BLEEDING AS THE INITIAL MANIFESTATION OF SYSTEMIC LUPUS-ERYTHEMATOSUS

Systemic lupus erythematosus (SLE) is an immunologic disease that is m ultisystemic and as a result can manifest itself in various organs, In general, the hematologic manifestations of the disease consist of mil d leukopenia (< 4500 white blood cells [WBCs]/mm(3)), thrombocytopenia (100,000-150,000 cells/mm(3)), and anemia, Hemolytic anemia and marke d thrombocytopenia are uncommon laboratory features of the disease. Ad ditional hematologic abnormalities include thrombosis, which can occur in 10-15% of patients. ((1)) The thrombosis has been attributed to th e presence of lupus anticoagulant. Bleeding is usually not seen in SLE since the hemolysis and thrombocytopenia seen in SLE generally are no t severe enough to result in significant blood loss, However, when sev ere anemia secondary to bleeding is seen three causes should be invest igated; thrombocytopenia, severe uremia, and the presence of lupus ant icoagulant with prothrombin antibody. We report an adolescent girl who initially presented with menorrhagia and subsequently was found to ha ve SLE,