Anemia with Lupus

Reviewed by: HU Medical Review Board | Last reviewed: March 2020

Anemia is a blood disorder that is caused by a shortage of healthy red blood cells needed by the body to carry oxygen to the body’s tissues.1,2 Anemia associated with lupus is very common – roughly half of all people living with lupus experience anemia.2

Anemia symptoms

Anemia symptoms vary depending on the cause, as does the severity of the condition. People with anemia may even have no symptoms at all. Symptoms that can occur include:1

  • Fatigue
  • Weakness
  • Pale or yellow skin
  • Irregular heartbeats
  • Shortness of breath
  • Dizziness and/or lightheadedness
  • Chest pain
  • Cold hands and feet
  • Headache

Anemia causes

Lupus is an autoimmune disease. For people living with lupus who develop anemia, it was initially thought that lupus attacks the body’s blood system, creating antibodies that damage the red blood cells. While this is still considered one main cause of lupus anemia, it is now understood that anemia in a person with lupus can be because of the autoimmune nature of the disease, or not related to the immune system at all.3

Lupus anemia can be caused by lupus itself, by other diseases that might also be present, or by the medication being prescribed to treat lupus.4 The most common factor that can lead to anemia is reduced red blood cell production, and this can be caused by a variety of things, such as:2,3

  • Not enough erythropoietin, a hormone made by the kidneys which trigger the production of red blood cells, caused by the autoimmune response triggered by lupus
  • Blood loss
  • Inflammation or swelling in the body
  • Infection
  • Iron or other nutritional deficiencies (ie, folate, B12)
  • Loss of bone marrow caused by certain medications used to treat lupus

Anemia treatments

Treating lupus anemia depends on the cause. If the anemia is due to inflammation, anti-inflammatory medications, such as prednisone, can be prescribed. In cases of iron deficiency, oral iron supplements are usually effective at treating anemia. For people who experience anemia due to blood loss, it would be necessary to treat the source of the problem in order to relieve the anemia. For anemia due to kidney problems and reduced production of erythropoietin, natural or synthetic erythropoietin hormone can be supplemented to stimulate the production of red blood cells. In cases where the autoimmune nature of lupus is producing antibodies that attack the red blood cells, prednisone can be prescribed. However, in cases where prednisone does not work, splenectomy — an abdominal surgery to remove the spleen — may be needed.5

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