Hematologic Treatments with Lupus

Reviewed by: HU Medical Review Board | Last reviewed: June 2023

Lupus affects the blood in several ways. People with lupus can become anemic, develop blood clots, too many or too few white blood cells, or a condition called antiphospholipid syndrome. Blood disorders are found so frequently in lupus that these are used to diagnose the disease.1

One study from Saudi Arabia found that nearly 83 percent of people with lupus had a blood (hematological) disorder. The most common conditions found were anemia, leukopenia, thrombocytopenia and antiphospholipid syndrome (APS). Another small study found that of 126 patients, 47 percent had neutropenia, 27 percent had thrombocytopenia, 20 percent had lymphopenia, and 13 percent had hemolytic anemia.1

Here are some of the treatments for the most common blood disorders caused by lupus.

Treatments for anemia

Anemia, the medical term for having too few red blood cells, is a common symptom of lupus. It may be caused by the inflammation of lupus, by consuming too little iron, by the malfunctioning bone marrow, kidney disease (lupus nephritis), bleeding, or the drugs taken to control lupus.

The treatment you receive for anemia will depend on the cause. Steroids may be prescribed for inflammation-induced anemia. Iron pills may be prescribed for iron deficiency. In people with kidney disease, erythropoietin (a hormone that regulates red cell production) or darbepoetin (a synthetic form of erythropoietin) may help the bone marrow make more red blood cells. Steroids or splenectomy may help those people whose red blood cells break down too fast due to antibodies.2

For cases of severe autoimmune hemolytic anemia, blood transfusions may be used, but this is rare.3

Treatments for low platelet count

Thrombocytopenia (also called cytopenia) is the medical term for low blood platelet count. Immunosuppressants may help with milder forms of thrombocytopenia.

For serious thrombocytopenia, you may need a high-dose of steroids given in what are called pulses, or short-term blasts. These pulses last for a few days and are given intravenously (IV). IV immunoglobulin, azathioprine, cyclophosphamide, or rituximab may be prescribed, or splenectomy may be recommended.4-6

Treatments for blood clots

Thrombosis is the medical term for the blood clotting too much or too easily. Many options exist to help prevent blood clots. Anticoagulants, such as heparin and warfarin, may be prescribed and the NSAIDs taken for joint pain and headaches may also help prevent blood clots.7

Treatments for antiphospholipid syndrome

Antiphospholipid syndrome, or antiphospholipid antibody syndrome, (APS) occurs when the body attacks normal proteins in the blood. APS causes blood clots, so your doctor may prescribe anticoagulants (blood thinners), aspirin, and antimalarials. If female, you may need to stop taking oral contraceptives (the pill) or hormone replacement therapy.8

Treatments for low white blood count

Leukopenia is the medical term for low levels of leukocytes or white blood cells. Neutropenia is the medical term for low levels of neutrophils, a type of white blood cell.

Lymphopenia is the medical term for low levels of lymphocytes, another type of white blood cell.

All of these conditions may be caused by the very drugs that are used to control lupus, such as azathioprine and cyclophosphamide. If your white cell counts get too low, your doctor may reduce the amount of these drugs you take. You may also need antibiotics to fight an infection if your white blood cell count is low due to infection.9

Because having a low white blood cell count makes you more vulnerable to infections, you will be encouraged to follow infection control techniques such as avoiding people with colds or the flu and washing your hands frequently.

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