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MEH > Haematology in systemic diseases > Flashcards

Haematology in systemic diseases Flashcards

1
Q

haematological abnormalities in systemic diseases

A

red cells
- anaemia of chronic disease
- anaemia of renal disease
- secondary polycythaemia

white cells
- infections
- inflammations
- drugs
- neutropenia or lymphopenia

platelets
- thrombocytopenia and thrombocytosis commonly reactive

clotting factors and fibrinogen
- bleeding in DIC due to sepsis, inflammation, cancer, trauma, obstetric emergencies
- thrombosis common via multi-factorial mechanisms

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2
Q

what is anaemia of chronic disease

A
  • associated with inflammatory condidtions life rheumatoid arthritis, chronic infections and malignancy
  • chronic release of cytokines (IL-6) increases production of hepcidin by liver
  • decreases ferroportin expression and promotes internalisation of ferroportin molecules
  • results in less iron absorption from gut and less release of iron from stores
  • functional loss of iron - not available for erythropoiesis
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3
Q

3 contributors to anaemia of chronic disease

A
  • iron dysregulation - available iron not released for use in bone marrow
  • marrow shows lack of response to erythropoietin
  • reduced lifespan of red cells
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4
Q

haematological features of anaemia of chronic disease

A
  • MCV normal but as disease progresses microcytic anaema results
  • increased macrophage activity reduces lifespan of RBCs
  • cytokines limit proliferation and differentiation of red cell progenitors
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5
Q

how to differentiate between anaemia of chronic disease and iron deficiency anaemia

A

iron deficiency anaemia will have reduced serum ferritin

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6
Q

treatment for anaemia of chronic disease

A

treat the underlying disorder

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7
Q

haematological abnormalities in anaemia of renal disease

A

normochromic, normocytic anaemia
- secondary polycythaemia renal transplant/tumour, polycystic kidneys
- neutropenia immunosuppressants, autoimmune kidney disease
- neutrophilia inflammation, infection, drugs
- thrombocytopenia uraemia, drugs, haemolytic uraemic syndrome
- thrombocytosis inflammation, bleeding, iron deficiency

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8
Q

factors underlying anaemia of chronic kidney disease

A
  • deficiency of erythropoietin production by damaged kidneys so lower level of erythropoiesis
  • reduced clearance of hepcidin from blood with increased production of hepcidin from liver causing functional iron deficiency
  • uraemia inhibits erythropoiesis and reduces lifespan of RBCs and inhbits platelet function
  • regular haemodialysis worsens anaemia due to loss and destruction of RBC
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9
Q

treatment of renal anaemia

A

recombinant human erythropoietin
- hypertension, seizures, clotting during dialysis can occur
- only effective if sufficient iron, folate and B12

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10
Q

what is Felty’s syndrome

A

triad of rheumatoid arthritis, splenomegaly and neutropenia

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11
Q

how does rheumatoid arthritis cause anaemia

A
  • anaemia of chronic disease
  • GI blood loss due to NSAIDS and steroids
  • autoimmune haemolytic anaemia
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12
Q

haematological abnormalities in rheumatoid arthritis

A
  • neutrophilia and thrombocytosis when disease is active
  • neutropenia and thrombocytopenia may occur due to treatment (DMARDs), autoimmune reactions or hypersplenism
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13
Q

treatment of rheumatoid arthritis

A

pain relief
- NSAIDs

disease modifying agents (DMARDs)
- corticosteroids
- chemotherapy eg. methotrexate
- biological agents - monoclonal antibodies against cytokines

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14
Q

haematological abnormalities of chronic liver disease/alcoholism

A
  • heavy alcohol consumption has toxic effect on bone marrow causing suppression of haematopoiesis and production of structurally abnormal blood cell precursors that can’t mature
  • macrocytic red cells
  • thrombocytopenia due to impaired thrombopoietin production by liver, splenic pooling and increased destruction
  • acetaldehyde from ethanol metabolism can produce adducts on RBCs causing immune response against the proteins
  • cirrhosis causes abnormal production of clotting factors contributing to GI bleeding causing anaemia
  • portal hypertension causes splenomegaly causing splenic sequestration and overactive removal of cells causing pancytopenia
  • alcohol abuse causes folic acid deficiency causing megaloblastic anaemia
  • target cells due to increased cholesterol:phospholipid ratio
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15
Q

haematological changes in post operative state

A

anaemia
- blood loss pre-op
- blood loss during op
- dilution by peri-operative IV fluid

temporary relatve polycythaemia
- dehydration

neutropenia
- severe sepsis

neutrophilia
- post-op reactive
- infection
- severe bleeding

thrombocytopenia
- drugs
- sepsis
- DIC

thrombocytosis
- post-op reactive
- infection
- bleeding

Howell-Jolly bodies

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16
Q

haematological changes in infection

A
  • chronic infection causes anaemia of chronic disease
  • bacterial infection causes neutrophilia
  • severe bacterial infection, viral infections and sepsis cause neutropenia
  • viral infection causes lymphocytosis
  • HIV causes lymphopenia
  • parasitic infection causes eosinophilia
  • sepsis causes DIC
  • E.coli diarrhoea causes MAHA
  • malaria and glandular fever cause splenomegaly
  • viral hepatitis causes aplastic anaemia
17
Q

how does sepsis cause DIC

A
  • pathological activation of coagulation
  • numerous microthrombi formed in circulation
  • leads to consumption of clotting factors causing MAHA
  • long clotting times, low fibrinogen, raised D-dimers or fibrin degradation products
  • risk of bleeding and thrombosis
18
Q

haematological changes in cancer

A

anaemia
- bleeding eg. bowel, stomach, bladder
- iron deficiency
- anaemia of chronic disease
- chemotherapy
- infiltration of bone marrow

polycythaemia
- EPO producing tumours

neutropenia
- chemotherapy
- marrow infiltrated by cancer cells

neutrophilia
- inflammation
- infection

thrombocytopenia
- chemotherapy
- sepsis
- DIC
- infiltrated marrow

thrombocytosis
- inflammation
- infection
- bleeding
- iron deficiency

much greater risk of venous thrombosis with cancer

19
Q

what is a leucoerythroblastic blood film

A

immature WBC (granulocyte precursors) and nucleated RBC seen on film
- sepsis/shock
- bone marrow infiltration by carcinoma or haematological malignancy
- severe megaloblastic anaemia
- primary myelofibrosis
- leukaemia
- storage disorders

MEH (26 decks)

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