Haematology in systemic disease Flashcards
What is the effect of a chronic release of cytokines on the liver and what effect does this have
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
What diseases are associated with anaemia of chronic disease
They are associated with chronic inflammatory conditions
R.A.
Chronic infections - TB
Renal disease
Systemic lupus erythematosus
Inflammatory bowel disease
Malignancies
What can anaemia of chronic disease develop into
Microcytic anaemia
What type of anaemia can patients with chronic kidney disease develop, what happens if there’s an iron deficiency
Develop normochromic normocytic anaemia
Anaemia can become microcytic with an iron deficiency
How does chronic kidney disease cause anaemia
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
What is given to treat renal anaemia and what are the conditions required for it to be successful
Erythropoietin
Patient must have sufficient iron, folate and B12 levels
What investigations can be done to check for anaemia of chronic disease
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
Why might co-existing iron-deficiencies occur in R.A.
Because of NSAIDs and corticosteroids used by the patient which can cause gastrointestinal blood loss
What might RA cause if the disease flares up
Neutrophilia and thrombocytosis
What is Felty’s syndrome
Triad of RA, splenomegaly and thrombocytopaenia
What is the triad of RA, splenomegaly and thrombocytopaenia
Felty’s syndrome
What does chronic excessive alcoholism affect in the body
Bone marrow
Spleen
Liver
Blood cells
What is excessive alcohol consumption’s affect on bone marrow
Suppresses haematopoiesis
Produces structurally abnormal blood cell precursors that cannot mature
What is excessive alcohol consumption’s affect on BCs
RBCs become macrocytic
Thrombocytopaenia is common
Acetaldehyde from ethanol metabolism forms acetaldehyde adducts on RBCs causing immune response against them
What is excessive alcohol consumption’s affect on the liver
Cirrhosis which results in abnormal production of some clotting factors
What is excessive alcohol consumption’s affect on the spleen
Can cause portal hypertension which leads to congestive splenomegaly and splenic trapping of all blood cells resulting in pancytopaenia
What infection causes neutrophilia
Bacterial
What infection causes neutropaenia
Post-viral infection
Sepsis
Severe infection
What infection causes lymphocytosis
Viral infection in children
What infection causes lymphopaenia
HIV
What infection causes eosinophilia
Parasitic infection
What infection causes DIC
Sepsis
What infection causes splenomegaly
Malaria
Glandular fever
What infection causes aplastic anaemia
Viral hepatitis
What infection causes haemolysis
Malaria
What infection causes thrombocytopaenia
Severe infection
Which patients are at increased risk of DVT and what factors increase their risk
Immobile patients post-operatively
Cancer, dehydration and/or pelvic or orthopadic surgery increases risk
What factors are patients likely to present with after minor surgery
Mild thrombocytosis or neutrophilia
What will most likely be seen post-splenectomy
Thrombocytosis and lymphocytosis
Howelll-jolly bodies in red cells
What blood film is seen if the bone marrow is infiltrated with a metastatic cancer
Leucoerythroblastic blood film - immature white cells and nucleated RBCs
How can cancer cause a fall in Hb
Chemotherapy interrupts blood cell production
Why might liver disease cause splenomegaly
Portal hypertension can lead to blood not flowing correctly from the spleen to the liver, so it backs up in the spleen causing splenomegaly
What does splenomegaly cause
Splenic sequestration of cells
Overactive removal of cells
Why might you get blood loss in a patient with liver disease
Deficiences in coagulation factors
Endothelial dysfunction - biochemical changes
Thrombocytopaenia - due to splenomegaly
Defective platelet function
Why does liver disease increase susceptibility to bleeding
Loss of clotting factors that are produced by the liver, also makes bleeding harder to stop
What sort of RBC might you see in a patient with liver disease and why
Macrocytosis and target cell formation
Due to altered lipid content of the blodd causing abnormalities in the RBC membrane
