Haematology In Systemic Disease Flashcards
What type of cells would be present in anaemia of chronic disease
Normochromic and normocytic cells
So would have the mild side effects
What would the interleukin 6 cytokines do in the ACD
Increase hepcidin
Inactivation of the ferroportin
Would have less iron absorption
So decreased erythropoiesis
What would interleukins 1 and TNF do in ACD
Decreased EPO receptors
EPO Less sensitive to receptors
Apoptosis of the erythroid progenitors
Low red blood cell half life (erythrophagocytosis)
What would the levels of transferrin and ferritin be in ACD
Low transferrin (large stored iron,not feeling the need for more transferrin)
High ferritin due to the high a,lungs that would be stored in the body
What would the levels of transferrin and ferritin be for the iron deficiency anemias
High transferrin (want to increase the levels of iron in the body)
Low ferritin (not have a lot of stored iron)
What does inflammation do to the levels of EPO
Increased inflammatory cytokines
So would have decreased gene expression of the EPO genes
Would have lower amounts of EPO
What could also effect erythropoiesis
Decreased bone marrow sensitivity
The increased size of the red blood cells and increased plasma viscosity
Kidneys not responding to hypoxia
How does rheumatoid arthritis lead to the anemia
Would be the anemia of chronic disease, so would effect the levels of cytokines and hepcidin
When people take NSAIDS, can also lead to GI bleeding, so can have the low Hb levels from this
How can renal disease affect erythropoiesis
Normochromic and normocytic anaemia
Low EPO
Low hepcidin clearance, so would increase levels (like that of ACD)
Uraemia, increased levels so would effect the half life of the blood cells
What does the thyroid gland do for erythropoiesis
Proliferation erythropoiesis precursors
Increased EPO gene expression
What would hyperthyroidism do
Leads to oxidative stress and the altered iron metabolism
So would increase the amount of osmotic fragility
Reduced half life of the blood cells
What does hypothyroidism do
Decrease levels of the EPO
Would not allow the erythropoiesis to happen effectively
How does GI disease effect the erythropoiesis
The nutrients deficiency, B12, folate (macrocytosis), iron deficiency (microcytosis)
Caloric deficiency would effect the bone marrow (bone marrow atrophy)
Occult bleeding
How does liver damage effect erythropoiesis
Produces some EPO
Cirrhosis would decrease EPO
Effect the clotting factors so can lead to the blood loss
Portal hypertension (sequestered blood cells, splenomegaly)
How does alcohol effect erythropoiesis
Thrombocytopenia
When would have withdrawal, reverses the effects and leads to thrombocytosis
Decreased nutrition
How does cancer effect the erythropoiesis
Normally the suppression of the EPO production (can be reversed with additional EPO)
anitcancer drugs can have the myelotoxic effects
Polycythemia
Thrombocytosis
What is leucoerthyroblastic anaemia
When would have the bone marrow releases some cells early, so would have a blood film with some reticulocytes
This would be caused but the tumours that would effect the MICROVASCULATURE OF THE BONE MARROW
How can you treat ACD
Treat the underlying disease, could then reverse the effects
Intravenous iron
Blood transfusions (only when the disease would be serious)
EPO therapy
What does sepsis lead to
The disseminated intravascular coagulation
Increased coagulation, fibrosis, rupture and then haemorrhage
What type of anaemia does anterior pituitary gland failure lead to
Normocytic and Normochromic anaemia
What type of anaemia does hypothyroidism lead to
Normocytic and normochromic
(Relative macrocytosis)
What type of anaemia would hyperthyroidism lead to
Microcytic anaemia
Risk of agranulocytosis (very low neutrophil count)
What does Cushing’s syndrome lead to
Polycythaemia
What does the adrenal insufficiency lead to
Lymphocytosis, neutropenia and eosinophilia
