Current concepts in SLE thrombocytopenia: From pathophysiology to therapeutic interventions

Current Rheumatology Reviews

Volumn 2, Issue 4, 2006, Pages 359-367

  Voulgarelis, Michael ^a   Ziakas, Panayiotis D ^a   Tzioufas, Athanasios G ^a  

^a UNIVERSITY OF ATHENS MEDICAL SCHOOL   (Greece)

Author keywords

Pathogenesis; Prognosis; Systemic lupus erythematosus; Thrombocytopenia

Indexed keywords

ANDROGEN; AZATHIOPRINE; CD20 ANTIBODY; CORTICOSTEROID; CYCLOPHOSPHAMIDE; CYCLOSPORIN; CYTOTOXIC AGENT; DANAZOL; EPRATUZUMAB; FC RECEPTOR; IMMUNOGLOBULIN; IMMUNOMODULATING AGENT; METHOTREXATE; MYCOPHENOLIC ACID 2 MORPHOLINOETHYL ESTER; PREDNISONE; RECEPTOR ANTIBODY; RITUXIMAB; THROMBOCYTE ANTIBODY;

ANTIGEN ANTIBODY COMPLEX; ANTIPHOSPHOLIPID SYNDROME; B LYMPHOCYTE; BLEEDING; BONE MARROW; BONE MARROW TOXICITY; CELL DESTRUCTION; CELL INTERACTION; CLINICAL FEATURE; COHORT ANALYSIS; CYTOPENIA; DISEASE ACTIVITY; DISEASE COURSE; DRUG MEGADOSE; DYSPLASIA; HEMATOPOIESIS; HEMOPHAGOCYTIC SYNDROME; HUMAN; HYPOPLASIA; IMMUNOSUPPRESSIVE TREATMENT; LYMPHOCYTE DEPLETION; MACROPHAGE; MAINTENANCE DRUG DOSE; ORGAN INJURY; PATHOGENESIS; PATHOPHYSIOLOGY; PREDICTION; PRIORITY JOURNAL; REVIEW; SPLENECTOMY; STROMA; SYSTEMIC LUPUS ERYTHEMATOSUS; THROMBOCYTE; THROMBOCYTE COUNT; THROMBOCYTOPENIA; THROMBOTIC THROMBOCYTOPENIC PURPURA;

EID: 33750709660     PISSN: 15733971     EISSN: None     Source Type: Journal    
DOI: 10.2174/157339706778699805     Document Type: Review

References (109)

