In one sense, all autoimmune disease might be considered a “blood disorder”, in the sense that the problem common to all of them is a misdirected attack on various targets, by their own white blood cells, which are the body’s immune cells.
Within this very broad category of autoimmune disease, there is a subset of conditions in which such attacks by white blood cells are focused on various individual blood cell types, including other white blood cells, red blood cells (which carry oxygen) and platelets (which aid in clotting). As a result, there are several disorders that are autoimmune in nature but specifically directed at different blood cells (as opposed to organs, vessels, joints, etc.). Here we discuss a bit about this sub-category of autoimmune disease, where blood cells themselves are both the cause as well as the victim.
What are the main autoimmune blood disorders and what distinguishes them from one another?
There are two different types of autoimmune blood disorders: those that involve a direct assault against the actual blood cells (which are technically the only true “blood disorders”), and those where another autoimmune disease results in changes affecting blood and its components.
As far as the former are concerned, in general terms, they often result in one or more of the following:
- lowered white blood cells (neutropenia)
- lowered red blood cells (anemia) and/or
- lowered platelets (thrombocytopenia)
In ITP, antibodies directed against platelets lead to their entrapment in the spleen, which removes them from the body, resulting in decreased platelets.
In AHA, antibodies attack red blood cells, causing them to split open and become dysfunctional, whereupon they are also removed from the body.
The effects of lowered platelets and red blood cells, respectively, can include trouble clotting and poor oxygenation of tissues. Another condition known as autoimmune lymphoproliferative syndrome (ALPS) actually causes a rise in white blood cells, which can sometimes predispose to certain blood-based cancers.
In the second group are diseases such as lupus and antiphospholipid syndrome (APLS), among others. Patients with APLS (also known as Hughes syndrome) tend to experience increased clotting, which can lead to a greater risk for stroke and heart attack; those with lupus may have any combination of anemia, neutropenia and/or thrombocytopenia. Several other autoimmune diseases can also lead to bloodstream abnormalities that may or may not require intervention.
What makes autoimmune blood disorders less common than other types of autoimmune conditions that affect millions of women?
There are two answers to this question. First, the short answer, as with so many autoimmune conditions, is that we simply just don’t know. Based solely on informed speculation, we might guess it’s because of the relatively few autoimmune targets in the blood, as compared to the rest of the body. But this is far from known or accepted.
The other response is that this is not necessarily always the case. Though it’s probably true most of the time, certain autoimmune blood disorders may occur almost as much, if not as often, as other autoimmune conditions. This is especially true of those that tend to appear along with other systemic autoimmune diseases, such as those conditions listed in the second category above.
Are autoimmune blood disorders typically seen in women with other autoimmune conditions, or do they usually develop on their own?
This depends somewhat on the exact problem under consideration, but in general, the nature of autoimmune disease is such that the presence of one will frequently lead to the discovery of others at some point. But there is debate within the scientific community regarding whether such diagnoses are distinctly separate diseases, or merely varied manifestations of the same disease process.
However, both ITP and AHA, the two “real” blood disorders, may occur completely on their own, without other evidence of autoimmune pathology. Fortunately, research has yielded a few moderately successful treatments for these and similar conditions.
Questions for your doctor:
- What is the exact cause/mechanism (if known) of my disease(s)?
- Are there any new treatments/medications for my condition?
- What precautions should I take given my specific disorder, in terms of daily activities, exercise, etc.?
- Do you know of any research or experimental medication studies taking place? Am I a candidate for the latter if my current therapy isn’t fully effective?
- What can I expect in the months and years to come, in terms of medical complications or lifestyle changes?
Do you or a family member have ITP, AHA or ALPS? Did you onset these conditions alongside other autoimmune diseases? What treatments have worked for you overall and specifically for these conditions?
About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians. After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time. He may be reached at [email protected].