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MEH > 11. Haematology In Systemic Disease > Flashcards

11. Haematology In Systemic Disease Flashcards

1
Q

What are changes to the blood in systemic disease often caused by?

A

Underlying physiological or external cause - e.g. over expression of cytokines
Complications of the disease - e.g. ulcerative colitis
Treatment adverse effects - e.g. methotrexate

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2
Q

In anaemia of chronic disease what are the 3 main contributors caused by inflammatory cytokines?

A

Iron dysregulation: available iron not released for use in bone marrow
Marrow shows lack of response to erythropoietin
Reduced lifespan of red cells

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3
Q

What is anaemia of chronic disease?

A

Functional iron deficiency

Sufficient iron in the body but not available to the developing erythroid cells

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4
Q

What is hepcidin regulated by?

A

HFE
Transferring receptor
Inflammatory cytokines

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5
Q

What is the role of hepcidin and how does it work?

A

Prevents iron absorption from gut and prevents iron release form macrophages
Works by degrading ferroportin the protein involved in moving iron out of cells

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6
Q

Describe anaemia of chronic kidney disease

A

Reduced erythropoietin production due to damage to kidneys
Underlying cause often associated with raised cytokines (makes more hepcidin)
Reduced clearance of hepcidin
Reduced lifespan of RBC as direct effect of uraemia

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7
Q

What negative effect can dialysis have?

A

Damage to red blood cells

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8
Q

What can uraemia cause?

A

Reduced lifespan of RBC

Inhibits megakaryocytes leading to low platelet counts

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9
Q

What are the treatments for anaemia of chronic disease?

A

If associated with renal failure, recombinant human erythropoietin
Ensure vit B12 folate and iron stores are adequate
Transfuse red cells, only if all else fails and patient is symptomatic

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10
Q

What are the possible haematological abnormalities in kidney disease related to red cells?

A

Anaemia - CKD, blood loss, dietary causes

Secondary polycythaemia - renal transplant, renal tumour, polycystic kidneys

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11
Q

What are the possible haematological abnormalities in kidney disease relating to neutrophils?

A

Neutropenia - immunosuppression (post renal transplant), autoimmune kidney disease
Neutrophilia - inflammation, infection, drugs (steroids)

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12
Q

What are the possible haematological abnormalities in kidney disease relating to platelets?

A

Thrombocytopenia - uraemia, many drugs, haemolytic uraemia syndrome
High - inflammation, bleeding, iron deficiency

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13
Q

What is rheumatoid arthritis treated with?

A

Pain relief - often NSAIDs

Disease modifying agents - corticosteroids, chemotherapy, biological agents

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14
Q

How is the haematology affected in rheumatoid arthritis?

A

High platelets and neutrophils when disease is active (CRP also up)
Low platelets and neutrophils may occur due to treatment, autoimmune reactions or to hypersplenism
Felty’s syndrome

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15
Q

What is Felty’s syndrome?

A

Rheumatoid arthritis, splenomegaly and neutropenia
Neutropenia thought to be due to splenomegaly contributing to peripheral destruction of eutrophic and failure of bone marrow to produce neutrophils as insensitivity of myeloid cells to GCSF

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16
Q

What can chronic liver disease cause?

A

Portal hypertension which causes splenomegaly which leads to splenic sequestration of cells and overactive removal of cells
Low blood counts

17
Q

What are the haematological features of liver disease?

A

Portal hypertension leads to oesophageal and gastric varies
Blood loss contributed to by deficiencies of coagulation factors, endothelial dysfunction, thrombocytopenia, defective platelet function

18
Q

Why does thrombocytopenia occur n patients with liver disease?

A

Impaired production as thrombopoietin is made in the liver
Splenic pooling
Increased destruction
Platelets made often have reduced function which contributes to bleeding

19
Q

What cells are often seen in liver disease?

A

Target cells, due to increased cholesterol:phospholipid ratio, membrane not as tight

20
Q

What is the effect of alcohol excess?

A

Directly toxic to bone marrow cells - can contribute to pancytopenia
Secondary malnutrition common (esp. folic acid deficiency) - leading to megaloblastic anaemia

21
Q

What is the effect of viral hepatitis?

A

Bone marrow failure can develop after an episode of hepatitis

22
Q

What is he effect of autoimmune liver disease?

A

Immune mediated anaemia
Thrombocytopenia
Neutropenia

23
Q

What post operative reactive changes can cause problem associated with red blood cells?

A

Anaemia - blood loss pre-op (trauma), blood loss during op

Temporary relative polycythaemia - dehydration (rare)

24
Q

What post operative reactive changes can occur relating to neutrophils?

A

Neutropenia - sever sepsis

Neutrophilia - post-op reactive, infection, severe bleeding

25
Q

What post operative reactive changes can occur relating to platelets?

A

Thromocytopenia - drugs, sepsis, DIC

Thrombocytosis - post-op reactive, infection, bleeding

26
Q

How can haematological changes with infection affect red blood cells?

A

Chronic infection can cause anaemia of chronic disease

Infection with malaria can cause haemolytic anaemia

27
Q

How can haematological changes with infection affect white blood cells?

A

Bacterial infection often associated with neutrophilia
Severe bacterial infection/sepsis can cause neutropenia
Parasitic infections associated with eosinophilia
Viral infections can cause lymphocytes is and neutropenia

28
Q

How can haematological changes with infection affect platelets?

A

Infection can cause reactive thrombocytosis
Severe infection can cause thrombocytopenia
Thrombocytopenia may be associated with DIC in severe sepsis

29
Q

What is disseminated intravascular coagulation (DIC)?

A

Pathological activation of coagulation
Numerous microthrombi are formed in circulation
Consumption of clotting factors and platelets and a consequent microangiopathic haemolytic anaemia
Long clotting times, low fibrinogen, raised D-dimers or fibrin degradation
Risk of bleeding and thrombosis

30
Q

What does a blood film show of DIC?

A

Fragmented RBC
Low platelets
Immature RBC

31
Q

What are the haematological changes in cancer relating to red blood cells?

A

Anaemia - bleeding, iron deficiency, ACD, treatments (chemotherapy)
Polycythaemia - EPO producing tumours

32
Q

What are the haematological changes in cancer relating to neutrophils?

A

Neutropenia - chemotherapy, marrow infiltrated by cancer cells
Neutrophilia - inflammation, infection

33
Q

What are the haematological changes in cancer relating to platelets?

A

Thrombocytopenia - chemotherapy, sepsis, DIC, marrow infiltrated
Thrombocytosis - inflammation, infection, bleeding, iron deficiency

34
Q

What is a leucoerythroblastic film?

A

Granulocyte precursors and nucleated RBC seen on blood film

Spilling out form marrow into blood when marrow is under stress

35
Q

When is a leucoerythroblastic film seen?

A 
Sepsis/shock
One marrow infiltration by carcinoma or haematological malignancy
Severe megaloblastic anaemia
Primary myelofibrosis (tear drop RBCs)
Leukaemia
Storage disorders

MEH (22 decks)

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