1. Tan EM, Cohen AS, Fries JF. et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25: 1271-7.
2. Michel M, Lee K, Piette JC. et al. Platelet autoantibodies and lupus-associated thrombocytopenia. Br J Haematol 2002; 119: 354-8.
3. Lipp E, von Felten A, Sax H, Muller D, Berchtold P. Antibodies against platelet glycoproteins and antiphospholipid antibodies in autoimmune thrombocytopenia. Eur J Haematol 1998; 60: 283-8.
4. Macchi L, Rispal P, Clofent-Sanchez G. et al. Anti-platelet antibodies in patients with systemic lupus erythematosus and the primary antiphospholipid antibody syndrome: their relationship with the observed thrombocytopenia. Br J Haematol 1997; 98: 336-41.
5. Diz-Kucukkaya R, Hacihanefioglu A, Yenerel M. et al. Antiphospholipid antibodies and antiphospholipid syndrome in patients presenting with immune thrombocytopenic purpura: a prospective cohort study. Blood 2001; 98: 1760-4.
6. Porta C, Bobbio-Pallavicini E, Centurioni R, Caporali R, Montecucco CM. Thrombotic thrombocytopenic purpura in systemic lupus erythematosus. ItalianCooperative Group for TTP. J Rheumatol 1993; 20: 1625-6.
7. Porta C, Caporali R, Montecucco C. Thrombotic thrombocytopenic purpura and autoimmunity: a tale of shadows and suspects. Haematologica 1999; 84: 260-9.
8. Dhote R, Simon J, Papo T. et al. Reactive hemophagocytic syndrome in adult systemic disease: report of twenty-six cases and literature review. Arthritis Rheum 2003; 49: 633-9.
9. Kuwana M, Okazaki Y, Kajihara M. et al. Autoantibody to c-Mpl [thrombopoietin receptor] in systemic lupus erythematosus: relationship to thrombocytopenia with megakaryocytic hypoplasia. Arthritis Rheum 2002; 46: 2148-59.
10. Scofield RH, Bruner GR, Kelly JA,. et al. Thrombocytopenia identities a severe familial phenotype of systemic lupus erythematosus and reveals genetic linkages at 1q22 and 11p13. Blood 2003; 101: 992-7.
11. Harrington WJ, Minnich V, Hollingsworth JW, Moore CV. Demonstration of a thromhocytopenic factor in the blood of patients with thrombocytopenic purpura 1951. J Lab Clin Med 1990; 115: 636-45.
12. Kurata Y, Hayashi S, Kosugi S. et al. Elevated platelet-associated IgG in SLE patients due to anti-platelet autoantibody: differentiation between autoantibodies and immune complexes by ether elution. Br J Haematol 1993; 85: 723-8.
13. Michel M, Khellaf M, Desforges L. et al. Autoimmune thrombocytopenic Purpura and Helicobacter pylori infection. Arch Intern Med 2002; 162: 1033-6.
14. Ziakas PD, Routsias JG, Tasidou A, Giannouli S, Tzioufas AG, Voulgarelis M. Suspects in the tale of lupus-associated thrombocytopenia. Clin Exp Immunol 2006; 145: 71-80.
15. Ruggeri ZM, Zimmerman TS, Russell S, Bader R, De Marco L. von Willebrand factor binding to platelet glycoprotein Ib complex. Methods Enzymol 1992; 215: 263-75.
16. Semple JW. Immune pathophysiology of autoimmune thrombocytopenic purpura. Blood Rev 2002; 16: 9-12.
17. Boshkov LK, Kelton JG, Halloran PF. HLA-DR expression by platelets in acute idiopathic thrombocytopenic purpura. Br J Haematol 1992; 81: 552-7.
18. Semple JW, Milev Y, Cosgrave D. et al. Differences in serum cytokine levels in acute and chronic autoimmune thrombocytopenic purpura: relationship to platelet phenotype and antiplatelet T-cell reactivity. Blood 1996; 87: 4245-54.
19. Lazarus AH, Ellis J, Semple JW, Mody M, Crow AR, Freedman J. Comparison of platelet immunity in patients with SLE and with ITP. Transfus Sci 2000; 22: 19-27.
20. Roark JH, Bussel JB, Cines DB, Siegel DL. Genetic analysis of autoantibodies in idiopathic thrombocytopenic purpura reveals evidence of clonal expansion and somatic mutation. Blood 2002; 100: 1388-98.
21. Pujol M, Ribera A, Vilardell M, Ordi J, Feliu E. High prevalence of platelet autoantibodies in patients with systemic lupus erythematosus. Br J Haematol 1995; 89: 137-41.
22. McMillan R. Immune thrombocytopenia. Clin Haematol 1983; 12: 69-88.
23. Fossati G, Bucknall RC, Edwards SW. Fcgamma receptors in autoimmune diseases. Eur J Clin Invest 2001; 31: 821-31.
