas na própria instituição. Conclusão: O banco de pele do HUEM disponibilizou aloenxertos que beneficiaram 194 pessoas em 7 anos de funcionamento. Em sua maioria, os doadores e receptores eram do sexo masculino e tinham, aproximadamente, 40 anos de idade. O número de captações realizadas por este banco de pele foi compatível com o de outras instituições do Brasil

Introduction: Homologous skin grafting may represent the difference between the life and death of large burned patients. Its use consists of a precious treatment when there is no availability of autologous graft. The tissue banks were created to perform the processing and storage of the allogenous skin. The objective is to analyze the epidemiological profile of skin donors and recipients from the skin bank of the Hospital Universitário Evangélico Mackenzie (HUEM) and its productivity, from its inauguration in 2013 to 2019. Methods: Consultation of annual reports for the seven years. Results: The skin of 187 donors was captured, of which 61% were men and 39% were women. The mean age was 41.07 years. The number of donors averaged 21.3 per year. A total of 201,000cm2 of viable tissue were collected, which resulted in 3,770 skin slides. Since 2013, 325 allogenous grafts have been performed at HUEM that have benefited 194 people. The mean age of patients receiving the skin was 34.67 years. Most of the skin captured, processed, and stored by the HUEM bank (about 91%) was used in grafting carried out in the institution itself. Conclusion: The HUEM skin bank provided allografts that benefited 194 people in 7 years of operation. Most donors and recipients were male and approximately 40 years old. The number of captures performed by this skin bank was compatible with that of other institutions in Brazil.

Distúrbios fibroproliferativos: relato e discussão da conduta em queloide / Fibroproliferative disorders: report and discussion on keloid management

Os distúrbios fibroproliferativos expressam-se pelas cicatrizes hipertróficas e pelos queloides, sendo estes últimos mais agressivos e derivados de um processo anormal da cicatrização. São multifatoriais relacionando-se com agentes físicos, químicos, biológicos e endógenos. Apresentam predisposição genética, com incidência maior em orientais e negros. As modalidades terapêuticas compreendem, na maioria das vezes: compressão do queloide, criocirurgia, aplicação de placas de silicone, exérese operatória isolada ou seguida de radioterapia, aplicação de laser e injeção intralesional de corticoesteroides. O objetivo do estudo é relatar um caso de distúrbio fibroproliferativo do tipo queloide de grandes dimensões com alta resposta terapêutica e discutir suas etiologias e diversas modalidades terapêuticas.

Fibroproliferative disorders are expressed in hypertrophic scars and keloids, the latter being more aggressive and derived from an abnormal healing process. They are multifactorial and relate to physical, chemical, biological, and endogenous agents. They have a genetic predisposition, with a higher incidence in Asian and black people. The therapeutic modalities comprise most of the times: compression of the keloid, cryosurgery, application of silicone plates, surgical excision isolated or followed by radiotherapy, laser application, and intralesional injection of corticosteroids. The study aims to report a considerable keloidtype fibroproliferative disorder with a high therapeutic response and discuss its etiologies and various therapeutic modalities.

Ressecção endoscópica de papiloma escamocelular em pólipo de esôfago distal: relato de caso / Endoscopic resection of distal esophagus polyp with squamous cell papilloma: case report

INTRODUÇÃO: Papiloma escamocelular de esôfago é uma lesão benigna, geralmente diagnosticada incidentalmente por meio de uma Endoscopia Digestiva Alta (EDA). A etiologia dessas lesões ainda é desconhecida. A média de idade dos pacientes com essa lesão é de 50 anos. Tipicamente se apresenta como uma lesão verrucosa única, localizada nos terços médio e distal do esôfago. A maioria dos pacientes é assintomático ao diagnóstico. O tratamento dessas lesões pode ser realizado de várias formas, todas envolvendo a remoção do pólipo. DESCRIÇÃO DO CASO: Paciente J.M.C., masculino, 60 anos, queixa de epigastralgia moderada há um ano. EDA apresenta pólipo único em esôfago distal, tendo sido realizada ressecção completa da lesão e envio do material para análise anatomopatológica, na qual foi realizado o diagnóstico de papiloma escamocelular. Em nova EDA após 2 meses, demonstrou-se nova lesão polipoide em esôfago distal, compatível com pólipo de glândulas fúndicas. O paciente segue em acompanhamento ambulatorial, e encontra-se assintomático desde o terceiro retorno, após novo ajuste medicamentoso. CONCLUSÃO: Papilomas escamocelulares de esôfago são patologias de apresentação rara, que merecem atenção especial, principalmente pela possibilidade de malignização.

