Haematology In systemic Disease Flashcards
What is Anaemia of Chronic Disease?
(Anaemia of Inflammation)
A common cause of anaemia associated with chronic inflammatory conditions
Examples of Conditions that can cause Anaemia of Chronic disease
Rheumatoid Arthritis
Chronic infection (TB)
Malignancy
Ulcerative colitis (Inflammatory bowel disease)
Chron’s disease (Inflammatory bowel disease)
How does Anaemia of Chronic Disease/Inflammation result in anaemia?
Inflammation = constant release of CYTOKINES (IL6)
CYTOKINES increase production of Hepcidin (liver)
More Hepcidin = more Ferroportin Internalised and degraded
Less iron can be released from Gut cells (enterocyte) into blood, less iron released from macrophages
Traps the iron in cells
FUNCTIONAL LOSS OF IRON = LESS ERYTHROPOIESIS
In Anaemia of chronic diseases, what does the functional lack of iron do to the size of the Erythrocytes?
Early stages MCV is normal
Eventually becomes Microcytic
Anaemia of Chronic disease, how they cause anaemia 3 methods: (all cytokine related)
Iron dysfunction (lack of functional iron)
Bone marrow shows lack of response to EPO
Reduced RBC life span due to macrophage stimulation
The descriptors of the size and pigmentation of a patient with Chronic Kidney disease
Normocytic
Normochromic
WHat determines the severity of the anaemia that results due to Chronic Kidney disease?
Severity of Chronic Kidney Disease
3 Methods which Chronic Kidney disease causes anaemia
EPO deficiency (kidney can’t make enough Erythropoietin (less erythropoiesis)
Less renal clearance of Hepcidin (more Hepcidin in blood)
More Hepcidin produced as more cytokines produced
What is Uraemia?
Increased urea concentration in the blood
What does Uraemia cause?
Inhibit erythropoiesis
Reduces red cell lifespan
Inhibits Megakaryocytes (inhibiting platelets, thrombocytopenia) May cause chronic bleeding of GI Tract
How does the anemia of a patient undergoing Haemodialysis for their Chronic Kidney Disease worsen?
Dialysis damages red cells
Mechanical Haemolysis to remove damaged red cells
Treating/managing Anaemia of Chronic Renal Failure
Recombinant Human Erythropoietin (Man made EPO)
Ensure B12, folate and Iron stores are adequate for Erythropoiesis to happen
What important tests will be done to check that anaemia is not being caused by IRON DEFICIENCY and so its an Anaemia of Chronic Disease
CHr (Reticulocyte Haemoglobin Content/or % hypochromic cells)
Check Serum Ferritin (If low indicates Iron Deficiency)
Treating Anaemia of Rheumatoid Arthritis
Pain Relief NSAIDS (Non-steroid anti-inflammatory drugs) and Corticosteroids. CAN CAUSE GI BLOOD LOSS and so COEXISTING IRON DEFICIENCY
DMARDS (Disease Modifying Anti Rheumatic drugs)
-Biological agents block cytokines
-Corticosteroids
-Chemotherapy (methotrexate)
What haematological abnormalities will be present in an individual when Rheumatoid Arthritis is active?
Neutrophilia (High Neutrophils)
Thrombocytosis
In Anaemia of Rheumatoid arthritis why may Neutropenia and thrombocytopenia occur?
Treatments like DMARDS
Autoimmune reactions (bone marrow)
Hypersplenism (can cause Splenomegaly)
Folate inhibition
What is Felty’s Syndrome?
Triad of Rheumatoid Arthritis, Splenomegaly and Neutropenia
What 3 things are affected in Anaemia of Chronic Liver Disease (Often caused by Alcoholism)?
Bone marrow
Spleen
Blood cells
How is BONE MARROW affected in Anaemia of Chronic Liver Disease?
Excess alcohol = toxic affect on bone marrow (alcohol has anti-folate effect)
Haematopoiesis suppressed
Abnormal blood precursors that can’t mature into functional cells
What happens to Red Cells in Anaemia of Chronic Liver Disease?
Macrocytic
Acetaldehyde forms protein-acetaldehyde adducts on RBCs — Leads to immune response against modified proteins (haemolysis)
Thrombocytopenia
How is the Spleen affected in Anaemia of Chronic Liver Disease?
Splenomegaly due to Portal Hypertension
Causes more blood cells to be removed (pancytopenia) due to more blood pooling here. Splenic sequestration (blood gets stuck here)
How does Liver Cirrhosis affect blood clotting?
Worsens it since liver produces many clotting factors
Vitamin K needed to synthesis clotting factors
How does Liver Cirrhosis/Anaemia of Chronic Liver disease affect Thrombocyte/Platelet levels?
Decreased
Thrombopoietin made in LIver
Increased splenic pooling due to Portal Hypertension removes more platelets
Platelets remaining have impaired function (due to alcohol)
What type of cells are often present in a blood film in a patient with liver disease?
Target cells
Why do target cells have the structure that they do?
Increased cholesterol:phospholipid ratio
Portal Hypertension as a result of Chronic Liver Disease consequences for Oesophageal and Gastric lumen
Oesophageal and Gastric Varices
Varices = Swollen/dilated veins due to high blood pressure
Prone to bleeding
What is the common cause of Neutrophilia?
BACTERIAL INFECTION
What is the common cause of Neutropenia?
Severe bacterial infection/sepsis
Viral Infections
What is the common cause for Eosinophilia?
Parasitic infection
What is a common cause for lymphocytosis?
Viral infections
How can malaria cause Haemolytic anaemia?
Spleen and Reticuloendothelial system (RES) destroy infected RBCs
What is Disseminated Intravascular Coagulation (DIC)?
Pathological activation of coagulation/blood clotting
Clumps of platelets form in small blood vessels
Causes MAHA (Microangiopathic haemolytic anaemia)
MAHA happens since red cells get damaged against the clots
Clotting factors and Platelets depleted (used quicker than made)
What are the 2 things someone is at risk of if they have DIC?
Bleeding and Thrombosis
What haematological change is expected after a patient has has major surgery?
Mild Thrombocytosis or Neutrophilia
Should settle
What does worsening Neutrophilia or Thrombocytosis and DIC indicate after major surgery?
Infection
What are seen in RBCs post splenectomy?
Howell-Jolly bodies (fragments of nucleus that the spleen would’ve removed from red cells)
Reasons why cancer may cause anaemia
Bleeding
Haemolytic anaemia
Infiltration of bone marrow
Chemotherapy interrupts blood cell production
What is a Leucoerythoblastic film?
Blood film that sees immature white and red cells
Why may you see Granulocyte precursors and nucleated RBCs on a Leucoerythoblastic film of someone who has cancer?
Cancer invades bone marrow causing stress, leads to marrow spilling out
