NMO Treatment and Anemia

Neuromyelitis optica (NMO) does not have a cure. But there are treatments aimed at preventing attacks or reducing relapses. Unfortunately, sometimes these medicines can have harmful side effects. One serious side effect linked to some NMO drugs is anemia.1,2

What is anemia?

Anemia happens when our bodies do not have enough healthy red blood cells. Red blood cells are important because they carry oxygen throughout the body. There are many different types of anemia. Some people may have it from not eating enough iron. But sometimes, it can be related to drugs.3

Autoimmune hemolytic anemia

Autoimmune hemolytic anemia is a rare but serious immune disorder. It happens when your immune system starts to attack your own red blood cells by mistake. This leads to a low number of red blood cells and anemia. It is very serious and can cause death in some cases.4,5

Symptoms of anemia

Not everyone with anemia will have symptoms, especially if it is mild. But symptoms may get worse over time. Symptoms of anemia include:3

  • Feeling tired, weak, dizzy, or lightheaded
  • Pale or yellow skin
  • Shortness of breath
  • Irregular heartbeat
  • Chest pain
  • Headaches
  • Cold hands or feet
  • What's listed above can also be symptoms of autoimmune hemolytic anemia. Other symptoms of autoimmune hemolytic anemia include:4,5

  • Fever
  • Muscle pain
  • Dark pee
  • Difficulty breathing
  • Nausea and vomiting
  • Diarrhea
  • Drugs for NMO that may cause anemia

    NMO is often treated with a type of drug called monoclonal antibodies. Some monoclonal antibodies are linked to anemia or autoimmune hemolytic anemia. We do not fully understand this link. But it is possible some drugs can increase your risk for anemia. These drugs include:1,2

    1. Soliris®(eculizumab)Anemia is a side effect of Soliris.
    2. Rituxan® (rituximab) – Rituxan may cause autoimmune hemolytic anemia.
    3. Campath® and Lemtrada® (alemtuzumab) – Campath and Lemtrada may cause autoimmune hemolytic anemia.

    When should you talk to your doctor about anemia?

    If you are experiencing symptoms of anemia, contact your doctor. Autoimmune hemolytic anemia can become serious if it is not treated. If your doctor thinks you might have anemia, they will recommend a complete blood count (CBC).1,4,5

    A CBC counts the number of blood cells in a small sample of your blood. For anemia, your doctor will want to know the numbers of red blood cells and hemoglobin in your blood. Your doctor may also test the size and shape of your red blood cells. If you have low counts or the doctor sees other abnormalities, they may diagnose you with anemia.1,4,5

    Treatment for autoimmune hemolytic anemia

    Some cases of autoimmune hemolytic anemia can be mild. But for other people it can be fatal if it is not treated. About 20 to 30 percent of people require medicine, surgery, or a blood transfusion to treat it. If your doctor suspects your anemia is caused by an NMO drug, you may have to stop taking it. You may also have to take a different drug to manage the anemia, such as a steroid.4,5

    Anemia can also be linked to the amount of iron in your blood. Taking iron pills or increasing the iron in your diet may help. However, diet and supplements are not enough to treat autoimmune hemolytic anemia. Contact your doctor if you are concerned about anemia.4,5

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