11- Haematology In Systemic Disease

Question 1

• briefly outline the life cycle of blood cells
• changes to blood in systemic disease often multifactorial due to what 3 factors?
• give 3 examples of diseases that cause reduced or dysfunctional erythropoiesis.

Answer 1

• BM-> peripheral RBCs -> removal by RES
• due to an underlying physiological cause, complications of a disease, adverse effects from treatment.
• chronic kidney disease (pericytes can’t sense hypoxia so can’t secrete more EPO so RBCs not made), chemotherapy for cancer(BM is under strain so can’t make RBCs), rheumatoid arthritis or any other chronic (anaemia of CD= inflammation causes iron to not be made available to BM for RBC synthesis)

Question 2

• how does chronic inflammation result in disease? Give 3 contributors.
• why is anaemia of chronic disease called a functional iron deficiency?
• give factors resulting in anaemia from chronic kidney disease.
• how do you treat anaemia of chronic disease?

Answer 2

• iron dysregulation (available iron not released to BM), BM lacks response to EPO, reduced lifespan of RBCs.
• sufficient iron in the body but not made available to BM. Inflammatory cytokines increase hepcidin, inhibits ferroportin (the transporter of iron out of macrophage for recycling) so reduced iron absorption and release from RES.
• less EPO secreted bc pericytes damaged, raised cytokines causes hepcidin increase, reduced lifespan of RBCs due to uraemia, dialysis needed bc of damaged RBCs
• to treat AOCD, treat the underlying cause, if bc of renal failure give EPO injection, make sure vitB12 and folate levels are good -

Question 3

• give some haematological abnormalities in kidney disease.
• describe rheumatoid arthritis and treatments.
• give the components of the triad found in Felty’s syndrome.

Answer 3

• RBCs= anaemia (blood loss, kidney stones, diet) Neutrophils=neutropenia (immunosuppression, autoimmune kidney disease) or neutrophilia (inflammation, infection) platelets= thrombocytopenia (uraemia inhibits platelets, drugs) or high platelets (inflammation, bleeding, iron def)
• chronic immune mediated inflammatory condition, high platelets, CRP and neutrophils in this disease, treat w pain relief (NSAIDS), corticosteroids.
• rheumatoid arthritis, splenomegaly, neutropenia (thought to be bc splenomegaly is destroying neutrophils & BM can’t make more)

Question 4

• give some pathological features of chronic liver disease.
• give haematological features of chronic liver disease.
• what are some possible underlying causes of chronic liver disease?
• give post operative reactive changes seen in the blood.

Answer 4

• causes portal hypertension (causes varices which are dilated veins prone to bleeding) which causes splenomegaly leading to pooling of cells in spleen (esp platelets), thrombocytopenia, over removal of cells so low blood counts
• impaired thrombopoeitin is made in the liver so splenic pooling and increased destruction removes the few platelets in circulation, target cells seen on film
• excess alcohol consumption (toxic to BM cells), viral hepatitis(BM failure) autoimmune liver disease.
• anaemia (blood loss pre &post op), temp RELATIVE polycythaemia (reduced plasma makes haematocrit seem larger), neutropenia (severe sepsis), neutrophilia (post op reaction, severe bleeding, infection), thrombocytopenia (drugs, DIC, sepsis)

Question 5

• give some haematological changes that occur during infection
• what is DIC? what can cause it and what does it cause?
• give haematological changes in cancer.
• under what circumstances can granulocyte precursors and nucleated RBCs be seen on blood film?

Answer 5

• if chronic it causes AOCD, malarial infection causes haemolytic anaemia, bacterial=neutrophilia, if severe=neutropenia, parasitic=eosinophilia, viral=lymphocytosis + neutropenia, infection can cause thrombocytosis/severe=thrombocytopenia
• DIC=disseminated intravascular coagulation, a pathological activation of clotting, lots of clots formed in circulation leads to usage of platelets + MAHA bc RBCs must squeeze past clots (microangiopathic…)
• cancer=anaemia (bleeding, iron deficiency, chemo, polycythaemia (many cells=tumour making EPO), neutropenia(chemo), thrombocytopenia (chemo, sepsis, DIC)
• septics/shock, BM infiltrated by tumour, leukaemia, megaloblastic anaemia.