Blood disorders are common in lupus. The most common blood disorder is anemia and it affects half of all people with active lupus. Anemia is measured and discussed in several different ways, including a low red blood cell count, low hemoglobin, or low hematocrit. Each doctor usually has a preference for using a particular term. In the most important sense, anemia means too little hemoglobin. Hemoglobin is the protein inside red cells that carries oxygen from the lungs to all the tissues of the body. Fatigue, a very common lupus symptom, is generally the first and most common symptom of anemia.
Normal red blood cells live only 120 days (about four months) and must constantly be produced by the bone marrow. Anemia is reduced red cell production. Many doctors feel that this may be due to inflammation; kidney problems (when the kidneys do not produce enough of the hormone, erythropoietin, that stimulates the marrow to make more red cells); iron deficiency (without which hemoglobin cannot be made—iron deficiency may result from menstrual bleeding or from intestinal bleeding due to non-steroidal anti-inflammatory drugs); or direct depression of the bone marrow by certain lupus drugs (such as azathioprine or cyclophosphamide). Intestinal bleeding can be obvious if the stool is red, maroon, or pitch black in color, but often bleeding is so slow and gradual that special stool tests are needed to detect the bleeding.
The treatment of anemia in lupus depends on its cause. Inflammation can be reduced with drugs such as prednisone. For iron deficiency, iron given orally, such as ferrous sulfate or ferrous gluconate, is almost always effective. In the case of bleeding, the source should be determined in order to correct the problem. Erythropoietin or darbepoietin may be given to individuals with kidney problems to stimulate the bone marrow to make more red blood cells. The same may be given to patients with anemia who are taking azathioprine or cyclophosphamide. For hemolysis due to antibodies, prednisone and other drugs are often helpful, but sometimes the best treatment is splenectomy. This is an abdominal surgery to remove the spleen (which may be done laparoscopically, that is, with small incisions in the abdominal wall).
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