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Care of the Lupus Patient

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Hematologic Manifestations

Overview

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

Anemia, which is common in SLE patients, reflects insufficient bone marrow activity, shortened RBC life span, or poor iron uptake. Aspirin, NSAIDs, and prednisone can cause stomach bleeding and exacerbate the condition. There is no specific therapy for this type of anemia. Immune-mediated anemia (or hemolytic anemia), which is due to antibodies directed at RBCs, is treated with corticosteroids.

Thrombocytopenia may occur and 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 APLs and APL syndrome are venous thrombosis, arterial thrombosis, and thrombocytopenia with a history of positive anticardiolipin antibody (ACL) 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 active SLE, but it does not always mirror disease activity.

Potential Problems

  1. Inability to complete ADL because of fatigue and weakness.
  2. Anemia
  3. Potential for hemorrhage
  4. Potential to develop venous or arterial thromboses
  5. Increased risk of infection

Potential Hematologic Manifestations

Anemia

  • Decreased hemoglobin and hematocrit values
  • Positive Coombs' test (hemolytic anemia)
  • Tachycardia
  • Palpitations
  • Dizziness
  • Sensitivity to cold
  • Chronic fatigue, lethargy, and malaise
  • Pallor
  • Weakness
  • Dyspnea on exertion
  • Headache

Thrombocytopenia

  • Petechiae
  • Excessive bruising of skin
  • Bleeding from gums, nose
  • Blood in stool

Nursing Interventions

Objective: Minimize Fatigue

  1. Refer to the nursing interventions for fatigue in this article.

Objective: Recognize Anemia and Develop Plan of Care

  1. Monitor patient for signs and symptoms of anemia and for altered laboratory values.
  2. Develop a plan with patient to conserve energy.
  3. Teach patient the basics of good nutrition.
  4. Instruct patient to take iron preparation medications as prescribed.

Objective: Minimize Episodes of Bleeding

  1. Assess 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 patient why she or he is at risk of bleeding (low platelet count, anemia, thrombocytopenia) and to report episodes to physician.
  3. Encourage patient to wear a medical alert bracelet or carry a card.
  4. Teach patient measures to prevent bleeding, such as use of a soft toothbrush or an electric shaver.

Objective: Decrease Risk of Infection

  1. See the nursing interventions for infection in this article.
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