INTRODUCTION: Esophageal squamous cell papilloma is a benign lesion, usually diagnosed incidentally by upper gastrointestinal endoscopy. The etiology of such lesions is still unknown. The average age of patients is 50 years old. Typically, this disease presents itself as a single wart-like growing, found in the middle and distal thirds of the esophagus. Most patients are asymptomatic at the time of diagnosis. The treatment of this ailment can be done in several ways, all of which involve removal of the polyp. CASE DESCRIPTION: 60-year-old male, complains of pain in the epigastrium for over a year. Upper GI endoscopy shows single polyp in the distal esophagus, with complete resection of the lesion and pathology analysis, which showed squamous cell papilloma. A second upper GI endoscopy after 2 months showed a new polypoid lesion in the distal esophagus, compatible with fundus glands polyp. He remains is outpatient follow-up, and has been asymptomatic for months. CONCLUSION: Squamos cell papillmas are rare presenting pathologies, which deserve special attention, mainly due to the possibility of malignization.

Perfil epidemiológico de crianças de 0-18 anos vítimas de queimaduras atendidas no Serviço de Cirurgia Plástica e Queimados de um Hospital Universitário no Sul do Brasil / Epidemiological profile of 0­18-year-old child victims of burns treated at the Plastic Surgery and Burns Service of a University Hospital in Southern Brazil

Introdução: Lesões geradas por queimaduras representam um importante problema de saúde pública, constituindo a quarta causa de morte na infância no Brasil e Estados Unidos. Além disso, poucas são as doenças que trazem prejuízos tão importantes, com considerável morbidade pelo desenvolvimento de sequelas físicas e psicossociais. Diante disso, o objetivo deste estudo é traçar o perfil epidemiológico de crianças de 0-18 anos atendidas em um hospital escola de Curitiba, Paraná. Métodos: Estudo transversal e retrospectivo realizado através da análise de 625 prontuários de internação de crianças de 0-18 anos vítimas de queimaduras, entre janeiro de 2010 a dezembro de 2017. Foram coletadas informações sobre idade, sexo, tempo de internação, óbito, região corporal atingida, extensão da superfície corporal, grau de profundidade, agente etiológico e abordagem terapêutica. Resultados: A maior parte da amostra era composta por lactentes (43%), com média de idade de 12,6 anos. O sexo mais afetado foi o masculino e os pacientes permaneceram cerca de 14,5 dias internados. No estudo, 98% das queimaduras apresentaram como etiologia o agente térmico, principalmente por líquido quente. Em relação ao grau de profundidade, a maioria das queimaduras foram de 2º grau (61,3%), atingindo até 25% de superfície corporal queimada (SCQ), sendo o tronco o mais afetado. Dentre as modalidades de tratamento, 44% dos pacientes necessitaram de intervenção cirúrgica com debridamento e enxertia. Conclusão: Crianças mais novas são mais propensas a sofrerem queimaduras principalmente no ambiente domiciliar e, além disso, uma equipe preparada e capacitada é de crucial importância no prognóstico destes doentes.

Introduction: Injuries caused by burns represent a significant public health problem, constituting the fourth leading cause of childhood death in Brazil and the United States. In addition, few diseases carry such substantial losses as burns, with considerable morbidity due to the development of physical and psychosocial sequelae. This study aimed to outline the epidemiological profile of 0­18-year-old children treated for burns at a teaching hospital in Curitiba, Paraná. Methods: This cross-sectional, retrospective study involved analysis of 625 medical records of 0­18-year-old children who were victims of burns from January 2010 to December 2017. Information was collected on age, sex, length of hospitalization, death, body region affected, burned body surface area (BSA), depth, etiologic agent, and therapeutic approach. Results: A plurality of the sample were infants (43%), and the average age of the sample was 12.6 years. Most of the sample was comprised males, and the patients remained hospitalized for an average of 14.5 days. Of the burns, 98% were caused by thermal agents, particularly hot liquids. Most burns were second-degree burns (61.3%), reaching up to 25% of the BSA, and the most affected region was the trunk. Among the treatment modalities, 44% of the patients needed surgical intervention with debridement and grafting. Conclusion: Younger children are more prone to burns, especially in the home environment. A prepared and qualified team is of crucial importance for optimizing outcomes in these patients.

