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Haemotology > Haematology in systemic disease > Flashcards

Haematology in systemic disease Flashcards

1
Q

Physiological life cycle of blood cells

A

Blood cells made in bone marrow—> sent out to the periphery and then removed by the spleen (reticulocytes-endothelial system)

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2
Q

Haematological changes associated with

A
  1. Anaemia of chronic disease and anaemia of renal disease
  2. Rheumatoid arthritis
  3. Liver disease / alcohol excess
  4. Post-operative state and infection
  5. Cancer
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3
Q

Changes to the blood is systemic disease are often multi-factorial due to…

A
  • Physiological causes e.g. inflammatory cytokines (IL-6)
  • Complications of the disease
    • e.g. UC loss of blood and unable to absorb nutrients
  • Treatment- adverse effects e.g. methotrexate
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4
Q

Anaemia results due to

A
  • Lack of response from haemostatic loop
    • E.g. in chronic kidney disease the kidney stops making EPO
  • Bone marrow unable to respond to EPO
    • E.g. after chemotherapy, toxic insult or infections (parvovirus)
  • In anaemia of chronic disease e.g. rheumatoid arthritis, iron is not made available to marrow for RBC production
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5
Q

which cells produce erythropoietin in response to hypoxia

A

pericytes in the kidney

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6
Q

EPO binds to

A

receptros on erythroblasts in bone marrow and stimualtes red cell production

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7
Q

anaemia of chronic disease: examples of chronic disease

A

Rheumatoid arthritis, IBD, chronic infections e.g. TB

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8
Q

mode of actiom of anaemia of chronic disease

A

IL- 6 released by immune cells due to inflamamtory condition

  • increased production of hepicidin by the liver
  • hepcidin
    • inhibits ferroprotion
      • decreased iron release from RES
      • decreased iron absorption in the gut
      • leads to plasma iron reduced
  • plasma iron reduction leads gto inhibition of EPO in bone marrow –> anaemia
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9
Q

anaemia of chronic disease leads to what sort of iron deiciency

A

Functional iron deficiency- sufficient iron in the body but not available to develop erythropoiesis cells

à due to hepcidin

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10
Q

hepcidin prevents

A

iorn release from macrophages and iron absorption from the gut

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11
Q

anaemia of chronic kidney disease

A
  • Kidney becomes damaged and less functional throughout disease
  • Will need renal replacement therapy e.g. dialysis or intraperitoneal dialysis
  • Underlying cause of CKD often associated with raised cytokines
    • Reduced clearance of hepcidin and increase hepcidin production due to inflammatory cytokines
  • Dialysis- damages red blood cells- shear stress e.g. of the dialysis tubing
  • Reduced lifespan of RBC as a direct effect of uraemia - high levels of urea
    • Ureamia also inhibits megakaryocytes- leading to low platelet count
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12
Q

ureamia

A

inhibits megakaryocytes leading to low platelet count

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13
Q

Treatment of anaemia of chronic disease

*

A
  • Treat underlying condition
  • Associated with renal failure
    • Give recombinant human EPO
    • Ensure Vit B12 folate and iron stores are adequate
  • Transfuse red cells- only if all else fails and patient symptomatic
  • Absorption given in IV form due to absorption being impaired
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14
Q

with A of CKD what csan be used to assess function iron deficiency

A

reticulocyte haemoglobin content

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15
Q

how to treat A of CKD low iron

A

give ferritin

  • iron should be given in intravenous form as absorption
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16
Q
A
17
Q

possible haematological abnormalities in kidney disease

A
18
Q

3. Rheumatoid arthritis

A

A chronic immune mediated inflammatory condition

19
Q

treatment of RA

A
  • Pain relief (NSAIDS)
  • Disease modifying agents (DMARDs)
    • Corticosteroids
    • Chemotherapy e.g. methotrexate
    • Biological agents – monoclonal antibodies against cytokines
20
Q

features of RA

A
  • Anaemia is multifactorial
    • ACD
    • GI blood loss due to NSAIDS and steroids
    • Risk of autoimmune haemolytic anaemia
  • High platelets and neutrophils when disease is active (CRP will also be up)
  • Low platelets and neutrophils may occur due to treatment, autoimmune reactions or to hypersplenism (splenomegaly can occur in this condition)
    • Feltys syndrome
21
Q

