[Clinical characteristics analysis of patients with immune-related pancytopenia complicated by connective tissue diseases].

Abstract

A retrospective collection of clinical data was conducted on patients with connective tissue diseases (CTD) complicated by cytopenia (which could not be attributed to any currently named hematological diseases) who were hospitalized and treated in the Department of Hematology, Tianjin Medical University General Hospital from May 2022 to May 2024. Based on the prognosis, the patients were divided into the remission group (including complete remission and partial remission) and the non-remission group (clinically non-remission). Follow-up was conducted until December 2024 or until the patient's death, with an analysis of their clinical manifestations, laboratory findings, and prognosis, etc. A total of 45 patients were included, comprising 2 males and 43 females, with an age of (57±15) years. The follow-up duration [M (Q₁, Q₃)] was 9 (6, 18) months. Thirty-seven patients (82.2%) had other organ involvement, with 23 patients (51.1%) experiencing infections, 7 patients (15.6%) having thrombosis, 7 patients (15.6%) having neoplastic diseases. Forty-two patients (93.3%) exhibited bicytopenia or pancytopenia, with a median neutrophil-to-lymphocyte ratio of 2.4 (1.0, 6.6). In 91% (41/45) of the patients, reticulocyte counts were not low, and all patients demonstrated active bone marrow in the iliac crest and/or sternum. Among the 37 patients (82.2%) with positive antinuclear antibodies, a negative correlation was observed between antinuclear antibody titers and red blood cell levels (r=-0.40,P=0.015). There were 30 cases in the remission group and 15 cases in the non-remission group. The ferritin levels in the non-remission group were higher than those in the remission group [838 (61, 1 695) vs 123 (30, 279)μg/L, P=0.035]. Patients with immune-related pancytopenia complicated by CTD exhibited no inversion of the neutrophil-to-lymphocyte ratio, no low reticulocyte counts, and active bone marrow proliferation. Their antinuclear antibody titers were negatively correlated with the degree of red blood cell reduction, and the ferritin levels were higher in the non-remission group.