Associate Professor, Doctor Hoang Thi Lam, Head of the Clinical Immunology Department at Tam Anh General Clinic District 7, reported that blood, urine, and antinuclear antibody tests revealed the patient had an acute lupus flare-up, causing hematologic damage (to the blood-forming system) with leukopenia and autoimmune hemolytic anemia. Thuy's hemoglobin level was approximately 6 g/dL (normal 12-16 g/dL), with significantly reduced red blood cell count and hematocrit, while her platelet count remained within normal limits.

Systemic lupus erythematosus is a chronic autoimmune disease where the immune system attacks the body's own tissues and organs. This can lead to damage in the skin, joints, heart, lungs, kidneys, nervous system, and blood-forming system. Patients may experience anemia, leukopenia, or thrombocytopenia. Some patients may also develop autoimmune hemolytic anemia, where the immune system generates abnormal antibodies that attack red blood cells, causing them to be destroyed prematurely.

In Thuy's case, lupus also caused glomerulonephritis and myocarditis, making her anemia more dangerous. When hemoglobin levels dropped significantly, her heart had to increase its rate and output to meet the body's oxygen demands. However, her inflamed heart muscle limited its ability to compensate effectively.

During the first week of treatment, doctors focused on managing the autoimmune hemolytic anemia, leukopenia, and controlling the active lupus flare-up to prevent multi-organ damage. Blood counts were closely monitored to assess disease progression and treatment response.

Thuy received blood transfusions and blood products to compensate for the blood deficit, improve oxygen transport, and reduce the strain on her heart and kidneys. Concurrently, doctors investigated the underlying cause of her chronic anemia, rather than merely elevating her hemoglobin levels temporarily.

The patient was prescribed medication to control acute inflammation and immunosuppressants to limit organ damage. Doctors monitored urine protein levels, kidney filtration function, and cardiac function indicators to assess treatment response and manage lupus-induced myocarditis.

Associate Professor Lam analyzes Thuy's blood test results. *Photo: Tam Anh General Hospital*

After one week of intensive treatment, Thuy's indicators stabilized, and her hemolytic anemia and multi-organ damage improved, allowing her to be discharged for outpatient care. However, in the following months, her anemia remained challenging to control, particularly during menstruation or periods of stress, causing her hematologic parameters to fluctuate. Doctors continued to monitor her blood count, lupus activity, and adjusted her treatment regimen based on her response.

After more than one year of adhering to the treatment protocol, Thuy's hematologic parameters finally returned to normal and stabilized. Her health significantly improved; she no longer experienced fatigue or anxiety. Currently, she has follow-up appointments every 3 months to check her blood count, heart and kidney function, and lupus activity.

According to Associate Professor Lam, the initial manifestations of lupus are often non-specific, typically presenting as persistent fatigue, fever, joint pain, and muscle pain. These symptoms can easily be mistaken for common illnesses. When the disease is highly active, multiple organs can be damaged simultaneously. Therefore, patients require a comprehensive evaluation rather than treatment of individual symptoms in isolation.

Individuals experiencing chronic or recurrent anemia, accompanied by fever, joint pain, fatigue, anxiety, or signs of organ damage, should seek examination at a hospital with a Clinical Immunology specialty to identify the underlying cause, rather than merely supplementing iron or treating symptoms. Early diagnosis and consistent treatment help limit damage to the blood-forming system and other vital organs.

Minh Huong

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