Felty’s syndrome

A

Triad: Rheumatoid arthritis, splenomegaly and neutropenia

  • Neutropenia due to splenomegaly contributing to peripheral destruction of neutrophils and failure of bone marrow to respond to GCSF (myeloid cell stimulator)
22
Q

liver disease

A

Chronic liver disease will cause portal

hypertension which causes splenomegaly

which leads to:

  • Splenic sequestration of cells
  • Overactive removal of cells
  • Low blood count
23
Q

Haematological features of liver disease

A

Thrombocytopenia in 75% of patients

  • Impaired production of thrombopoietin is made in the liver
  • Splenic pooling
  • Increased destruction
  • Those platelet made often have reduced function which contributes to bleeding

*Target cells often seen in liver disease- due to increased cholesterol: phospholipid ratio

24
Q

why does chronic kliver diseas elead to splenomegaly

A

portal hypertneson

25
Q

Portal hypertension also leads to

A

oesophageal and gastric varices (dilated veins prone to bleeding due to higher than normal pressure)

  • Most clotting factors are made by the liver, synthesis of some dependent on vitamin k- patients will become quickly deficiency in clotting factors
26
Q

blood loss in chronic liver disease contributed to by

A
  • Deficiencies of coagulation factors
  • Endothelial dysfunction
  • Thrombocytopenia
  • Defective platelet function
27
Q

Other haematological features of liver disease are depending on the underlying cause

A

Alcohol excess

  • Directly toxic to bone marrow cells- pancytopenia
  • Secondary malnutrition – folic acid deficiency

Viral hepatitis

  • Bone marrow failure (hypoplastic/aplastic marrow) can develop after hepatitis

Autoimmune liver disease

  • Immune mediated anaemia, thrombocytopenia or neutropenia
28
Q
A
29
Q

5. Post operative reactive changes

A
30
Q

6. Haematological changes with infection

A

Red blood cells- chronic infection can cause anaemia of chronic disease e.g. malaria can cause haemolytic anaemia

31
Q

neutrophil reaction to bacterial infection

A
  • Neutrophilia- associated with bacterial infections
  • Neutropenia- associated with severe bacterial infection/sepsis
32
Q

neutrophil reaction to paracytic infection

A

eosinophilia

33
Q

neutrophil reaction to viral infection

A

lymphocytosis and neutropenia

34
Q

thrombocytes and infection

A
  • Infection can cause reactive thrombocytosis
  • Severe infection can cause thrombocytopenia
  • Thrombocytopenia may be associated with with disseminated intravascular coagulation (DIC) in severe sepsis
35
Q

Sepsis can lead to clotting abnormalities- disseminated intravascular coagulation (DIC)

A
  • Pathological activation of coagulation
  • Numerous microthrombi are formed in the circulation
  • Consumption of clotting factors and platelets and a consequence microangiopathic haemolytic anaemias (MAHA)
  • Clotting tests
    • Clotting time ling
    • Low fibrinogen
    • Raised D-dimers
  • Risk of both bleeding and thrombosis
36
Q

Leucoerythroblastic film

*

A

Granulocyte precursors and nucleated RBC seen on blood film

  • Spilling out from the marrow into the blood when the marrow is under stress
    • Sepsis
    • Bone marrow infiltration by carcinoma or haematological malignancy
    • Severe megaloblastic anaemia
    • Primary myelofibrosis
    • Leukaemia
    • Storage disorder
37
Q

haematological changes in cancer

A

Haemotology (12 decks)

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