Red blood cells transport oxygen to cells throughout the body. People with lupus may experience a reduction in red blood cells known as inflammation-related anemia, which can cause a range of symptoms.
The signs of inflammation-related anemia, or “anemia of inflammation,” can show up throughout the entire body as the brain, organs, and other body tissues receive insufficient oxygen. The symptoms of anemia can range from uncomfortable to dangerous and even life-threatening.
Symptoms of Inflammation-Related Anemia
Anemia deprives the body of oxygen, which all of the cells in your body use in the process of turning carbohydrates and fat from fuel into the energy. When there are not enough healthy red blood cells carrying oxygen to your organs and tissues, your body is forced to work with less. This causes the following symptoms:
- Fatigue and lack of energy
- Headaches and dizziness
- Difficulty thinking clearly
- Lower stamina during exercise, more muscle pain, and longer recovery time after exercise
- Shortness of breath
- Pale skin
While treatment of inflammation-related anemia is possible, it is not always prioritized by lupus treatment teams. Clinicians often prioritize the health of organs, which is crucial but can lead to people living with anemia symptoms.
The symptoms of inflammation-related anemia in lupus can mask other symptoms of SLE and can get in the way of lupus treatment and a healthy lifestyle.
Anemia can also be an important sign of dangerous SLE symptoms, such as internal bleeding, or serious inflammation damage of the organs. Of particular note, anemia caused by kidney damage can inhibit the body’s ability to filter the blood properly. This can leave toxic waste products to float around in the blood stream.
In general, people with lupus-related anemia were found to be more sensitive to light and to have more kidney problems. Organs besides the kidneys can also be involved and may provide clues for the optimal lupus treatment methods.
Lupus and Anemia
A study published in the European Journal of Rheumatology found that of the people they tested, over 50% of people with systemic lupus experienced anemia as a symptom. Systemic lupus damages organs throughout the body, including the organs responsible for blood production. These organs can include the:
- Bone marrow
- Produces red blood cells
- Stores red blood cells
- Filters toxins from the blood
- Filter toxins from the blood
- Produce erythropoietin, a hormone that encourages the production of red blood cells.
- Absorbs iron, a key component of red blood cells
Macrophages and Anemia
In addition to impacting specific organs, lupus alters the effectiveness of the immune system as a whole. One way it does this is by reducing the number of macrophages. Macrophages are white blood cells that “eat” & destroy bacteria and damaged red blood cells. Fewer macrophages can lead to an increase in unhealthy and damaged red blood cells circulating in the body.
On the other hand, during symptom flare-ups, the immune systems of people with SLE can become turbocharged and end up attacking healthy red blood cells. If they attack too many red blood cells, then there is not enough for the body to use, leading to anemia.
Lupus, Anemia, and You
Fortunately, anemia – regardless of cause – is very treatable on its own through:
If the cause is unknown or isn’t treatable, then synthetic erythropoietin, the hormone that causes the bone marrow to produce more red blood cells, may help. Injected directly into the body, medications that use synthetic erythropoietin (such as EPO and Abseamed) help spur the body into producing more red blood cells on its own. These medications reduce the anemia symptoms and may help with other lupus symptoms.
These medications do have some potential side effects, however, such as high blood pressure, swelling, fever, dizziness, nausea, and soreness. Synthetic erythropoietin also does not address the underlying issues, such as organ damage, and might cover up the problems. As with all medications, talk to your lupus treatment team about synthetic erythropoietin to see if it is the right choice for you.
If medication is inappropriate, or if the cause of the anemia is the poor absorption of nutrients into the body, then injections of iron, vitamin b12, and folic acid may be helpful. These nutrients are key components to building and maintaining red blood cells in the body, and supplements of iron, vitamin b12, and folic acid increase blood production by ensuring that the body has enough raw materials.
A diet rich in these vitamins and nutrients, along with dietary supplements can also help. Talk to a nutritionist on your lupus treatment team to help figure out meals and vitamins/supplements, that may be beneficial.
For very severe cases of anemia, the best way to take care of it may be not so much producing more of your own blood, but getting an infusion of someone else’s blood. A blood transfusion will give you all of the blood components that you need and will help you build up a healthy level of blood.
Side effects are generally minimal, but for many people with lupus this is only a short-term solution to keep them out of dangerous levels of anemia, give them time to find and treat the underlying cause of their anemia, or until they figure out the right treatment for their anemia.
Some people with lupus, however, may find that blood transfusions are their only, or primary, choice.
Want to know more about lupus and inflammation-related anemia?
Anemia might not be the only thing causing fatigue — find out how you can manage your lupus fatigue in this article.
Kidney damage is a major contributor to lupus-related anemia, and there is a type of lupus, lupus nephritis, that specifically attacks the kidneys. Learn more about it here.
Other types of anemia that can come with lupus: Hemolytic anemia is a lupus symptom that involves less-resilient or more easily damaged red blood cells. Read more about it in our article here!
Methotrexate, an immune-system suppressant and cancer chemotherapy drug used to treat leukemia and some types of arthritis, may lead to or exacerbate organ damage and anemia. Read more about it here.