nephritis Plasmapheresis has been used in the treatment of severe lupus nephritis, but its use should be limited to centers experienced in the care of acutely ill children with SLE Hematologic Complications Anemia is common in SLE and may have many causes Most typically, patients have a nonspecific normocytic, normochromic anemia of chronic disease Microcytic anemia, in contrast, may be a sign of GI blood loss caused by vasculitis or gastritis, with the urgency of further investigation dependent on the severity of the bleeding and the patient’s overall well-being Hemolytic anemia in SLE may be related to the disease itself (anti-erythrocyte antibodies) or to medications The antibody responsible for autoimmune hemolytic anemia may not be demonstrated by the standard Coombs test, so more sensitive assays may be necessary Management of anemia depends on the severity (see Chapter 93 Hematologic Emergencies ) Corticosteroids are the most effective agents for the control of autoimmune hemolytic anemia in SLE Prednisone at mg/kg/day is the initial treatment of choice For severe hemolytic anemia requiring transfusion, additional immune modulatory therapies may be required Consultation with a hematologist and rheumatologist is recommended Leukopenia occurs in about 50% of patients with SLE It may be caused by a reduction in granulocytes, lymphocytes, or both Granulocytopenia may be caused by drugs used in the treatment of SLE or less commonly by disease-related destruction Febrile children with absolute granulocyte counts of