haematology in systemic disease Flashcards
abnormal blood test results
red cells- anaemia and polycycthaemia
white cells - raised due to infection lowered due to disease or drugs use
platelets - thrombocythaemia (high) and thrombocytopenia (low)
clotting factors and fibrinogen - bleeding occurs because of consumption of these factors
what causes anaemia of chronic disease
inflammatory condition causes cytokines to be released by immune cells. this increases hepcidin production by liver decreasing iron released and its absorption into the gut. also cytokines inhibit eryhtropoetin production by kidneys = ANAEMIA
RBC become microcytic and life span is reduced
treatment of anaemia of chronic disease
treat the underlying causes
presentation of kidney disease
normochromic and normocytic cells
lower GFR = higher severity of kidney disease
causes of anaemia in chronic kidney disease
damaged kidneys means less erythropeotin and less eryhtorpoetis
damaged kidney = removal of hepcidin from blood = less iron
increased hepcidin production by liver = further decrease in iron
loss of RBC by mechanical destruction from dialysis
kidney dysfunction = uraemia (more urine in blood) = inhibits erythropoesis and uraemia also inhibits platelet function which can cause chronic bleeding from the GI tract
treatment of chronic kidney disease
treat using erythropoietin. need iron, folate and B12 to support this. given by dialysis and this can result in hypotension, seizures and blood clotting
abnormalities of blood count in someone with rheumatoid arthritis
people often have blood abnormalities. anaemia of disease is often proportional to the severity of the disease
anaemia may also be be due to NSAID’s and corticosteroids which can cause GI bleeding
in flares patient may have neutrophillia and thrombocytosis where thrombocytopenia and neutropenia are often a side effect of the drugs due to marrow suppression, immune cases or folate inhibition
how alcoholism affect FBC
excessive alcohol has toxic effect on bone marrow - haematopoeiss is surpressed and also causes the production of abnormal precursors
acetaldehyde produced by alcohol metabolism produce acetylaldehyde adducts which attach to RBC leading to an immune response against these cells
cirrhosis leads to abnormal production of clotting factors = GI bleeding and anaemia
portal hypertension = back pressure which causes pooling of cells in spleen and splenomegaly
how alcoholism affect FBC
excessive alcohol has toxic effect on bone marrow - haematopoeiss is surpressed and also causes the production of abnormal precursors
acetaldehyde produced by alcohol metabolism produce acetylaldehyde adducts which attach to RBC leading to an immune response against these cells
cirrhosis leads to abnormal production of clotting factors = GI bleeding and anaemia
portal hypertension = back pressure which causes pooling of cells in spleen and splenomegaly
common cause of of folic acid deficiency = megaloblastic anaemia
blood abnormalities caused by different infections
neutrophila - bacterial infection neutropenia - post-viral infection lymphocytosis - viral infection in children lymphopenia - HIV eosinophilia - parasitic infection DIC - sepsis MAHA - E>coli splenomegaly - glandular fever, malaria aplastic anaemia - viral hepatitis
post operative changes in FBC
anaemia due to blood loss/dilution
mild thrombocytosis and neutrophillia often present but if these worsen this is sign of infection
DIC can also signify infection - this makes patients especially at risk of thrombosis
FBC after splenectomy
thrombocytosis, lymphocytosis and Howell jolly bodies
causes of anaemia in cancer patients
low Hb due to anaemia of chronic disease, blood loss, haemolytic anaemia, infiltration bone marrow or chemo interupting RBC production
bone marrow invaded by cancer - leucoerythroblastic blood film may be seen = immature WBC and nucleated RBC
risks in terms of anaemia for cancer patients
may need blood support and more at risk of thromboembolism and neutropenic sepsis (complication of anticancer treatment)
