Overview

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

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 lowdose 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-.2 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.

Potential Problems

1. pain

2. alteration in joint function

Nursing Interventions

Objective: Minimize pain from joint and muscle complications.

1. inability to complete activities of daily living because of fatigue and weakness

2. anemia

3. potential for hemorrhage

4. potential to develop venous or arterial thromboses

5. increased risk of infection

Nursing Interventions

Objective: Minimize fatigue.

Refer to the nursing interventions for fatigue on pages 29-30.

Objective: Recognize anemia and develop a plan of care.

1. Monitor the patient for signs and symptoms of anemia and for altered laboratory values.

2. Develop a plan with the patient to conserve energy.

3. Teach the patient the basics of good nutrition.

4. Instruct the patient to take iron preparation medications as prescribed.

Potential Hematologic Manifestations 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 usually not associated with symptoms Thrombocytopenia petechiae excessive bruising of skin bleeding from gums, nose blood in stool

Objective: Minimize episodes of bleeding.

1. Assess the patient for signs and symptoms of bleeding, such as petechiae, bruises, GI bleeding, blood in urine, ecchymoses, nose bleeds, bleeding from the gums, heavy menses, and bleeding between menstrual periods.

2. Teach the patient why she or he is at risk of bleeding (low platelet count, anemia, thrombocytopenia) and to report episodes to physician.

3. Encourage the patient to wear a medical alert bracelet or carry a card.

4. Teach the patient measures to prevent bleeding, such as use of a soft toothbrush or an electric shaver.

Objective: Decrease risk of infection.

See the nursing interventions for infection.

Note: For more information, see Laboratory Tests Used to Diagnose and Evaluate SLE and the Patient Information Sheet on Preventing Fatigue Due to Lupus.



Source: National Institutes of Health, U.S.Dept of Health and Human Services