Lupus Site - a guide for lupus patients and their families

Anaemia is the most common blood problem in people with SLE. It is the lack of red blood cells, or the presence of red blood cells that do not have enough oxygen-carrying capacity due to a deficiency in iron or vitamins.

Anaemia is diagnosed using blood tests - the red blood cell count, or the haemocrit.

In lupus patients, anaemia can be caused by chronic inflammation, iron deficiency, prolonged uraemia, or haemolytic anaemia.

Red blood cells are produced by bone marrow, but prolonged inflammation can hinder the production of red blood cells. When there is inflammation, iron is not handled properly, and accumulates in the bone marrow tissue. But iron is needed to produce haemoglobin (red pigment in the cells), and if it is accumulating in the marrow tissue, it can't be used to produce the red cells. Therefore, treating the anaemia as one normally would with iron would be useless if the anaemia is caused by inflammation. In these cases the production of red blood cells would return to normal only when the inflammation is treated.

Uraemia is marked kidney insufficiency in which wastes normally excreted by the kidneys remains in the bloodstream. Uraemia can cause anaemia in lupus patients, but can be treated with androgens (male hormones), or with a hormone called erythropoietin.

Anaemia can also be caused by iron deficiency, which can be brought on by heavy periods in women, or internal bleeding in the stomach (which can be caused by NSAIDs). Treatment is with iron tablets.

Haemolytic anaemia is a condition where red blood cells are prematurely destroyed. Red blood cells normally live for 120 days, but in haemolytic anaemia, they only live for about 10-15 days. In lupus patients, it can be caused by antibodies that are made against the red blood cells. If other substances such as complement are present, the antibodies can pop the red cells. It can be treated with corticosteroids or cytotoxics, but in some cases, the spleen may have to be removed.