Lupus: Low Platelets, Pregnancy Concerns, and Treatment Options

Systemic lupus erythematosus (SLE)

Hello Dr.
Tseng,
I have some questions regarding systemic lupus erythematosus (SLE).
My wife has low platelet counts, and the hospital has identified three criteria that are consistent with SLE; we are still waiting for the X-ray results.
If she is indeed diagnosed with SLE, it's worth noting that she has undergone annual health check-ups where her platelet counts were normal until 2012, when they suddenly dropped.
What could have caused her to develop SLE suddenly?
So far, aside from the low platelet counts (ranging from 50,000 to 70,000), she has not experienced any other significant symptoms, although she does bruise more easily.
Does this qualify as an onset of the disease? Does she currently require medication for treatment?
Additionally, can SLE cause fetal edema? In this case, the fetus has edema, and the mother's low platelet count has led doctors to suspect SLE as the cause.
However, my research indicates that while SLE can lead to miscarriages, it does not typically cause generalized edema in the fetus.
We also had an amniocentesis at 20 weeks, which confirmed that the fetus has Down syndrome.

Mr. R, 30~39 year old female. Ask Date: 2016/06/13

Dr. Zeng Guosen reply Internal Medicine

Hello, netizen.

1.
Systemic lupus erythematosus (SLE) typically presents with sudden onset of symptoms or abnormalities discovered during examinations, and the exact etiology is not fully understood.

2.
If thrombocytopenia is the only finding during pregnancy, it does not necessarily confirm a diagnosis of systemic lupus erythematosus; differential diagnoses such as antiphospholipid syndrome must be considered.

3.
There are many fetal complications associated with systemic lupus erythematosus, so it is recommended to consult an obstetrician-gynecologist.

Thank you for your question.

Reply Date: 2016/06/13

More Info

Understanding lupus, particularly in the context of low platelets and pregnancy, is crucial for managing both maternal and fetal health. Systemic lupus erythematosus (SLE), commonly known as lupus, is an autoimmune disease that can manifest with a variety of symptoms and complications, including thrombocytopenia (low platelet count).
In your wife's case, the sudden onset of low platelets in 2012, after years of normal counts, raises questions about the underlying mechanisms of lupus. Lupus is characterized by periods of flares and remissions, and it can sometimes present with new symptoms or laboratory findings after years of stability. The exact cause of lupus is not fully understood, but it is believed to involve a combination of genetic, environmental, and hormonal factors. The development of lupus can be insidious, and it may not always be linked to a specific trigger.

Regarding the current situation, the presence of low platelets (50,000 to 70,000) alongside other symptoms, such as easy bruising, suggests that your wife may be experiencing a mild form of thrombocytopenia. While this alone does not confirm a lupus diagnosis, it is essential to consider it in conjunction with other clinical findings and laboratory tests. The fact that she has three criteria met for lupus is significant, but further evaluation, including imaging studies like X-rays, is necessary to establish a definitive diagnosis.

As for treatment, the management of lupus and associated thrombocytopenia often depends on the severity of symptoms and the degree of platelet reduction. If your wife is asymptomatic aside from the low platelet count, immediate treatment may not be necessary. However, if she experiences symptoms such as significant bleeding or if her platelet count continues to decline, medications such as corticosteroids or immunosuppressants may be indicated. Regular monitoring by a rheumatologist is crucial to adjust treatment as needed.

Regarding pregnancy, lupus can complicate maternal and fetal health. It is known to increase the risk of miscarriage, preterm birth, and other complications. The concern about fetal edema (swelling) is valid, as lupus can lead to conditions like antiphospholipid syndrome, which is associated with vascular complications in pregnancy. However, fetal edema can also arise from various other causes, including genetic conditions like Down syndrome, which was identified in your case. It is essential to work closely with a maternal-fetal medicine specialist to monitor the pregnancy closely and manage any risks associated with lupus.

In summary, while your wife's low platelet count and potential lupus diagnosis warrant careful monitoring and possibly treatment, it is essential to consider the broader context of her health and pregnancy. Collaboration between rheumatologists, obstetricians, and maternal-fetal medicine specialists will provide the best care for both her and the baby. Regular follow-ups and open communication with her healthcare team will be vital in navigating this complex situation.

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