11 - Haematology in Systemic Disease Flashcards
What is the mechanism of anaemia of chronic disease?
- Chronic inflammatory conditions, e.g rheumatoid arthritis, TB and malignancy
- Functional loss of iron
- Early stages MCV normal then microcytic
(reduced life span of RBC, bone marrow less effect by EPO, less iron release)
How do you treat anaemia of chronic disease?
Treat the underlying condition, e.g arthritis
What type of anaemia develops in chronic kidney disease?
- Normocytic, normochromic
- Severity of anaemia proportional to severity of kidney disease
Why does chronic kidney disease cause anaemia?
- Deficiency of EPO due to kidney damage so less erythropoiesis
- Reduced clearane of hepcidin and increased hepcidin due to cytokines from inflammation (functional loss of iron)
- Dialysis damage to RBC and bleeding
- Uraemia decreasing lifespan of RBC and platelets so bleeding in GI so more blood loss
How would you treat a patient with anaemia from chronic kidney disease?
- Recombinant EPO
- Ensure sufficient iron, B12 and folate
- Monitor as adverse effects like hypertension, seizures and blood clotting
What is hepcidin regulated by?
How would you investigate anaemia of chronic disease?
How should you treat a patient with functional iron deficiency?
IM injection of iron as absorption is impaired so cannot take orally
What haematological abnormalities may you see in anaemia of chronic kidney disease, e.g neutrophilia, and why?
Why do people with rheumatoid arthritis often have iron deficiency?
- Take NSAID’s and corticosteroids which can cause ulcers and bleeding
What is Felty’s syndrome?
Neutropenia due to splenomegaly and failure of bone marrow to produce neutrophils
SANTA
What haematological abnormalities can arise with anaemia with rheumatoid arthritis?
- Flares: neutrophilia and thrombocytosis
- DMARDS: thrombocytopenia and neutropenia by bone marrow suppression, immune causes or folate inhibition
How can chronic alcohol consumption cause anaemia?
- Toxic effect on bone marrow so pancytopenia
- Secondary malnutrition of folate and B12
- Acetaldehyde from ethanol metabolism adducts on RBC causes immune response of RBC
- Cirrhosis can lead to less cloting factors and thrombopoietin so GI bleeding
- Portal hypertension causing splenomegaly
What will anaemia of alcoholism present as?
- Megaloblastic (folate deficiency)
- Macrocyctic
- Thrombocytopenia
- Pancytopenia
What are some causes of liver disease that can cause anaemia also and how can you distinguish between them?
Why does liver disease cause anaemia and what would a blood film look like with liver disease?
- Can’t produce thrombopoietin
- Deficience of coagulation factors
- Portal hypertension causing splenomegaly and gastric varices which can bleed out
- Target and spur cells
What are some haemotological features of liver disease and why are they caused?
What are the common causes of the following things:
- Neutropenia
- Neutrophilia
- Lymphocytosis
- Eosionophilia
- Thrombocytosis
- Thrombocytopenia
- Severe infection/Sepsis and post viral
- Bacterial infectuon
- Viral infection in children
- Parasitic infection
- Infection
- DIC, severe infection
What are some post operative reactive changes in the blood, e.g thrombocytopenia?
- Thrombocytosis and neutrophila normal after major surgery and should settle
- If doesn’t settle could be infective complication e.g DIC
- Post splenectomy high thrombocytosis and lymphocytosis which may persist with Howell Jolly bodies
What patients are at risk of DVT after surgery and why?
- Immobile patients as there is a thrombocytosis
- Cancer, dehydration and/or pelvic or orthapaedic surgery
Why may patients with cancer have anaemia?
- Anaemia of chronic disease
- Haemolytic anaemia
- Blood loss
- Chemotherapy
- Infiltration of bone marrow
What would a blood film look like from a patient with a metastatic cancer in bone marrow?
- Leucoeryhtroblastic film
- Nucleated RBC and immature WBC in circulation
- Also seen in shock
What are patients undergoing chemotherapy at risk of?
Neutropenic sepsis so may need blood product support
What are the adaptations for anaemia?
- Increase EPO
- Tachycardia
- Increased 2,3 BPG
What are some ways of measuring iron deficiency?
Why can iron deficiency affect epithelial cells?
Iron in catalase and cytochrome c so cannot undergo aerobic respiration as well