Tratamento cirúrgico de cisto de mesentério sintomático: relato de caso / Surgical treatment of symptomatic mesenteric cyst: case report

INTRODUÇÃO: Cistos mesentéricos são tumorações císticas intra-abdominais benignas do mesentério. O colon ascendente é o mais afetado. A sintomatologia dos cistos mesentéricos é extremamente inespecífica. Pode ser dividida em seis tipos, cada um com seus subtipos: cistos de origem linfática, cistos de origem mesotelial, cistos de origem entérica, cistos de origem urotelial, teratomas císticos maduros e pseudocistos não-pancreáticos. O diagnóstico é realizado por meio de uma ultrassonografia abdominal ou uma tomografia computadorizada. O tratamento destas lesões deve ser a excisão cirúrgica. A ressecção laparoscópica é mais indicada, por diminuir a dor do paciente, reduzir o tempo de internamento pós-operatório e agilizar a recuperação. O prognóstico desses pacientes é muito bom, pois, à exceção dos cistos mesoteliais malignos, todos os cistos mesentéricos são benignos e sua exérese, geralmente, é curativa. DESCRIÇÃO CASO: Paciente feminina, 24 anos, queixa de dor e "contrações" em parede abdominal. Realizado tratamento cirúrgico, por meio de laparotomia exploratória, com ressecção de cisto mesentérico. Foi encontrado: cisto em mesocólon com cerca de 10x10cm, a nível de porção média de cólon ascendente, não aderido a planos profundos, com conteúdo claro em seu interior. Paciente recebeu alta no terceiro dia pós-operatório. A análise anatomopatológica apresentou como resultado: segmento de tecido conjuntivo com infiltrado inflamatório crônico linfoplasmocitário, condizente com parede de cisto simples. O apêndice cecal apresentou hiperplasia folicular linfoide. CONCLUSÃO: Cistos mesentéricos são patologias raras, porém devem ser consideradas nos diagnósticos diferenciais em casos de massas abdominais. Têm bom prognóstico e o tratamento é cirúrgico, principalmente com a excisão laparoscópica

INTRODUCTION: Mesenteric cysts are benign intraabdominal cystic masses, that arise from the mesentery. The symptoms are extremely unspecific. The division can be made in six types, each one with different subtypes: lymphatic-origin cysts, mesothelial-origin cysts, enteric-origin cysts, urothelial-origin cysts, mature cystic teratomas and non-pancreatic pseudocysts. There are various etiologies for mesenteric cysts. The diagnosis is made with an abdominal ultrasound or a CT scan. The treatment of such lesions must be surgical excision. The laparoscopic resection has better indications, due to the reduction of the patients pain levels and length of hospital stay, and expedited recovery. These patients have very good prognosis, because, except for mesothelial malignant cysts, all mesenteric cysts are benign, and the resection of such tumors is, usually, healing. CASE DESCRIPTION: Female patient, 24 years-old, with pain and "contractions" on the abdominal wall. The patient was treated surgically, with an exploratory laparotomy, with the resection of a mesenteric cyst. Upon cavity inspection, it was found: mesocolonic cyst around the middle portion of the ascending colon, not adhered to deep surfaces, with clear liquid content. The patient was discharged on the third post-operative day. The anatomopathological analysis showed: connective tissue segment with chronic lymphoplasmocytic inflammatory infiltrate, consistent with simple cyst wall. The caecal appendix showed lymphoid follicular hyperplasia. CONCLUSION: Mesenteric cysts are rare pathologies, however, it should be considered as differential diagnosis for patients wth abdominal masses. The diagnosis must utilize some type of imaging. The prognosis is good, and the treatment should be laparoscopic excision

Hérnia de Amyand encarcerada: caso clínico e discussão de literatura / Incarcerated Amyand's hernia: case report and literature discussion

INTRODUÇÃO: O termo hérnia de Amyand é empregado para caracterizar as hérnias inguinais cujo saco herniário contém o apêndice cecal. A incidência de apendicite aguda nesses casos varia de 0,07- 0,13%. O tratamento de escolha é a apendicectomia, juntamente com a herniorrafia inguinal. Pela raridade do caso, não há estudos estatisticamente significativos com relação às diferentes formas de realizar a correção dessa hérnia. DESCRIÇÃO DO CASO: Paciente masculino, 43 anos, com quadro de dor em região inguinal direita, com 24h de evolução, com piora progressiva da dor e aumento de volume no local. Herniação apresentava-se irredutível. Referia náuseas. Levemente febril, normocárdico, eupneico e hipertenso. Foi realizado tratamento cirúrgico por meio de hernioplastia inguinal unilateral e apendicectomia. No primeiro dia pós- -operatório, paciente apresentou-se sem queixas, negava dor. Ao segundo dia, paciente referiu boa recuperação, e recebeu alta com analgesia e orientações de retorno ao pronto-socorro, se necessário, e retorno ao ambulatório do cirurgião responsável em 15 dias. CONCLUSÃO: Pode-se concluir que a hérnia de Amyand é uma patologia rara, mas que deve ser considerada como diagnóstico diferencial em casos de hérnia inguinal direita com sinais flogísticos. O tratamento deve ser cirúrgico, avaliando a possibilidade de uso de telas para a correção da hérnia

