INTRODUCTION

If you have lupus, there is a significant chance that you have experienced or are currently living with, the medical condition known as anemia.  It is reported that nearly half of those living with lupus are anemic.  Because this is such a common condition for those in our Kaleidoscope community, we felt it was important to delve into the warning signs of anemia, the different types associated with it, and the most common treatment options.  

WHAT IS ANEMIA?

Anemia is a condition where the red blood cell count, iron count or hemoglobin is less than normal due to illness, inflammation, iron deficiency or loss of blood.  

SYMPTOMS

Some people who are anemic are not symptomatic.  However, generally speaking, most people experience these common symptoms as the anemia worsens:

  • Exhaustion or fatigue
  • Feeling weak
  • Having pale or yellowish skin  
  • Rapid heartbeat
  • Feeling short of breath
  • Dizziness or lightheadedness
  • Chest pain
  • Cold hands and feet
  • Headache

DIAGNOSIS

Anemia can be diagnosed through a complete blood cell count or CBC test and a ferritin test.  The doctor will want to see the size and color of your red blood cells, your hematocrit level and ferritin level.  Though, these levels differ between men and women, and may vary at different laboratories, normal ranges are typically as follows:

Men:  Normal hemoglobin – more than 13.5 gram/100 ml

Women:  Normal hemoglobin – more than 12.0 gram/100 ml

Men: Normal hematocrit – between 38.8 and 50 percent

Women: Normal hematocrit – between 34.9 and 44.5 percent

Men: Normal ferritin – between 12-300 ng/mL

Women: Normal ferritin – between 12-150 ng/ML

WHAT IS FERRITIN?

Ferritin is a protein in your blood that helps store iron, hence, a low level of ferritin means a low level of stored iron. 

Different types of anemia and their causes:

  • Iron deficiency anemia: Worldwide, this is the most common type of anemia that is caused by a shortage of iron in the body. Without the right amount of iron, the body cannot produce enough hemoglobin for healthy red blood cells.  This type of anemia occurs in many pregnant women, from blood loss (i.e. bleeding ulcer, cancer, and heavy menstrual bleeding) or from regular use of some pain relievers, like aspirin.
  • Anemia of chronic disease:  Diseases like leukemia, rheumatoid arthritis, kidney disease, Crohn’s disease, HIV/AIDS, myelofibrosis and other chronic inflammatory diseases, such as lupus — can interfere with the production of red blood cells.
  • Aplastic anemia:  This life-threatening anemia is due to the body not producing enough red blood cells. It is rare, but causes include: infections, certain medicines, autoimmune involvement and exposure to toxic substances.
  • Sickle cell anemia:  Sickle cell is an inherited condition that can result in serious complications. It’s caused by defective hemoglobin that drives the red blood cells to change to a sickle or crescent shape.  The sickle shaped blood cells don’t survive, resulting in chronic anemia.
  • Vitamin deficiency anemia:  Besides iron, the body needs vitamin B12 and folate to manufacture the right amount of healthy red blood cells. A diet lacking in these nutrients or problems with processing the vitamins can cause anemia.  
  • Other anemias:  There are several other forms of anemia, such as thalassemia malarial anemia and hemolytic anemia.

THE ANEMIA/LUPUS CONNECTION 

As mentioned above, anemia is the most common blood disorder found in lupus, affecting one in every two lupus patients.  The most prevalent lupus symptom, fatigue, usually is the first symptom of anemia. So why does lupus and anemia seem to go hand and hand? Well, most medical professionals would suggest the following reasons:

  • Inflammation hindering red cell production.
  • A problem with the hormone erythropoietin, which is produced by the kidneys and stimulates the bone marrow to make more RBC’s.
  • Iron deficiency caused by bleeding due to NSAID use.  Common NSAIDs include: aspirin, ibuprofen and naproxen.  These medications may also, in rare instances, cause bone marrow suppression.
  • Bone marrow loss due to the use of lupus treatments like azathioprine (Imuran), and cyclophosphamide.

TREATMENTS

Treatment for anemia depends greatly on the cause of the condition.  If you have been diagnosed with iron-deficiency anemia, treatments may include dietary changes and supplements, medicines or surgery.  If you have severe iron-deficiency anemia, you may require a blood transfusion, iron injections or IV iron therapy. These treatments are provided at a hospital by licensed medical professionals.  The goal is to treat the cause of the iron-deficiency and restore normal levels as soon as possible.

  • Supplements and dietary changes: Your doctor may suggest iron supplements to build up your levels quickly.  Remember that large amounts of iron are not healthy, and can be harmful. Only take iron as prescribed by your doctor and always keep your supplements out of a child’s reach. Your doctor may also tell you to increase foods in your diet that are high in iron.  These include: red meat (beef and liver), chicken, turkey, pork, fish and shellfish. Non-meat iron rich foods include: breads, cereal, peas, lentils, beans, tofu, dried fruits (prunes), spinach and other leafy dark green vegetables. Note: the body tends to absorb iron from meat better than non-meat foods.  Vitamin C is also a good supplement to help your body absorb iron.
  • Treatments for bleeding issues: Anemia from blood loss will need to be treated specifically targeting the cause of the bleeding.  Surgery may be required for a cancerous tumor or polyp. A bleeding ulcer may need antibiotics or other medications.  If it is due to heavy menstrual flow, birth control may be prescribed to help lighten the bleeding or even surgery in severe cases.

  • Blood transfusions/Iron therapy:  Severe iron-deficiency anemia may require a blood transfusion of red blood cells.  This is a very safe and very common IV treatment. The positive is that it will treat the anemia immediately, the negative is, the doctor will still have to be mindful of the root cause of the anemia to prevent it from recurring.  Iron therapy as another treatment for severe anemia. It is usually prescribed to people who need iron long-term but cannot tolerate iron supplements by mouth. The iron is given through shots or an IV at a hospital or clinic by experienced medical professionals  

PREVENTATIVE MEASURES 

If you have lupus and are worried about anemia, being proactive with your health is important.  Here are some simple steps:

  • Try to eat a well-balanced iron rich diet
  • Reduce your caffeine intake.  Caffeine can make it harder for your body to absorb iron.  
  • Ask your doctor about taking a vitamin C supplement or eating vitamin C rich foods.

**All images unless otherwise noted are property of and were created by Kaleidoscope Fighting Lupus.  To use one of these images, please contact us at info@kflupus.org. Written permission, image credit and link-back must be given to Kaleidoscope Fighting Lupus. **All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your medical provider with any specific questions or concerns.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4963652/

https://resources.lupus.org/entry/what-you-need-to-know-about-anemia

https://www.medicinenet.com/anemia/article.htm

https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360

https://www.nhlbi.nih.gov/health-topics/iron-deficiency-anemia

http://www.bodyandsoul.com.au/health/health-az/prevention-and-treatment-of-anemia/news-story/d89ebc67f25fc54cf217e37689e37c6e

 

*All images unless otherwise noted are property of and were created by Kaleidoscope Fighting Lupus. To use one of these images, please contact us at info@kflupus.org for written permission; image credit and link-back must be given to Kaleidoscope Fighting Lupus. **All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your medical provider with any specific questions or concerns.

 

Article by : Kelli Roseta

Kelli Roseta has been living with lupus since she was diagnosed at 11 years old. She is a tireless advocate for those living with lupus.