Understanding The Connection Between Lupus And Anemia

Can lupus cause anemia? The truth is that anemia can manifest as a symptom of several underlying conditions. Often, anemia is scientifically linked to various clinical conditions, such as chronic kidney disease (CKD), cancer, and ulcerative colitis.¹

However, reliable evidence suggesting a connection between lupus and anemia has also come to light recently. In this post, you'll discover all there is to know about lupus and anemia, including how one can lead to the other.²

Can lupus cause anemia?

People with a specific type of lupus have a higher chance of getting anemia due to the condition. However, to better understand the connection between anemia and lupus, you must first know what lupus is.³

What is lupus?

Lupus belongs to a group of diseases referred to as autoimmune conditions. An autoimmune disease is caused by the immune system repeatedly destroying and inflaming cells throughout the body.

With lupus, the body continuously experiences localized (in one area) or systemic (throughout the body) inflammation. It all depends on the type of lupus you have, including:

• Systemic lupus erythematosus (SLE): This is the most common lupus type. With SLE, inflammation occurs across various organ systems in the body. These may include the skin, kidneys, lungs, heart, and nervous system.

• Cutaneous lupus erythematosus: Inflammation in this type of lupus is generally localized to the skin.

• Drug-induced lupus: Long-term use of specific prescribed medications, such as arrhythmia drugs, can lead to drug-induced lupus erythematosus (DILE). Arrhythmia drugs are prescribed for irregular heartbeats. Examples include procainamide and quinidine.

• Neonatal lupus: This type of lupus only affects infants. It is transmitted from pregnant mothers with lupus antibodies to the fetus during pregnancy.

How are anemia and lupus related?

While there is a relationship between lupus and anemia, it is witnessed more in people with a specific type of lupus. People with SLE have a greater chance of getting anemia than those with other types of lupus. In fact, the study revealed that almost half of those with SLE are likely to develop one of four types of anemia due to the condition.⁴

Lupus, iron deficiency, and low hemoglobin: what is the connection?

Several types of anemia are common in people with SLE and are associated with the disease. These include:

Anemia of chronic disease (ACD)

ACD is the most common hematological abnormality in people with SLE. It occurs as a result of the hypoproliferative process. In this process, certain antibodies cause resistance to erythropoietin and limit erythropoietin production in the body.⁵

Erythropoietin is a major chemical substance produced in the kidney that stimulates red blood cell production in the body. Therefore, red blood cell production reduces when the erythropoietin count is low, causing anemia.

Iron deficiency anemia (IDA)

Lupus and iron deficiency are two abnormalities that frequently occur in people with SLE. Many people with SLE develop iron deficiency from taking anti-inflammatory drugs, anticoagulants, and aspirin over time.

These medications cause excess intestinal bleeding and menorrhagia or heavy bleeding during menstruation. Loss of such huge amounts of blood deprives the body of iron faster than it can be replenished. Since iron is essential for producing hemoglobin, lack of it causes iron deficiency anemia.

Autoimmune hemolytic anemia (AHA)

AHA is a rare blood disorder where antibodies fight the red blood cells, causing them to burst. Although AHA isn't common, this hematological disturbance can also manifest in people with SLE. That's because most people with SLE suffer from lupus nephritis.⁶

With lupus nephritis, lupus antibodies damage kidney function and erythropoietin production. As a result, the production of red blood cells lowers.

Symptoms of lupus and anemia

The general symptoms of lupus and anemia include:

• Joint pain

• Iron deficiency

• Fatigue

• Fever

• Irregular heartbeat

• Skin lesions

• Shortness of breath

• Headaches

• Memory loss

• Internal organ issues

Lupus photosensitivity

On top of the general lupus symptoms, people with lupus may also develop sensitivity to sunlight or some artificial lights. Too much direct exposure to ultraviolet rays from light sources can trigger additional symptoms, including:

• Rashes 

• Skin sensitivity

• Internal swelling

What are the causes of anemia and lupus?

While doctors and scientists don't know the exact cause of anemia in people with lupus, they attribute it to several factors. These include:

• Environment, including exposure to toxins, stress, and smoking habit

• Hormones, or increased estrogen levels⁷

• Genetics

• Infections, such as cytomegalovirus and Epstein-Barr⁸

Risk factors for people with anemia and lupus

You can have lupus and anemia symptoms without experiencing any of these causes. Certain risk factors can also increase your chances of getting the condition. These include:⁹

• Gender, wherein women are likelier to develop lupus than men

• Age, affecting people aged 15 to 40 years

• Ethnicity, affecting those in minority groups, such as Black people and other people of color¹⁰

How can anemia and lupus be diagnosed?

A doctor may perform a series of blood tests to diagnose lupus and anemia in the body. These include:

• Complete blood count (CBC): This test involves counting the total number of cells in the body. It helps determine any increase or decrease in red blood cell count.

• Erythrocyte sedimentation rate (ESR): ESR is a test that involves sinking red blood cells into the bottom of a test tube. The rate of RBC settlement in the tube helps determine the level of inflammation in the body.

• C-reactive protein test (CRP): This involves looking at CRP levels in the body to help determine the inflammation rate. CRP is produced by the liver when levels of inflammation are high.

• Antinuclear antibody test: This blood test looks at the body's antibody production rate. Doing so helps determine the presence of an autoimmune condition such as lupus in the body.

Treatment for anemia in people with lupus

There is no permanent cure for anemia in people with lupus. However, your doctor may recommend several medications plus lifestyle changes to help manage and prevent its effects. These include:

Medications

Some of the medications your doctor may recommend to help manage lupus symptoms include:

• Non-steroidal anti-inflammatory drugs (NSAIDs) to help reduce swelling and pain throughout the body

• Anti-malarial medication to help reduce lupus symptoms such as rashes and joint pain, especially in pregnant mothers

• Corticosteroids to help reduce swelling and pain throughout the body, which can include creams, injections, and tablets

• Biologics, which contains antibodies to block the protein responsible for immune system response

Keep in mind that your doctor may increase or reduce treatments, including adjusting your dosages based on your progress. 

Lifestyle changes

Your doctor may also recommend several lifestyle changes to help prevent an outburst of lupus symptoms. These include:

• Avoiding too much exposure to ultraviolet light

• Getting regular exercise

• Avoiding smoking

• Taking specific supplements such as vitamins, calcium, and fish supplements to help reduce symptoms

The lowdown

Lupus and anemia have a scientific connection. The impact of SLE on the body can bring forth anemic symptoms. Lupus and low hemoglobin and lupus and iron deficiency are some of the causes of lupus and anemia. Talk to a doctor for immediate medical treatment if you experience any lupus symptoms, especially SLE.

Frequently asked questions

Is lupus contagious?

No. Lupus is not a contagious disease. Still, people with a family history of lupus are likely to develop the condition at some point in their lives.

Who is more likely to get lupus between men and women?

Lupus is more common in women aged 15 to 44 than in men in the same age bracket.

Is lupus and anemia in children different from adults?

No. Lupus symptoms in children are typically similar to those in adults, including fatigue, joint pain, fever, weight loss, and rash.