24. King M, McDermott P, Schreiber AD. Characterization of the Fc gamma receptor on human platelets. Cell Immunol 1990; 128: 462-79.
25. Hed J.Role of complement in immune or idiopathic thrombocytopenic purpura. Acta Paediatr Suppl 1998; 424: 37-40.
26. Spycher MO, Nydegger UE. Participation of the blood platelet in immune reactions due to platelet-complement interaction. Infusionsther Transfusionsmed 1995; 22: 36-43.
27. Cervera R, Piette JC, Font J. et al; Euro-Phospholipid Project Group. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 2002; 46: 1019-27.
28. Harris EN, Asherson RA, Gharavi AE, Morgan SH, Derue G, Hughes GR. Thrombocytopenia in SLE and related autoimmune disorders: association with anticardiolipin antibody. Br J Haematol 1985; 59: 227-30.
29. Sachse C, Luthke K, Hartung K. et al. Significance of antibodies to cardiolipin in unselected patients with systemic lupus erythematosus: clinical and laboratory associations. The SLE Study Group. Rheumatol Int 1995; 15: 23-9.
30. Nojima J, Suehisa E, Kuratsune H. et al. High prevalence of thrombocytopenia in SLE patients with a high level of anticardiolipin antibodies combined with lupus anticoagulant. Am J Hematol 1998; 58: 55-60.
31. Abu-Shakra M, Gladman DD, Urowitz MB, Farewell V. Anticardiolipin antibodies in systemic lupus erythematosus: clinical and laboratory correlations. J Med 1995; 99: 624-8.
32. Krause I, Blank M, Fraser A, et al. The association of thrombocytopenia with systemic manifestations in the antiphospholipid syndrome. Immunobiology 2005; 210: 749-54.
33. Amoroso A, Mitterhofer AP, Del Porto F. et al. Antibodies to anionic phospholipids and anti-beta2-GPI: association with thrombosis and thrombocytopenia in systemic lupus erythematosus. Hum Immunol 2003; 64: 265-73.
34. Sebastiani GD, Galeazzi M, Tincani A. et al. Anticardiolipin and anti-beta2GPI antibodies in a large series of European patients with systemic lupus erythematosus. Prevalence and clinical associations. European Concerted Action on the Immunogenetics of SLE. Scand J Rheumatol 1999; 28: 344-51.
35. Ziakas PD, Giannouli S, Zintzaras E, Tzioufas AG, Voulgarelis M. Lupus thrombocytopenia: clinical implications and prognostic significance. Ann Rheum Dis 2005; 64: 1366-9.
36. Galli M, Daldossi M, Barbui T. Anti-glycoprotein Ib/IX and IIb/IIIa antibodies in patients with antiphospholipid antibodies. Thromb Haemost 1994; 71: 571-5.
37. Godeau B, Piette JC, Fromont P, Intrator L, Schaeffer A, Bierling P. Specific antiplatelet glycoprotein autoantibodies are associated with the thrombocytopenia of primary antiphospholipid syndrome. Br J Haematol 1997; 98: 873-9.
38. Hasselaar P, Derksen RH, Blokzijl L, de Groot PG. Crossreactivity of antibodies directed against cardiolipin, DNA, endothelial cells and blood platelets. Thromb Haemost 1990; 63: 169-73.
39. Out HJ, de Groot PG, van Vliet M, de Gast GC, Nieuwenhuis HK, Derksen RH. Antibodies to platelets in patients with antiphospholipid antibodies. Blood 1991; 77: 2655-9.
40. Deckmyn H, De Reys S. Functional effects of human antiplatelet antibodies. Semin Thromb Hemost 1995; 21: 46-59.
41. Shi W, Chong BH, Chesterman CN. Beta 2-glycoprotein I is a requirement for anticardiolipin antibodies binding to activated platelets: differences with lupus anticoagulants. Blood 1993; 81: 1255-62.
42. Fureder W, Firbas U, Nichol JL. et al. Serum thrombopoietin levels and anti-thrombopoietin antibodies in systemic lupus erythematosus. Lupus 2002; 11: 221-6.
43. Kuter DJ, Beeler DL, Rosenberg RD: The purification of megapoietin: A physiological regulator of megakaryocyte growth and platelet production. Proc Natl Acad Sci USA 91: 11104, 1994
44. Kaushansky K. Thrombopoietin: the primary regulator of platelet production. Blood 1995; 86: 419-431.
45. Zucker-Franklin D, Kaushansky K: Effect of Thrombopoietin on the Development of Megakaryocytes and Platelets: An Ultrastructural Analysis Blood, 1996; 88: 1632.
