Hematologic (Blood) Lupus Complications

Abnormal blood conditions are common in patients with lupus. Problems include anemia, leukopenia, thrombocytopenia, and other clotting disorders.

Potential Problems:

• inability to complete activities of daily living because of fatigue and weakness
• anemia
• potential for hemorrhage
• potential to develop venous or arterial thromboses
• increased risk of infection

Anemia, which is common in SLE patients, reflects insufficient bone marrow activity, shortened red blood cell (RBC) life span, or poor iron uptake. Aspirin, NSAIDs, and prednisone can cause stomach bleeding and exacerbate the condition. Iron deficiency is treated by iron supplementation. Immune-mediated anemia (or hemolytic anemia), which is due to antibodies directed at RBCs, is treated with corticosteroids.
Leukopenia, which is also relatively common in SLE patients, may be more severe with flares of the disease or with the use of immunosuppressive drugs. In severe cases, low WBC counts can increase the risk of infections.

Thrombocytopenia may occur and – if it is mild – may respond to low-dose corticosteroids. Mild forms may not need to be treated, but a severe form requires high-dose corticosteroid or cytotoxic drugs. The major clinical features of antiphospholipid antibodies (APLs) and antiphospholipid syndrome are venous thrombosis, arterial thrombosis, pregnancy loss or thrombocytopenia with a history of positive anticardiolipin antibody, anti-ß2 glycoprotein I, or lupus anticoagulant tests.

Abnormal laboratory tests may include a false-positive VDRL test for syphilis. Fluorescent treponemal antibody absorption (FTA-ABS) and microhemagglutination-Treponema pallidum (MHA-TP) tests, which are more specific tests for syphilis, are almost always negative if the patient does not have syphilis. An elevated erythrocyte sedimentation rate (ESR) is a common finding in SLE, but it does not mirror disease activity.

Summary of Potential Hematologic Lupus Complications

• Anemia – decreased hemoglobin and hematocrit values; positive Coombs’ test (hemolytic anemia); dizziness; sensitivity to cold; chronic fatigue, lethargy, and malaise; pallor; weakness; dyspnea on exertion; headache
• Leukopenia – increased risk of infection n usually not associated with symptoms
• Thrombocytopenia – petechiae; excessive bruising of skin; bleeding from gums, nose; blood in stool