INTRODUCTION: The term Amyand's Hernia is used to caracterize inguinal hérnias which contain the caecal appendix. The incidence of acute appendicitis in these cases varies for 0,07-0,13%. The treatment of choice is appendectomy, along with inguinal herniorrhaphy. Due to the rarity of the case, there are no statistically significant studies analyzing the different ways to correct this type of hernia. CASE DESCRIPTION: Male, 43 years-old, with a 24h history of pain in the right inguinal region, associated with gradual worsening of the pain and increase in volume. Herniation appeared irreducible. Slightly febrile, normocardic, eupneic and hypertensive. Surgical treatment was performed, with unilateral inguinal hernioplasty and appendectomy. On the first post-operative day, the patient had no complaints, and denied feeling pain. On the second day, the patient had recovered well, and was discharged with analgesics and directions to return to the emergency room, if necessary, and to schedule an appointment with the lead surgeon in 15 days. CONCLUSION: It can be inferred that Amyand's hernia is a rare pathology, but must be considered as differencial diagnosis in cases of right inguinal hernia, with inflammatory signs. Treatment must be surgical, evaluating the possibility of using a mesh to repair the hernia

Use of an algorithm in choosing abdominoplasty techniques.

OBJECTIVE: to validate an algorithm for the choice of the abdominoplasty surgical technique among the five approaches established in the literature, according to the characteristics of the abdominal wall. METHODS: we conducted a retrospective study of 245 patients undergoing abdominoplasty, for whom the method of choice of the surgical technique was the proposed algorithm, based on the degree of abdominal flaccidity determined by bimanual maneuver. We studied its applications and conveniences, as well as the complications inherent in each group studied. RESULTS: according to the algorithm used, the most frequently chosen technique was "Technique IV" (transverse dermolipectomy of Pitanguy - or with a Baroudi-Kepke incision), in 25.71% of the cases. "Technique I" (mini abdominoplasty) had the lowest incidence and the lowest rate of complications. On the opposite, "Technique III", dermolipectomy with remaining vertical scarring, presented a higher incidence of complications, requiring extreme caution in its indication, particularly in relation to patients' expectations regarding the resulting scar and its legal aspects. Among all conducts, the most frequent complication was seroma, with a 10.2% occurrence, solved by simple syringe aspiration and use of elastic compression mesh. CONCLUSION: the proposed algorithm facilitated the choice of abdominoplasty techniques, offering satisfactory results, which are in line with the complication rates published in the world literature.

Use of an algorithm in choosing abdominoplasty techniques / Emprego de um algoritmo na escolha de técnicas de abdominoplastia

ABSTRACT Objective: to validate an algorithm for the choice of the abdominoplasty surgical technique among the five approaches established in the literature, according to the characteristics of the abdominal wall. Methods: we conducted a retrospective study of 245 patients undergoing abdominoplasty, for whom the method of choice of the surgical technique was the proposed algorithm, based on the degree of abdominal flaccidity determined by bimanual maneuver. We studied its applications and conveniences, as well as the complications inherent in each group studied. Results: according to the algorithm used, the most frequently chosen technique was "Technique IV" (transverse dermolipectomy of Pitanguy - or with a Baroudi-Kepke incision), in 25.71% of the cases. "Technique I" (mini abdominoplasty) had the lowest incidence and the lowest rate of complications. On the opposite, "Technique III", dermolipectomy with remaining vertical scarring, presented a higher incidence of complications, requiring extreme caution in its indication, particularly in relation to patients' expectations regarding the resulting scar and its legal aspects. Among all conducts, the most frequent complication was seroma, with a 10.2% occurrence, solved by simple syringe aspiration and use of elastic compression mesh. Conclusion: the proposed algorithm facilitated the choice of abdominoplasty techniques, offering satisfactory results, which are in line with the complication rates published in the world literature.

