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If you’re living with lupus and find yourself feeling more drained than usual, it might be a sign the lupus is affecting your blood. Anemia and other blood disorders are common in people with systemic lupus erythematosus (SLE), the most common form of lupus. These conditions can make you feel dizzy, weak, or short of breath, and they often show up first during routine blood work. Certain changes in blood cells such as low platelets (cells that help blood clot) or leukocytes (white blood cells) are even classification criteria that can help diagnose the disease.
Having low red blood cells (RBCs), white blood cells, or platelets can mean your immune system is attacking parts of your blood. Sometimes, it’s caused by inflammation, medication side effects, or even kidney disease.
In this article, we’ll explore how lupus can affect your blood cells. We’ll also cover what symptoms to watch out for and how these issues are diagnosed and treated.
Anemia happens when you don’t have enough healthy red blood cells. RBCs deliver oxygen from your lungs to other parts of your body. You need oxygen to have energy and stay healthy. When your red blood cell count is low, your body has to work harder. That’s why you might feel tired, weak, or out of breath. Some people also feel dizzy or get headaches.
Other possible symptoms include:
Doctors find anemia by checking your blood. A test called a complete blood count (CBC) shows how many red blood cells you have. It also measures hemoglobin, the part of the cell that carries oxygen. Researchers estimate that as many as 50 percent of people with lupus are affected by anemia at some point.
Yes, lupus can cause anemia. It’s one of the most common blood problems in people with SLE. However, anemia can happen for different reasons, like inflammation, kidney disease,or medications.
There are different types and causes of anemia. Certain types are caused by not having enough iron, while others happen when the immune system attacks red blood cells. Lupus anemia symptoms may vary depending on the specific type. Here, we’ll cover some of the most common types seen in lupus.
Anemia of chronic disease is caused by long-term inflammation from the immune system. This is the most common type of anemia in people with lupus. In lupus, the immune system makes antibodies that attack healthy tissues by mistake. This constant activity creates inflammation, which can prevent your bone marrow from making enough red blood cells. It can also keep your body from using iron correctly — even if you’re not low on iron.
Doctors often see this kind of anemia occur during flares or when the disease is active. It’s sometimes also called “anemia in lupus” or “anemia of inflammation.” This type usually shows up in blood tests like a CBC. Your hemoglobin might be low, but your iron levels may look normal. Treating the lupus itself often helps improve anemia, too.
In some cases, people with lupus develop anemia because their bodies don’t have enough iron. This is called iron-deficiency anemia. Your body needs iron to make red blood cells. Without it, your hemoglobin drops and your blood can’t carry enough oxygen. Iron-deficiency anemia affects about one-third of people with SLE.
People can become low on iron for several reasons. In lupus, chronic inflammation can make it harder for your body to absorb iron from food. Some people also eat less during flares due to nausea or fatigue, which lowers iron intake. Chronic bleeding is another common culprit. Additionally, kidney disease — including lupus nephritis, kidney disease caused by SLE — can also lead to iron loss in the urine.
Common symptoms include fatigue, shortness of breath, and dizziness. Some people also get unusual cravings, like wanting to chew ice, dirt, or paper. Others may notice muscle cramps, a sore tongue, brittle nails, or hair loss. Symptoms may be mild at first but can get worse over time without proper treatment.
Doctors use blood tests like a CBC or iron panel to check for this type of anemia. Iron supplements can help, but treating the root cause — like inflammation or kidney disease — is key in managing lupus and iron deficiency.
Autoimmune hemolytic anemia is a rare but serious type of anemia in people with lupus. It happens when your immune system makes autoantibodies (immune proteins that attack your own cells) that target your red blood cells. This can cause RBCs to break apart too early — a process known as hemolysis. This type of anemia affects approximately 10 percent of people with SLE.
Symptoms of autoimmune hemolytic anemia may come on slowly or appear suddenly within just a few days. The most common symptoms include:
To diagnose autoimmune hemolytic anemia, doctors use tests like the CBC or reticulocyte count, which measures how many young red blood cells you have. A special test called a Coomb’s test can also be used to figure out whether your body is making the autoantibodies responsible for destroying RBCs.
Treatment options for this condition include targeted therapies, corticosteroids, or immunosuppressants. If that doesn’t work, and the hemoglobin level is very low, blood transfusions may be needed to replace the lost blood cells.
Sometimes, lupus treatments can cause anemia as a side effect. For example, certain medicines — like immunosuppressives or chemotherapy drugs — can affect how well your bone marrow makes red blood cells. Certain types of antibiotics or nonsteroidal anti-inflammatory drugs (NSAIDs) can also lead to anemia. When this happens, it’s called drug-induced anemia.
Symptoms can include fatigue, dark urine, pale skin color, or feeling short of breath or weak. Your healthcare team can check your hemoglobin and red blood cell counts using a CBC or other blood test. Treating drug-induced anemia usually involves adjusting your lupus care plan while still controlling the disease.
Lupus doesn’t just affect red blood cells. It can also cause problems with your white blood cells and platelets, which are also made in the bone marrow.
Leukopenia means you have a low white blood cell count. These are the cells that help fight off infections. In lupus, autoantibodies may destroy white blood cells by mistake. Certain lupus medicines can also lower how many white blood cells you have. This condition affects nearly half of people with SLE.
If you have leukopenia, you may get sick more often or have trouble fighting off infections. You might also run a fever without knowing why.
Thrombocytopenia means you don’t have enough platelets, which help your blood clot. If your platelet count drops too low, you may bruise or bleed easily, get nosebleeds, or notice bleeding gums. In more serious cases, you could be at risk for internal bleeding or blood clots. As many as 40 percent of people with SLE are affected by thrombocytopenia.
People with lupus may also be more likely to develop another blood condition called antiphospholipid syndrome. This can lead to an increased risk of thrombosis, or dangerous blood clots in your lungs, brain, or legs.
People with lupus may be able to donate plasma (the liquid part of your blood) or blood, depending on their health, medications, and blood counts. However, if you also have anemia, you probably won’t be able to donate. That’s because donating removes red blood cells, and your body may not have enough to spare. Certain medications also require a waiting period before you can donate. If your disease is well controlled and you feel healthy, you may still qualify.
Wondering how much blood is too much? A regular blood donation is about one pint or 450 milliliters — far more than a few vials drawn for regular blood testing. If you still have questions, talk to your rheumatologist (inflammatory disease specialist) or a member of your healthcare team.
MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, members come together to ask questions, give advice, and share their stories with others who understand life with lupus.
Are you living with lupus and anemia? What treatments have been most helpful for you? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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