2.3 Haematological abnormalities in non haematological conditions

Question 1

What are the characteristic features of anaemia of chronic disorders?

Answer 1

Normochromic or mildly hypochromic anaemia

Systemic disease - not a disorder on its own

Hb usually low but MCV normal

Question 2

What conditions are associated with anaemia of chronic disorders?

Answer 2

Chronic infection: osteomyelitis (infection of bone), bacterial endocarditis, TB (very common) – mainly subtle systemic TB

Chronic inflammatory disorders: RA (rheumatoid arthritis), PMR, SLE (systemic lupus), IBD. Treatable but not curable, all have periods of flare ups

Malignancy: carcinoma, myeloma, lymphoma

Others: congestive cardiac failure, AID syndrome

Question 3

What is the pathogenesis of anaemia of chronic disease?

Answer 3

1. T cell activation
2. Cytokine release
3. Cytokines stimulate hepcidin release
4. Increased iron uptake decreasing its availability
5. cytokine inhibition of EPO
6. Cytokine inhibition of
   differentiation and proliferation of erythroid progenitor cells

Question 4

What is the pathogenesis of anaemia of chronic disease?

Answer 4

1. T cell activation
2. Cytokine release (TNF-alpha, IL-1, IL-6)
3. Cytokines stimulate hepcidin release
4. Increased iron uptake decreasing its availability
5. cytokine inhibition of EPO
6. Cytokine inhibition of
   differentiation and proliferation of erythroid progenitor cells

Question 5

What are the haematological factors of anaemia of chronic disorders

Answer 5

HB: not less than 90g/l 
MCV: normal or mildly reduced 
Serum iron and total iron binding capacity: reduced 
Serum ferritin: normal or increased 
Transferrin sats: mildly reduced 
CRP: usually raised

Question 6

What is the treatment for anaemia of chronic disorders?

Answer 6

Treat underlying condition
Iron therapy only if iron deficient
Transfusion if anaemia is severe

Question 7

What is the treatment for anaemia of chronic disorders?

Answer 7

Treat underlying condition
Iron therapy only if iron deficient
Transfusion if anaemia is severe

Question 8

What is the mechanism for DIC?

Answer 8

1. Damaged tissue triggers thrombin
2. Initially this is bound by antithrombin but eventually this will be consumed leading to a build up of thrombin
3. There will be an increase in the intravascular formation of fibrin
4. Fibrin and platelets will be consumed and the result will be bleeding
5. Fibrin deposition on endothelial cells stimulates the release of tPA leading to fibrinolysis leading to the network of thrombosis being dismantled
6. can have reperfusion injury to organs that suffered hypoxia form thrombosis of end organ vessels

Question 9

What are the tests of liver failure induced anaemia?

Answer 9

PT
FVII (failing liver cannot maintain these levels)
FVIII and fibrinogen are the last to fall (suspect DIC)