What’s the Connection Between Lupus and Anemia?

Anemia is when there are not enough red blood cells in your blood. Without these cells, your body doesn’t get enough oxygen-rich blood. The low levels of oxygen may cause you to feel tired, dizzy, or weak.

Anemia can have different causes. In people with lupus, the most common type of anemia is anemia of chronic disease, also called anemia of inflammation.

About 50% of people with active lupus have anemia. Most people with lupus experience periods of symptom flares followed by periods of remission. Lupus is considered active whenever symptoms flare up.

Anemia of chronic disease is when inflammation stops the body from using its iron stores to make healthy red blood cells. If you have this kind of anemia, you may have normal levels of iron in your body but lower amounts in your blood.

Anemia of chronic disease is often found in people who have chronic conditions associated with inflammation, like lupus.

But people with lupus can also have other forms of anemia.

Iron-deficiency anemia, the most common type of anemia overall, is when your body doesn’t have enough iron stores to make enough healthy red blood cells. People with iron-deficiency anemia have low iron levels in the blood and the body’s tissues.

Iron-deficiency anemia can happen at any time, even when you’re not experiencing a lupus flare.

The symptoms of anemia can be the same as other lupus symptoms. It can be hard to tell the difference between anemia and your regular lupus symptoms.

Symptoms of anemia may include:

• feeling weak
• fatigue
• chills
• shortness of breath
• dizziness
• fainting
• headache
• pale skin
• bleeding
• jaundice

In order to diagnose anemia, a doctor will need to order some blood tests. These tests can also help determine which kind of anemia you have.

The first step toward identifying anemia is usually a complete blood count (CBC). Primary care doctors often order this test as part of routine care. A CBC measures most components of your blood, including:

• red blood cells
• white blood cells
• hemoglobin
• hematocrit
• platelets

Your red blood cell count measures the number and average size of red blood cells in your body.

Hemoglobin is a protein that carries oxygen to your cells. Low levels of hemoglobin are often a sign of anemia.

Hematocrit measures the percentage of red blood cells in your body. Low levels of hematocrit mean your body doesn’t have enough red blood cells to carry oxygen around your body. This is also a sign of anemia.

The doctor treating your lupus may order a CBC as part of your regular care. They may also order other tests that look for signs of anemia.

Other tests can measure your body’s iron levels. Doctors can look for:

• iron in your blood
• transferrin, a protein that carries iron
• ferritin, a protein that stores iron

Diagnosing lupus

Lupus is a difficult condition to diagnose. People often live with symptoms of the condition for some time before receiving a diagnosis. If you haven’t received a lupus diagnosis, a doctor can perform a physical exam, listen to your symptom history, and run a series of tests that will help them make a diagnosis.

Your doctor may start with an antinuclear antibodies test. If this comes out positive, they may refer you to a rheumatologist, which is a doctor who specializes in lupus. They may also order additional tests, such as:

• anti-double-strand DNA (anti-dsDNA)
• anti-Smith (anti-Sm)
• antiphospholipid antibodies

They may also run a test of your blood cell counts, including tests for anemia. These all contribute to the lupus diagnosis.

Your anemia treatment may depend on your overall health and other lupus symptoms. Treatment options depend on what kind of anemia you have.

Anemia of chronic disease

Treating anemia of chronic disease often involves targeting the underlying condition, in this case, lupus. Your doctor may recommend following your lupus management plan to reduce inflammation and help resolve the anemia.

Lupus treatment often involves medications like:

• nonsteroidal anti-inflammatory drugs (NSAIDs)
• antimalarials
• corticosteroids
• drugs that suppress the immune system
• biologics

If you have severe anemia, your doctor may recommend a blood transfusion. This increases the amount of hemoglobin and oxygen in the blood.

Iron-deficiency anemia

Treating iron-deficiency anemia often involves iron supplementation to increase the levels of iron in your body. In severe cases, a doctor may also recommend a blood transfusion.

There’s no way to prevent anemia of chronic disease, but reducing inflammation may lower your risk of developing it. Following a lupus treatment plan that focuses on reducing immune system activity can reduce inflammation and help prevent lupus flares.

To prevent iron-deficiency anemia, consider adding more iron-rich foods to your diet. You may want to ask your doctor if taking iron supplements is safe and effective for you while you follow a lupus treatment plan.

Eating healthy is one way to treat and prevent iron-deficiency anemia, especially eating foods rich in iron and foods with high amounts of vitamin B12.

Iron-rich foods include:

• fish
• poultry
• red meat
• eggs
• nuts
• legumes
• leafy green vegetables
• iron-fortified cereals

Iron from non-meat sources, such as chard or kale, is absorbed better by the body when eaten with a food or beverage containing vitamin C. Examples of vitamin C-containing foods include citrus fruits, broccoli, and bell peppers.

Foods high in vitamin B12 include:

• meat
• poultry
• fish
• eggs
• B12-fortified foods

About 50% of people with lupus will experience anemia. The most common form of anemia in people with lupus is anemia of chronic disease, a condition where inflammation stops the body from using iron stores.

People with lupus also get other forms of anemia, such as iron-deficiency anemia. Treatment depends on the underlying cause and your other lupus treatments.