Wednesday, 12 July 2017

Lupus and Anaemia



Last year, I was diagnosed with severe iron deficiency anaemia. It crept up on me slowly and quietly at first, and I slowly became even more tired than usual, short of breath, light-headed, dizzy and faint. I soon began to suffer with fierce palpitations that were sometimes so severe I thought I was going to die. I looked like a vampire movie damsel in distress: pale, drawn, half-dead and listless. All I did was sleep. Blood tests showed that I had anaemia of chronic disease (see below). I was put on strong iron pills, but as they did not work at first, my haemoglobin levels kept falling and I nearly needed blood transfusions.

I was sent for various tests: endoscopy, colonoscopy and ultrasounds. The tests revealed gastritis, a hiatus hernia and gallstones, but nothing that explained the anaemia. If I wasn't at a medical appointment, I was asleep in bed, too exhausted to lift my head some days. Eventually, the iron pills did start to work and my haemoglobin levels stopped falling, and for a while, I felt better. But recently, the beast started creeping up on me again. So the whole exhausting process of tests, medical appointments and seeing specialists begins again. I'm absolutely thrilled by this...NOT!    




What is Anaemia?


Anaemia is a very common illness, affecting both lupies and non-lupies. It affects half of all patients with active lupus. Dr Michael Rosove, speaking to the LFA says that "anemia means too little haemoglobin. Haemoglobin is the protein inside red cells that carries oxygen from the lungs to all the tissues of the body."
Anemia is a condition in which a person has a lower than normal number of red blood cells or the amount of hemoglobin in the red blood cells drops below normal, which prevents the body’s cells from getting enough oxygen1.

Symptoms of Anaemia


Symptoms include fatigue, palpitations, breathlessness, dizziness, fainting, pale skin, headaches and rarer symptoms such as tinnitus, sore tongue, itching, spoon-shaped nails, pica and ulcers2. Frustratingly, many of those symptoms are the same as those in lupus, so it may take a while before the anaemia is diagnosed.


Causes of Anaemia in Lupus Patients


There are several causes of anaemia in lupus patients:
  • Inflammation
  • Inadequate erythropoietin, a hormone produced by the kidneys, that stimulates the marrow to make more red cells
  • Iron deficiency: Iron is necessary for the production of hemoglobin. Iron (as part of the protein hemoglobin) carries oxygen from the lungs throughout the body. Iron deficiency also may result from menstrual bleeding or from intestinal bleeding due to non-steroidal anti-inflammatory drugs.
  • Loss of bone marrow caused by certain drugs used to treat lupus (such as azathioprine or cyclophosphamide)


How is Anaemia Diagnosed?


A complete blood count (CBC) is used to check for anaemia; plus your doctor may order the following blood tests:

  • Haemoglobin levels 
  • Red blood cell count (RBC) 
  • Reticulocyte count
  • Serum ferritin level
  • Serum iron level


Anaemia of Chronic Disease (ACD)


This is an anaemia that occurs with chronic illnesses, inflammatory disorders, cancer, infections and other illnesses. "Inflammatory and chronic diseases interfere with the body's ability to use stored iron and absorb iron from the diet."2


Anemia of inflammation and chronic disease is caused by red blood cells not functioning normally, so they cannot absorb and use iron efficiently. In addition, the body cannot respond normally to erythropoietin (EPO), a hormone made by the kidneys that stimulates bone marrow to produce red blood cells. Over time, this abnormal functioning causes a lower than normal number of red blood cells in the body. Some of the chronic diseases that lead to ACD include infectious and inflammatory diseases, kidney disease, and cancer. Certain treatments for chronic diseases may also impair red blood cell production and contribute to ACD.3

People with lupus and similar illnesses are often diagnosed with "anemia of chronic disease", if all other causes (e.g. poor nutrition, gastrointestinal bleeding etc) of the anaemia has been ruled out. This type of anemia develops slowly. Doctors treat the illness by dealing with the underlying disorder (e.g. lupus, rheumatoid arthritis, infections etc). If the disorder doesn't respond to treatment, drugs that stimulate the bone marrow to produce red blood cells may be given. If the anaemia becomes severe, blood transfusions may be recommended.4

 


Treatment of Anaemia


Depending on the severity, cause and type of the anaemia, treatments may involve dietary changes, iron supplements, iron injections, B12 supplementation, folic acid, erythropoietin injections and in some cases, blood transfusions. Bupa says that "Your GP or specialist will always treat the underlying cause of your anaemia [such as lupus] before considering a blood transfusion."

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Sources:

1. https://www.niddk.nih.gov/health-information/blood-diseases/anemia-inflammation-chronic-disease
2. https://www.niddk.nih.gov/health-information/blood-diseases/anemia-inflammation-chronic-disease
3.https://www.niddk.nih.gov/health-information/blood-diseases/anemia-inflammation-chronic-disease
4. 
http://www.merckmanuals.com/home/blood-disorders/anemia/anemia-of-chronic-disease


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