46. Emmons RV, Reid DM, Cohen RL. et al. Human thrombopoietin levels are high when thrombocytopenia is due to megakaryocyte deficiency and low when due to increased platelet destruction. Blood 1996; 87: 4068-71.
47. Chang M, Suen Y, Meng G. et al. Regulation of TPO mRNA expression and protein production: TPO gene regulation appears post transcriptional, and endogenous levels are inverseley correlated to megakaryocyte mass and circulating platelet count. Blood 86: 368a, 1995 [abstr, suppl 1]
48. Pereira RMR, Velloso ERP, Menezes Y, Gualandro S, Vassalo J, Yoshinari NH. Bone marrow findings in systemic lupus erythematosus patients with peripheral cytopenias. Clin Rheumatol 1998; 17: 219-22.
49. Feng CS, Ng MH, Szeto RS, Li EK. Bone marrow findings in lupus patients with pancytopenia. Pathology 1991; 23: 5-7.
50. Voulgarelis M, Giannouli S, Tasidou A, Anagnostou D, Ziakas PD, Tzioufas AJ. Bone marrow histological findings in systemic lupus erythematosus with haematologic abnormalities: a clinicopathological study. Am J Hem 2006; 81: 590-7
51. Papadaki HA, Boumpas DT, Gibson FM. et al. Increased apoptosis of bone marrow CD34+ cells and impaired function of bone marrow stromal cells in patients with systemic 1upus erythematosus. Br J Haematol 2001; 115: 167-74.
52. Otsuka T, Okamura S, Harada M. et al. Multipotent hemopoietic progenitor cells in patients with systemic lupus erythematosus. J Rheumatol 1988; 15: 1085-90.
53. Alvarado-de la Barrera C, Alcocer-Varela J, Richaud-Patin Y, Alarcon-Segovia D, Llorente L. Differential oncogene and TNF-alpha mRNA expression in bone marrow cells from systemic lupus erythematosus patients. Scand J Immunol 1998; 48: 551-6.
54. Aleem A, Al-Sugair S. Thrombotic thrombocytopenic purpura associated with systemic lupus erythematosus. Acta Haematol 2006; 115: 68-73.
55. Manadan AM, Harris C, Schwartz MM, Block JA. The frequency of thrombotic thrombocytopenic purpura in patients with systemic lupus erythematosus undergoing kidney biopsy. J Rheumatol 2003; 30: 1227-30.
56. Dong JF, Moake JL, Nolasco L. et al. ADAMTS-13 rapidly cleaves newly secreted ultralarge von Willebrand factor multimers on the endothelial surface under flowing conditions. Blood 2002; 100: 4033-9.
57. Moake JL. Thrombotic microangiopathies. N Engl J Med 2002; 347: 589-600.
58. Mannucci PM, Vanoli M, Forza I, Canciani MT, Scorza R. Von Willebrand factor cleaving protease [ADAMTS-13] in 123 patients with connective tissue diseases [systemic 1upus erythematosus and systemic sclerosis]. Haematologica 2003; 88: 914-8.
59. Rieger M, Mannucci PM, Kremer Hovinga JA. et al. ADAMTS13 autoantibodies in patients with thrombotic microangiopathies and other immunomediated diseases.Blood 2005; 106: 1262-7.
60. Coppo P, Bengoufa D, Veyradier A. et al. Reseau d'Etude des Microangiopathies Thrombotiques de l'Adulte. Severe ADAM TS13 deficiency in adult idiopathic thrombotic microangiopathies defines a subset of patients characterized by various autoimmune manifestations, lower platelet count, and mild renal involvement. Medicine [Baltimore] 2004; 83: 233-44.
61. Billiau AD, Roskams T, Van Damme-Lombaerts R, Matthys P, Wouters C. Macrophage activation syndrome: characteristic findings on liver biopsy illustrating the key role of activated, IFN-gamma-producing lymphocytes and IL-6- and TNF-alpha-producing macrophages. Blood 2005; 105: 1648-51.
62. Shimamoto Y, Suga K, Ohta A, Yamaguchi M. Risk factors for the development of acute disseminated intravascular coagulation in patients with systemic lupus erythematosus. Clin Rheumatol 1995; 14: 176-9.
63. Alzeer AH, Al-Arfaj A, Basha SJ. et al. Outcome of patients with systemic lupus erythematosus in intensive care unit. Lupus 2004; 13: 537-42.
64. Ziakas PD, Poulou LS, Giannouli S, Tzioufas AG, Voulgarelis M. Thrombocytopenia in lupus: Baseline C3 as an independent risk factor for relapse. Ann Rheum Dis. [In press]
65. Miller MH, Urowitz MB, Gladman DD. The significance of thrombocytopenia in systemic lupus erythematosus. Arthritis Rheum 1983; 26: 1181-6.
66. Urowitz MB. SLE subsets - divide and conquer. J Rheumatol 1977; 4: 332-3.
