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May 4, 2011

Thrombocytopenia and Sarcoidosis—Reply

JAMA. 2011;305(17):1765-1766. doi:10.1001/jama.2011.561

In Reply: The underlying theme of our article was that sarcoidosis is a multisystem inflammatory disease. The case presented accentuates 2 points: sarcoidosis is often not benign, resulting in severe end-organ damage, and many patients are intolerant to the adverse effects of corticosteroids and consequently self-manage or discontinue their therapy. Dr Pierce highlights thrombocytopenia, a subtle feature of the case. The patient was taking no medications that cause marrow suppression, and she was referred to a hematologist. In addition to thrombocytopenia, other hematological manifestations of sarcoidosis include anemia, leukopenia, and lymphopenia. In an observational study, lymphopenia was reported in more than 50% of patients with pulmonary sarcoidosis.1 CD4+ lymphopenia may be associated with more severe disease and prove to be a marker for response to anti–tumor necrosis factor therapy.2

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