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Abstract

Background: Systemic lupus erythematosus (SLE) is a relapsing-remitting autoimmune disease with wide ranging organ involvement and clinical symptoms varying from mild and transient symptoms to death. Systemic lupus erythematosus typically develops between the teen and adult years, ranging from ages 15-44 years, predominantly affecting females in the reproductive age. Objective: To find the relationship between serum protein electrophoresis levels and hematological parameters and the severity of SLE in Iraqi patients. Patients and methods: the study involved a total of 40 SLE patients who attended one of Baghdad teaching hospitals from October 2018 until May 2019. Diagnosis of SLE was based on the criteria published by the American College of Rheumatology (ACR) for SLE classification and was subdivided depending on SLEDAI into SLE-S (29 sever) and SLE-M (11 moderate). SLEDAI was calculated for all patients (sever & moderate) as following: no activity (SLEDAI= 0), mild activity (SLEDAI 1-5), moderate activity (SLEDAI 6-10), high activity (SLEDAI 11- 19), very high activity (SLEDAI ≥20). In addition, a total of 10 apparently healthy individuals and 10 RA patients were included in the study as a control group. Blood samples were collected from patients and control, and serum was separated. Serum protein electrophoresis and hematological parameters were measured in both patients and control. In addition, urine samples were collected in plastic disposable tubes, and labeled from study patients and control for urinary RBC count and protein urea (persistent proteinuria greater than +3 by dipstick) were detected. Results: the study showed that the majority of patients (40%) were aged <20-29 years. A significant difference in the WBC count was noticed between SLE-S (5.10±2.33 109 /L), SLE-M(4.90±2.63 109/L), RA (5.06±2.45 109/L), and control (6.05±1.96 109/L).
On the other hand, Monocyte count showed no significant difference between SLE-S (4.25±1.51%), SLE-M (3.94±1.60%), RA (3.89±1.38%), and control (4.05±0.72%). While other hematological parameter showed a highly significant difference between studied groups such as hemoglobin between SLE-S (10.97±1.45 g/dL), SLE-M (11.05±1.86 g/dL), RA (10.68±1.27 g/dL), and control (13.95±0.62 g/dL) , platelet between SLE-S (229.76±99.2 109/L), SLE-M (242.16±104.4 109/L), RA (412.57±124.6 109 /L), and control (315.70±73.78 109 /L), Lymphocyte between SLE-S (28.39±11.28 %), SLE-M(28.60±10.11%),RA (24.88±8.13 %),and control (39.57±5.82%). There was a significant difference in Neutrophils between SLE-S (60.52±15.64%), SLE-M (62.31±9.34%), RA (63.85±7.53%), and control (52.86±10.29%). Similarly, Eosinophils were significantly different between SLE-S (1.28±0.68%), SLE-M (1.41±0.65%), RA (1.54±0.77%), and control (2.49±1.32%); and Basophils were significantly different between SLE-S (0.75±0.29%), SLE-M (0.77±0.28%), RA (0.91±0.37%), and control (0.56±0.21%). Finally, a significant difference was noticed in ESR between SLE-S (59.60±36.19 mm/hr), SLE-M (51.79±37.33 mm/hr), RA (86.40±45.34 mm/hr), and control (7.86±1.97 mm/hr). Furthermore, distribution of studied groups by results of urine protein and hematuria showed a highly significant difference. Also a highly significant difference in serum albumin was noticed between SLE (35.3412 g/l) and control (41.486 g/l). In addition, a highly significant difference in the gama globulin was noticed between SLE (15.4442 g/l) and control (9.656 g/l). Conclusion: decreased in serum albumin and increased in gamma globulin were found to be prevalent in SLE patients in our study. This decreased in serum albumin and increased in gamma globulin was related to proteinurea and disease score in SLE patients, and thus to disease activity.

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