Anemia 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. In lupus patients, anemia can be caused by chronic inflammation, iron deficiency, prolonged uraemia, or hemolytic anemia. Many Lupus patients suffer from hemolytic anemia, what we have is usually called autoimmune hemolytic anemia because of the malfunction of our immune system that produces autoantibodies which attack red blood cells as if they were substances foreign to the body. Autoimmune hemolytic anemia is gnerally caused by or occurs with another disease, such as systemic lupus erythematosus, and, on rare occassions, can be caused by certain drugs, such as penicillin.
The destruction of the red blood cells that is caused by autoantibodies can occur suddenly, or it may develop gradually. In some people, the destruction may stop after a period of time. But, in other people (especially those with SLE), it becomes chronic.
There are two main types of autoimmune hemolytic anemia: warm antibody hemolytic anemia and cold antibody hemolytic anemia. In the warm antibody type, the autoantibodies attach to and destroy red blood cells at temperatures equal to or in excess of the normal body temperature. In the cold antibody type, the autoantibodies become most active and attack red blood cells only at temperatures well below the normal body temperature.
The term for destruction of red blood cells is hemolysis. Red blood cells normally live for 120 days, but in hemolytic anemia, they only live for about 10-15 days. In lupus patients, this is caused by the antibodies that are made against the red blood cells. Like Lupus, hemolytic anemia can become chronic with periods of remissions and recurrence. The bone marrow is unable to compensate for the premature destruction of red blood cells by increasing their production. When the marrow is able to compensate, anemia does not occur. If other substances such as complement are present, the antibodies can pop the red cells. This is usually treated with corticosteroids or cytotoxics, but in very serious cases, the spleen may have to be removed. There is no known prevention for hemolytic anemia.
Red blood cells are produced by the bone marrow, but because lupus causes chronic inflammation, this inflammation can hinder the production of red blood cells. When there is inflammation, iron is not handled properly and it accumulates in the bone marrow tissue. But iron is needed to produce hemoglobin (red pigment in the cells), and if it is accumulating in the marrow tissue, it can't be used to produce the red cells. For Lupus patients, treating the anemia with iron is pretty much useless if the anemia is caused by inflammation. So, for Lupus patients, the production of red blood cells can only return to normal when the inflammation is treated.
Other causes of anemia in lupus patients are:
* Iron Deficiency
* Uraemia: This is a dysfunction of the kidney in which wastes, which are normally excreted by the kidneys, remains in the bloodstream. Uraemia can also cause anaemia in lupus patients. Uraemia is generally treated with androgens (male hormones), or with a hormone called erythropoietin.
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