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Metabolism, Endocrinology and Haematology > Haematology in systemic disease > Flashcards

Haematology in systemic disease Flashcards

1
Q

What is the effect of a chronic release of cytokines on the liver and what effect does this have

A

Causes increase production of hepcidin by the liver

Increased production causes less iron absorption from the gut and less release of iron by decreasing ferroportin expression

This then causes aneamia

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2
Q

What diseases are associated with anaemia of chronic disease

A

They are associated with chronic inflammatory conditions

R.A.

Chronic infections - TB

Renal disease

Systemic lupus erythematosus

Inflammatory bowel disease

Malignancies

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3
Q

What can anaemia of chronic disease develop into

A

Microcytic anaemia

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4
Q

What type of anaemia can patients with chronic kidney disease develop, what happens if there’s an iron deficiency

A

Develop normochromic normocytic anaemia

Anaemia can become microcytic with an iron deficiency

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5
Q

How does chronic kidney disease cause anaemia

A

Deficiency in erythropoietin production due to damaged kidneys

Reduced clearance of hepcidin from blood

Increased hepcidin production due to inflammatory response

Ureamia due to dysfunctional kidney results in RBC lifespan reduction and inhibition of erythropoiesis

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6
Q

What is given to treat renal anaemia and what are the conditions required for it to be successful

A

Erythropoietin

Patient must have sufficient iron, folate and B12 levels

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7
Q

What investigations can be done to check for anaemia of chronic disease

A

Ferritin - if raised it shows patient has chronic disease but it is also raised in infection

Reticulocyte haemoglobin count (CHr) - if raised it shows patient has anaemia

CRP - raised in inflammation

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8
Q

Why might co-existing iron-deficiencies occur in R.A.

A

Because of NSAIDs and corticosteroids used by the patient which can cause gastrointestinal blood loss

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9
Q

What might RA cause if the disease flares up

A

Neutrophilia and thrombocytosis

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10
Q

What is Felty’s syndrome

A

Triad of RA, splenomegaly and thrombocytopaenia

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11
Q

What is the triad of RA, splenomegaly and thrombocytopaenia

A

Felty’s syndrome

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12
Q

What does chronic excessive alcoholism affect in the body

A

Bone marrow

Spleen

Liver

Blood cells

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13
Q

What is excessive alcohol consumption’s affect on bone marrow

A

Suppresses haematopoiesis

Produces structurally abnormal blood cell precursors that cannot mature

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14
Q

What is excessive alcohol consumption’s affect on BCs

A

RBCs become macrocytic

Thrombocytopaenia is common

Acetaldehyde from ethanol metabolism forms acetaldehyde adducts on RBCs causing immune response against them

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15
Q

What is excessive alcohol consumption’s affect on the liver

A

Cirrhosis which results in abnormal production of some clotting factors

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16
Q

What is excessive alcohol consumption’s affect on the spleen

A

Can cause portal hypertension which leads to congestive splenomegaly and splenic trapping of all blood cells resulting in pancytopaenia

17
Q

What infection causes neutrophilia

A

Bacterial

18
Q

What infection causes neutropaenia

A

Post-viral infection

Sepsis

Severe infection

19
Q

What infection causes lymphocytosis

A

Viral infection in children

20
Q

What infection causes lymphopaenia

A

HIV

21
Q

What infection causes eosinophilia

A

Parasitic infection

22
Q

What infection causes DIC

A

Sepsis

23
Q

What infection causes splenomegaly

A

Malaria

Glandular fever

24
Q

What infection causes aplastic anaemia

A

Viral hepatitis

25
Q

What infection causes haemolysis

A

Malaria

26
Q

What infection causes thrombocytopaenia

A

Severe infection

27
Q

Which patients are at increased risk of DVT and what factors increase their risk

A

Immobile patients post-operatively

Cancer, dehydration and/or pelvic or orthopadic surgery increases risk

28
Q

What factors are patients likely to present with after minor surgery

A

Mild thrombocytosis or neutrophilia

29
Q

What will most likely be seen post-splenectomy

A

Thrombocytosis and lymphocytosis

Howelll-jolly bodies in red cells

30
Q

What blood film is seen if the bone marrow is infiltrated with a metastatic cancer

A

Leucoerythroblastic blood film - immature white cells and nucleated RBCs

31
Q

How can cancer cause a fall in Hb

A

Chemotherapy interrupts blood cell production

32
Q

Why might liver disease cause splenomegaly

A

Portal hypertension can lead to blood not flowing correctly from the spleen to the liver, so it backs up in the spleen causing splenomegaly

33
Q

What does splenomegaly cause

A

Splenic sequestration of cells

Overactive removal of cells

34
Q

Why might you get blood loss in a patient with liver disease

A

Deficiences in coagulation factors

Endothelial dysfunction - biochemical changes

Thrombocytopaenia - due to splenomegaly

Defective platelet function

35
Q

Why does liver disease increase susceptibility to bleeding

A

Loss of clotting factors that are produced by the liver, also makes bleeding harder to stop

36
Q

What sort of RBC might you see in a patient with liver disease and why

A

Macrocytosis and target cell formation

Due to altered lipid content of the blodd causing abnormalities in the RBC membrane

Metabolism, Endocrinology and Haematology (27 decks)

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