Hemolytic Anemia, Coombs’ Test, & Lupus

It’s no secret: lupus causes problems throughout the body. It can even cause hemolytic anemia which impacts red blood cells.

There are various types of anemias, but the symptoms are similar. Anemic people feel fatigued, weak, and like they might pass out.

If those symptoms sound and feel familiar, it’s because they are also common lupus symptoms. Recent research has explored the rate of anemia in people with lupus.

According to the Johns Hopkins Lupus Center, 10% of people with lupus will also have autoimmune hemolytic anemia (AIHA). People with AIHA may experience dizziness, fevers, a yellowed complexion or shortness of breath.

NOTE: Always bring up symptoms and concerns with your doctor and care team. And, if you experience severe shortness of breath, call 911 or your local emergency number

Red blood cells & hemolytic anemia

In hemolytic anemia, red blood cells (RBCs) have an abnormally short lifespan. In serious cases of hemolytic anemia, a red blood cell may only live for a few days. A healthy red blood cell lives somewhere between 100 and 120 days.

The body reacts to the anemia by and the bone marrow creates more red blood cells. The balance between this increased RBC production and the speed with which the RBCs are broken down determines the severity of the anemia.

Hemolysis is the name for this premature rupturing (lysis) of the cells – and explains the name ‘hemolytic anemia.’

However, red blood cells can rupture for a variety of reasons. Runners, for example, can experience “footstrike hemolysis” from the impact of running.

Because of this, it is important for a doctor to understand the underlying cause of the hemolytic anemia as treatment options can vary.

Hemolytic anemia and antibodies

Autoimmune hemolytic anemia (AIHA), also known as “immunohemolytic anemia,” occurs when antibodies cause the red bloods cells to rupture. A direct antiglobulin test (DAT), which is also known as a Coombs’ test, can be ordered by a clinician to determine if these antibodies are the true reason for the anemia.

A direct Coombs’ test requires a blood draw from a vein. The lab will then isolate the red blood cells and combine the cells with Coombs’ regent. If the antibody is present, the red blood cells will clump together. Additionally, there is a some variability with the antibody activity based on the temperature. There are different types of AIHA that are defined by the temperature at which the antibodies are active.

Note: There is also an indirect Coombs’ test. This is only conducted to test the blood of pregnant women prior to a blood transfusion.

Coombs’ tests and lupus (SLE)

A study published in Clinical Rheumatology in July 2017 explored the link between positive Coombs’ tests, lupus, and anemia.

12.8% of people with lupus had a positive Coombs’ test finding. And, of those people, 54.3% of them had hemolytic anemia. In total, that would mean that roughly 6.5% of people with lupus had this anemia.

This number is slightly lower than the number referenced above. Still, it is important to be aware of this relatively rare, but serious, health risk.

The Coombs’ test and determination of the type of AIHA that a person is experiencing changes the treatment plan. For warm-type AIHA, corticosteroids and immunosuppressant medications are common. Lupus Warriors may already be taking these medications, but the doses may need to be altered by a doctor.

Remember to take medications as they are prescribed by a doctor. If you believe that you may be experiencing symptoms related to AIHA, speak with your lupus treatment team.