Abnormal blood conditions are
common in patients with SLE.
Problems include anemia, leukopenia,
thrombocytopenia, and other clotting
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
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
Abnormal laboratory tests may
include a false-positive VDRL test
for syphilis. Fluorescent treponemal
antibody absorption (FTA-ABS) and
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.
2. alteration in joint function
Objective: Minimize pain from joint and
1. inability to complete activities
of daily living because of fatigue
3. potential for hemorrhage
4. potential to develop venous or
5. increased risk of infection
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
4. Instruct the patient to take
iron preparation medications as
- decreased hemoglobin and
- positive Coombs' test
- sensitivity to cold
- chronic fatigue, lethargy, and
- dyspnea on exertion
- increased risk of infection
- usually not associated with
- excessive bruising of skin
- bleeding from gums, nose
- blood in stool
Objective: Minimize episodes of
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
4. Teach the patient measures to
prevent bleeding, such as use of
a soft toothbrush or an electric
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