67. Alger M, Alarcon-Segovia D, Rivero SJ. Hemolytic anemia and thrombocytopenic purpura: two related subsets of systemic lupus erythematosus. J Rheumatol 1977; 4: 351-7.
68. Pistiner M, Wallace DJ, Nessim S, Metzger AL, Klinenberg JR. Lupus erythematosus in the 1980s: a survey of 570 patients. Semin Arthritis Rheum 1991; 21: 55-64.
69. Swaak AJ, Nossent JC, Bronsveld W. et al. Systemic lupus erythematosus. I. Outcome and survival: Dutch experience with 110 patients studied prospectively. Arm Rheum Dis 1989; 48: 447-54.
70. Reveille JD, Bartolucci A, Alarcon GS. Prognosis in systemic lupus erythematosus. Negative impact of increasing age at onset, black race, and thrombocytopenia, as well as causes of death. Arthritis Rheum 1990; 33: 37-48.
71. Ward MM, Pyun E, Studenski S. Mortality risks associated with specific clinical manifestations of systemic lupus erythematosus. Arch Intern Med 1996; 56: 1337-44.
72. Sultan SM, Begum S, Isenberg DA. Prevalence, patterns of disease and outcome in patients with systemic lupus erythematosus who develop severe haematological problems. Rheumatology [Oxford] 2003; 42: 230-4.
73. Mosca M, Bencivelli W, Vitali C, Carrai P, Neri R, Bombardieri S. The validity of the ECLAM index for the retrospective evaluation of disease activity in systemic lupus erythematosus. Lupus 2000; 9: 445-50.
74. Bencivelli W, Vitali C, Isenberg DA. et al. Disease activity in systemic lupus erythematosus: report of the Consensus Study Group of the European Workshop for Rheumatology Research. III. Development of a computerised clinical chart and its application to the comparison of different indices of disease activity. The European Consensus Study Group for Disease Activity in SLE. Clin Exp Rheumatol 1992; 10: 549-54.
75. Vitalli C, Bencivelli W, Isenberg DA. et al. Disease activity in systemic lupus erythematosus: report of the Consensus Study Group of the European Workshop for Rheumatology Research. II. Identification of the variables indicative of disease activity and their use in the development of an activity score. The European Consensus Study Group for Disease Activity in SLE. Clin Exp Rheumatol 1992; 10: 541-7.
76. Ho A, Barr SG, Magder LS, Petri M. A decrease in complement is associated with increased renal and hematologic activity in patients with systemic lupus erythematosus. Arthritis Rheum 2001; 44: 2350-7.
77. Thumboo J, Lee HY, Fong KY. et al. Accuracy of medical record scoring of the SLICC/ACR damage index for systemic lupus erythematosus. Lupus 2000; 9: 358-62.
78. Gladman DD, Urowitz MB, Goldsmith CH. et al. The reliability of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index in patients with systemic lupus erythematosus. Arthritis Rheum 1997; 40: 809-13.
79. Ziakas PD, Dafni UG, Giannouli S, Tzioufas AG, Voulgarelis M. Thrombocytopaenia in lupus as a marker of adverse outcome-seeking Ariadne's thread. Rheumatology [Oxford] 2006; (Epub ahead of print).
80. Fehr J, Hofmann V, Kappeler U. Transient reversal of thrombocytopenia in idiopathic thrombocytopenic purpura by high-dose intravenous gamma globulin. N Engl J Med 1982; 306: 1254-8.
81. Culic S. Recombinant factor VIIa for refractive haemorrhage in autoimmune idiopathic thrombocytopenic purpura. Br J Haematol 2003; 120: 909-10.
82. Boumpas DT, Chrousos GP, Wilder RL, Copps TR, Balow JE. Glucocorticoid therapy for immune-mediated diseases: basic and clinical correlates. Ann Intern Med 1993; 119: 1198-208.
83. Agnello V, Pariser K, Gell J, Gelfand J, Turksoy RN. Preliminary observations on danazol therapy of systemic lupus erythematosus: effects on DNA antibodies, thrombocytopenia and complement. J Rheumatol 1983; 10: 682-7.
84. Cervera H, Jara LJ, Pizarro S. et al. Danazol for systemic lupus erythematosus with refractory autoimmune thrombocytopenia or Evans' syndrome. J Rheumatol 1995; 22: 1867-71.
85. Maloisel F, Andres E, Zimmer J. et al. Danazol therapy in patients with chronic idiopathic thrombocytopenic purpura: long-term results. Am J Med 2004; 116: 590-4.