RESUMO Objetivo : validar um algoritmo para a escolha da técnica cirúrgica de abdominoplastia, entre as cinco abordagens consagradas na literatura, de acordo com as características da parede abdominal. Método: estudo retrospectivo de 245 pacientes submetidos à abdominoplastias, em que o método de escolha da técnica cirúrgica teve como ferramenta o algoritmo proposto, baseado no grau de flacidez abdominal determinado por manobra bimanual. Foram estudadas suas aplicações e conveniências, bem como identificadas as complicações inerentes a cada grupo estudado. Resultados: de acordo com o algoritmo empregado, a técnica mais frequentemente eleita foi a "Técnica IV" (dermolipectomia transversa à Pitanguy - ou com incisão de Baroudi-Kepke), em 25,71% dos casos. A "Técnica I" (miniabdominoplastia) demonstrou a menor incidência e a menor taxa de complicações. A "Técnica III", dermolipectomia com cicatriz vertical remanescente, ao contrário, apresentou maior incidência de complicações, requerendo extrema cautela na sua indicação, particularmente frente às expectativas dos pacientes quanto à cicatriz resultante e seus aspectos legais. Entre todas as condutas, a complicação mais frequente foi o seroma, com 10,2% de ocorrência entre os 245 casos operados, resolvido pela simples aspiração com seringa, e uso de malha compressiva elástica. Conclusão: o algoritmo proposto contribuiu para facilitar a escolha das técnicas na abdominoplastia, oferecendo resultados satisfatórios, que se alinham com as taxas de complicações publicadas na literatura mundial.

Prevalence of the american college of rheumatology hematological classification criteria and associations with serological and clinical variables in 460 systemic lupus erythematosus patients

Objective: To study systemic lupus erythematosus in a Brazilian population using the American College of Rheumatology hematological classification criteria and report associations of the disease with serological and clinical profiles. Methods: This is a retrospective study of 460 systemic lupus erythematosus patients followed in a single rheumatologic center during the last 10 years. Hematological manifestations considered for this study were hemolysis, leukopenia, lymphocytopenia and thrombocytopenia. Results: The cumulative prevalences of leukopenia, thrombocytopenia, lymphocytopenia and hemolytic anemia were 29.8%, 21.08%, 17.7% and 8.4%, respectively. A higher percentage of patients with hemolysis had anticardiolipin IgM (p-value = 0.002). Those with leukopenia had more lymphopenia (p-value = 0.02), psychosis (p-value = 0.01), thrombocy- topenia (p-value <0.0001) and anti-double stranded DNA antibodies (p-value = 0.03). Patients with lymphopenia had more leukopenia (OR = 1.8; 95% CI = 1.01-3.29) and lupus anticoagulant antibodies (OR = 2.2; 95% CI = 1.16-4.39) and those with thrombocytopenia had more leukopenia (OR = 3.1; 95% CI = 1.82-5.44) and antiphospholipid syndrome (OR = 3.1; 95% CI = 1.28-7.87). Conclusion: The most common hematological finding was leukopenia and the least common was hemolysis. Associations of low platelet count and hemolysis were found with antiphospholipid syndrome and anticardiolipin IgM positivity, respectively. Leukopenia and lymphocytopenia are correlated and leukopenia is more common in systemic lupus erythe- matosus patients with psychosis, thrombocytopenia and anti-double stranded DNA.

Prevalence of the American College of Rheumatology hematological classification criteria and associations with serological and clinical variables in 460 systemic lupus erythematosus patients.

OBJECTIVE: To study systemic lupus erythematosus in a Brazilian population using the American College of Rheumatology hematological classification criteria and report associations of the disease with serological and clinical profiles. METHODS: This is a retrospective study of 460 systemic lupus erythematosus patients followed in a single rheumatologic center during the last 10 years. Hematological manifestations considered for this study were hemolysis, leukopenia, lymphocytopenia and thrombocytopenia. RESULTS: The cumulative prevalences of leukopenia, thrombocytopenia, lymphocytopenia and hemolytic anemia were 29.8%, 21.08%, 17.7% and 8.4%, respectively. A higher percentage of patients with hemolysis had anticardiolipin IgM (p-value=0.002). Those with leukopenia had more lymphopenia (p-value=0.02), psychosis (p-value=0.01), thrombocytopenia (p-value <0.0001) and anti-double stranded DNA antibodies (p-value=0.03). Patients with lymphopenia had more leukopenia (OR=1.8; 95% CI=1.01-3.29) and lupus anticoagulant antibodies (OR=2.2; 95% CI=1.16-4.39) and those with thrombocytopenia had more leukopenia (OR=3.1; 95% CI=1.82-5.44) and antiphospholipid syndrome (OR=3.1; 95% CI=1.28-7.87). CONCLUSION: The most common hematological finding was leukopenia and the least common was hemolysis. Associations of low platelet count and hemolysis were found with antiphospholipid syndrome and anticardiolipin IgM positivity, respectively. Leukopenia and lymphocytopenia are correlated and leukopenia is more common in systemic lupus erythematosus patients with psychosis, thrombocytopenia and anti-double stranded DNA.