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The
Challenges of Lupus: Insights & Hope
(UK
customers)
Anaemia
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.
Thrombocytopaenia
Thrombocytes
(blood platelets) are tiny particles in the blood that are essential
for blood clotting, and thrombocytopaenia is a deficiency of these
platelets.
Symptoms
include petechiae (Small haemorrhages, or
pinpoint lesions, on the skin), excessive bruising, &
bleeding gums.
Idiopathic
thrombocytopaenic purpura (ITP) is a condition where there are decreased
platelet counts, along with the presence of platelet antibodies.
ITP can be present in patients who do not have lupus. It is usually
treated with corticosteroids, or with low doses of a drug called
danazol.
Lupus patients can also get qualitative platelet defects. Functional
blood clotting can be affected by aspirin, chronic renal failure
and platelet antibodies, even when platelet counts are in the normal
range. NSAIDs and steroids disrupt platelets, and induce purpura
(black and blue marks on the skin). It is a benign condition, and
no treatment is necessary if platelet counts are in the normal range.
Leukopaenia
Leukopaenia
means a low white cell count, & is quite common in lupus patients.
If a patient's white blood cell count falls below 3000, they are
thought to have leukopaenia, & it may suggest that they are
about to have a flare.
Corticosteroids
can be given to bring the white cell level back to normal. But if
the cell count is low because the patient is receiving chemotherapy,
a chemical called cytokine may be administered in order to bring
the cell count back to normal, thereby preventing fever or infection.
See
the blood tests page for details on normal
test values.
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