Haematological aspects of Systemic Disease Flashcards
What is the other name given to Anaemia of Chronic Disease?
Anaemia of Inflammation
In what group of people may Anaemia of Chronic Disease present?
=> Affects people that have conditions such as:
- Infections which cause inflammation
- Autoimmune disease
- Cancer risk
- Chronic Kidney Disease
What are the essential characteristics of Anaemia of Chronic Disease?
- Disordered Iron Metabolism
- Reduced Red Cell Lifespan
- Reduced Bone Marrow response to Erythropoietin
What factors contribute to Anaemia of Chronic Disease?
- Blood loss
- Nutritional State
- Medication effect
- Length and severity of inflammatory disease
How does Anaemia of Chronic Disease cause disordered iron metabolism?
- Anaemia of Chronic Disease causes an increase in Hepcidin levels
- Hepcidin is an iron regulatory protein made by the liver
- Its action is to reduce iron absorption in the gut and reduce plasma iron levels through inhibition of ferroportin
What is Ferroportin?
Transmembrane protein responsible for transporting iron from inside the cell to outside into the blood
=> Present in:
- Duodenum
- Liver
- Splenic macrophages
What causes an increase in Hepcidin levels in Anaemia of Chronic Disease?
- Inflammatory cytokines
- Bacterial components
- Plasma iron-transferrin levels
What are the levels of the following molecules in cases of Anaemia of Chronic Disease?
MCV Serum Iron Transferrin Saturation TIBC Ferritin BM iron stores Erythroblast iron stores Hepcidin CRP and ESR
MCV => normal or low Serum Iron => low Transferrin Saturation => low TIBC => low Ferritin => increased BM iron stores => present Erythroblast iron stores => absent Hepcidin => increased CRP => increased ESR => increased
CRP and ESR elevated due to possible infection
What are the levels of following molecules in cases of Iron Deficiency Anaemia?
MCV Serum Iron Transferrin Saturation TIBC Ferritin BM iron stores Erythroblast iron stores Hepcidin CRP and ESR
MCV=> low Serum Iron => low Transferrin Saturation => low TIBC => high Ferritin => low BM iron stores => absent Erythroblast iron stores => absent Hepcidin => normal CRP and ESR => normal
What are the causes of a reduced red cell lifespan in Anaemia of Chronic Disease?
- Immune mediated
- Medication
- Renal failure
What are the causes of blunted EPO response?
Reduced ability of RBC precursors to respond to EPO
What is the management of Anaemia of Chronic Disease?
- Iron supplementation
- EPO total
- Blood transfusion
What are the other haematological changes associated with Anaemia of Chronic Disease?
- Leukocytosis or Leukopenia
- Toxic neutrophilia
- Infectious mononucleosis
- Thrombocytosis or Thrombocytopenia
What is Disseminated Intravascular Coagulopathy (DIC)?
Systemic activation of clotting factors leading to coagulation all over the body
How is the DIC score calculated?
=> Platelet count
> 100 x 10^9/L is 0
< 100 x 10^9/L is 1
< 50 x 10^9/L is 2
=> Elevation of D-dimer
No increase = 0
Moderate increase = 2
Strong increase = 3
=> Prolonged PT
< 3s is 0
> 3 but < 6s is 1
> 6s is 2
=> Fibronegen level
> 1g/L = 0
< 1g/L = 1
≥ 5 means overt DIC, repeat score daily
< 5 suggests non-overt DIC =, repeat in next 1-2 days
