What is your approach to using medications that can cause bone marrow suppression in SLE patients who have persistent leukopenia?

I am so glad someone asked this question. I have heard some peers state that they are reluctant to use immunosuppressants in this situation.

However, I do not agree with this.

The whole reason our systemic lupus (SLE) patients have leukopenias is due to their autoimmunity (but make sure drugs, infe...

I agree with @Dr. First Last’s approach. It helps to look for anti-neutrophil/granulocyte and anti-lymphocytes antibodies in some cases (some but not all labs offer this). The older method for testing this is to provide a 10-20 day trial of steroid with taper to see if the WBC count improves. Doses ...

Generally, people are afraid of pushing Imuran, MTX, etc., if a patient with lupus has leukopenia. However, more often than not, the leukopenia is from the underlying autoimmune disorder, not from the drugs. Unless the WBC is extremely low, say 1,000 or so, I usually continue the DMARD. What matters...