Haematology in Systemic Disease

Question 1

Anaemia of chronic disease

Answer 1

Caused by chronic inflammation, caused by inflammatory cytokines

Question 2

How does anaemia of chronic disease work?

Answer 2

Available iron is not released for use in the bone marrow, marrow shows a lack of response to erythropoietin, reduced lifespan of RBC

Question 3

Examples of anaemia of chronic disease

Answer 3

• Rheumatoid arthritis, inflammatory bowel disease, chronic infections

Question 4

Hepcidin

Answer 4

Protein produced in liver, regulates iron metabolism

Question 5

How is hepcidin regulated?

Answer 5

cytokines, HFE

Question 6

Mechanism of hepcidin

Answer 6

Inhibits ferroportin so:
- decreases iron release from macrophages
- prevents iron absorption from gut

Question 7

Anaemia of chronic disease treatment

Answer 7

• treat underlying condition
• ensure B12, folate and iron stores are adequate

Question 8

Rheumatoid arthritis treatment

Answer 8

• for pain relief NSAIDs
• Disease Modifying Agents (DMARDs): corticosteroids, chemotherapy

Question 9

Rheumatoid arthritis and anaemia

Answer 9

GI blood loss due to NSAIDs and steroids

Question 10

Felty’s syndrome

Answer 10

rheumatoid arthritis, splenomegaly, neutropenia

Question 11

Haematological features of liver disease

Answer 11

• thrombocytopenia
• target cells
• blood loss