Anemia Of Chronic Diseases Flashcards
What is haemolysis?
The breakdown of red blood cells, which can lead to anaemia.
What common form of autoimmune haemolytic anaemia is associated with Chronic lymphocytic leukemia (CLL)?
Warm autoimmune haemolytic anaemia (AIHA)
What is a less common form of autoimmune haemolytic anaemia and its associated conditions?
Cold autoimmune haemolytic anaemia, found in Myeloma, lymphoplasmacytic lymphoma, and chronic cold agglutinin disease.
What type of anaemia may occur in association with disseminated carcinoma?
Microangiopathic haemolytic anaemia (MAHA) with intravascular haemolysis.
What chemotherapeutic agents are implicated in a syndrome resembling MAHA?
- Mitomycin
- Cisplatin
- Bleomycin
- Ciclosporin
What conditions lead to alcoholism-related anaemia?
Malnutrition and folate deficiency.
What are the morphologic abnormalities seen in alcoholism-related anaemia?
- Dimorphic anaemia in peripheral blood film
- Megaloblastic erythropoiesis
- Vacuolation of erythroblasts
- Ringed sideroblasts in bone marrow.
What are the clinical manifestations of lead poisoning?
Abdominal colic and motor neuropathy.
What type of anaemia is usually seen in lead poisoning?
Mild to moderate microcytic hypochromic anaemia.
What causes basophilic stippling in lead poisoning?
Aggregation of ribosomes within red blood cells due to lead-induced deficiency of Pyrimidine 5’ nucleotidase.
What findings in bone marrow are indicative of lead poisoning?
Erythroid predominance and ringed sideroblasts.
What is the mechanism of anaemia in lead poisoning?
Lead inhibits Aminolevulinic acid synthase (ALA), ALA dehydratase, and Ferrochelatase.
What laboratory findings are associated with lead poisoning?
- Increased Serum Iron
- Reduced TIBC (Total iron binding capacity)
- Increased RDW (red cell distribution width)
What is the most frequent haematological abnormality found in patients with malignancy?
Anaemia.
What factors can worsen anaemia in cancer patients?
Myelotoxic effects of chemotherapy.
What is the response of plasma Epo levels in patients with malignancy-related anaemia?
Plasma Epo levels tend to be inappropriately low but respond well to Epo therapy.
What conditions are associated with secondary acquired sideroblastic anaemia?
- Myeloproliferative disorders
- Multiple Myeloma (MM)
- Acute Myeloblastic leukemia (AML) M6 subtype
- Isoniazid, Pyrazinamide, Cycloserine, Chloramphenicol
- Alcoholism
- Lead poisoning
- Vitamin B6 deficiency
What characterizes primary acquired sideroblastic anaemia?
Refractory anaemia with ringed sideroblasts, typically found in myelodysplastic syndrome (MDS).
What morphological abnormalities are seen in neutrophils in sideroblastic anaemia?
- Pelger-Huet cells (neutrophils with double-lobed nucleus)
- Hypogranularity.
What is the pathogenesis of sideroblastic anaemia?
Haem synthesis is majorly affected.
What are the types of sideroblastic anaemia reported?
- Hereditary
- Secondary acquired.
What are the characteristics of hereditary sideroblastic anaemia?
- X-linked disorder
- Reduced activity of Delta aminolevulinic acid (δ-ALA) synthase
- Presents in childhood or early adulthood with moderate to severe anaemia.
What is red cell aplasia and where can it occur?
A condition where red blood cell production is severely reduced, found in Thymomas, CLL, NHL, and after chemotherapy/radiotherapy.
What is the common feature of anaemia in chronic renal disease?
Reduced Epo production affecting erythropoiesis.
What laboratory findings are indicative of anaemia of chronic renal disease?
Normocytic normochromic red cells and the presence of Burr cells (Echinocytes).
What are sideroblasts?
Erythroblasts containing aggregates of iron, demonstrable by Prussian Blue reaction.
What types of sideroblasts have been described?
- Type I: Normal sideroblasts
- Type II: Abnormal sideroblasts (numerous and large)
- Type III: Ringed sideroblasts.
What is the diagnosis criterion for ringed sideroblasts?
≥15% of these cells is diagnostic of sideroblastic anaemia.
What characterizes laboratory findings in anaemia of chronic disease (ACD)?
- Moderately reduced hemoglobin
- Normal or mildly reduced MCV
- Usually normal MCH
- Reduced serum iron
- Reduced TIBC
- Mildly reduced transferrin saturation
- Normal or increased serum ferritin
- Raised serum and urine hepcidin.
What cytokines are involved in the pathogenesis of anaemia of chronic disease?
- IL-1
- IL-6
- TNF
- Transforming growth factor (TGF-β).
What are the causes of anaemia in malignancy?
- Anaemia of chronic disease
- Blood loss
- Haemolysis (immune and non-immune)
- Pure red cell aplasia
- Megaloblastic anaemia
- Marrow hypoplasia.
What happens to Epo levels in anaemia of chronic disease compared to other types of anaemia?
Epo levels are inappropriately low.
What is the role of hepcidin in iron metabolism during chronic disease?
Hepcidin binds to Ferroportin, inhibiting iron absorption and export from macrophages.