86. Eisenberg R, Looney RJ. The therapeutic potential of anti-CD20 "what do B-cells do?". Clin Immunol 2005; 117: 207-13.
87. Braendstrup P, Bjerrum OW, Nielsen OJ. et al. Rituximab chimeric anti-CD20 monoclonal antibody treatment for adult refractory idiopathic thrombocytopenic purpura. Am J Hematol 2005; 78: 275-80.
88. Abu-Shakra M, Shoenfeld Y. Azathioprine therapy for patients with systemic lupus erythematosus. Lupus 2001; 10: 152-3.
89. Quartuccio L, Sacco S, Franzolini N, Perin A, Ferraccioli G, De Vita S. Efficacy of cyclosporin-A in the long-term management of thrombocytopenia associated with systemic lupus erythematosus. Lupus 2006; 15: 76-9.
90. Kappers-Klunne MC, van't Veer MB. Cyclosporin A for the treatment of patients with chronic idiopathic thrombocytopenic purpura refractory to corticosteroids or splenectomy. Br J Haematol 2001; 114: 121-5.
91. Howard J, Hoffbrand AV, Prentice HG, Mehta A. Mycophenolate mofetil for the treatment of refractory auto-immune haemolytic anaemia and auto-immune thrombocytopenia purpura. Br J Haematol 2002; 117: 712-5.
92. Chang HK. Successful treatment of refractory thrombocytopenia with mycophenolate mofetil in a patient with systemic lupus crythematosus. Korean Med Sci 2005; 20: 883-5.
93. Vasoo S, Thumboo J, Fong KY. Refractory immune thrombocytopenia in systemic lupus erythematosus: response to mycophenolate mofetil. Lupus 2003; 12: 630-2.
94. Katsifis GE, Tzioufas AG, Vlachoyiannopoulos PG, Voulgarelis M, Moutsopoulos HM, Ioannidis JP. Risk of myelotoxicity with intravenous cyclophosphamide in patients with systemic lupus erythematosus. Rheumatology [Oxford] 2002; 41: 780-6.
95. You YN, Tefferi A, Nagomey DM. Outcome of splenectomy for thrombocytopenia associated with systemic lupus erythematosus. Ann Surg 2004; 240: 286-92.
96. Amal C, Piette JC, Leone J. et al. Treatment of severe immune thrombocytopenia associated with systemic tupus erythematosus: 59 cases.J Rheumatol 2002; 29: 75-83.
97. Delgado Alves J, Inanc M, Diz-Kucukkaya R, Grima B, Soromenho F, Isenberg DA. Thrombotic risk in patients submitted to splenectomy for systemic lupus erythematosus and antiphospholipid antibody syndrome-related thrombocytopenia. Eur J Intern Med 2004; 15: 162-167.
98. Kyaw MH, Holmes EM, Toolis F. et al. Evaluation of severe infection and survival after splenectomy. Am J Med 2006; 119: 276.e1-7.
99. Melles DC, de Marie S. Prevention of infections in hyposplenic and asplenic patients: an update. Neth J Med 2004; 62: 45-52.
100. Sumaraju V, Smith LG, Smith SM. Infectious complications in asplenic hosts. Infect Dis Clin North Am 2001; 15: 551-65.
101. Vasoo S, Hughes GR. Theory, targets and therapy in systemic lupus erythematosus. Lupus 2005; 14: 181-8.
102. Rahman P, Humphrey-Murto S, Gladman DD, Urowitz MB. Cytotoxic therapy in systemic 1upus erythematosus. Experience from a single center. Medicine (Baltimore) 1997; 76: 432-7.
103. Avina-Zubieta JA, Galindo-Rodriguez G, Robledo I. et al. Long-term effectiveness of danazol corticosteroids and cytotoxic drugs in the treatment of hematologic manifestations of systemic lupus erythematosus. Lupus 2003; 12: 52-7.
104. Moschcowitz E. Hyaline thrombosis of the terminal arterioles and capillaries: a hitherto undescribed disease. Proc N Y Pathol Soc 1924; 24: 21.
105. Pagnoux C, Korach JM, Guillevin L. Indications for plasma exchange in systemic lupus erythematosus in 2005. Lupus 2005; 14: 871-7.
106. Solberg LA Jr. Biologic aspects of thrombopoietins and the development of therapeutic agents. Curr Hematol Rep 2005; 4: 423-8.
107. Bussel JB, Mukherjee R, Stone AJ. A pilot study of rhuIL-11 treatment of refractory ITP.Am J Hematol 2001; 66: 172-7.
108. Feinglass S, Deodhar A. Treitment of lupus-induced thrombocytopenia with recombinant human interleukin-11. Arthritis Rheum 2001; 44: 170-5.
109. Anolik JH, Aringer M. New treatments for SLE: cell-depleting and anti-cytokine therapies. Best Pract Res Clin Rheumatol 2005; 19: 859-78.