Lecture 11- Haematology In Systemic Disease

Question 1

Anaemia of chronic disease?

Answer 1

Reduced EPO production or reduced response of bone marrow to EPO eg myelofibrosis

Inflammatory cytokines cause hepcidin production which inhibits ferroportin for iron transport from gut epithelia and macrophages. Done to prevent infection getting iron but can lead to anaemia (functional iron deficiency)

Cytokines also reduce lifespan of RBCs, prevent iron release through hepcidin and cause marrow to show lack of response to EPO

Question 2

Anaemia of chronic renal failure?

Answer 2

Reduced EPO and clearance of hepcidin due to kidney damage. Also get uraemia which reduces lifespan of RBCs and causes thrombocytopenia.

Often normacytic or microcytic with raised CRP

Treated with EPO, IV iron and B12 and folate

Use reticulocyte haemoglobin content to test for functional iron deficiency

Question 3

What could cause high RBCs with renal disease?

Answer 3

A tumour

Question 4

What is felty,s syndrome?

Answer 4

A phenomenon whereby the patient has rheumatoid arthritis, splenomegaly and neutropenia due to splenic pooling.

Also high levels of G-CSF to try and compensate

Question 5

Main haematological changes with rheumatoid arthritis?

Answer 5

Immunosuppressants like methotrexate can result in low neutrophils but inflammation can cause high neutrophils.

Question 6

Haematological changes liver disease and alcohol?

Answer 6

Portal hypertension resulting in splenomegaly and over removal of cells .

Blood loss due to deficiency in clotting factors produced by liver

Gastric varices due to portal hypertension can result in bleeding

Lack of TPO produced by liver leading to thrombocytopenia

Alcohol toxic to bone marrow= pancytopenia

Question 7

What are varices?

Answer 7

Abnormally dilated vessels

Question 8

Post operative haematological changes?

Answer 8

Low RBC due to bleeding and high due to dehydration

Low platelets and neutrophils due to sepsis high due to infection

DIC can be triggered by bacterial toxins or endothelial damage. Uses up clotting factors, low fibrinogen and raised d dimers. Risk of bleeding and thrombosis

Question 9

Haematological changes associated with cancer?

Answer 9

Low RBCs with chemo high with EPO secreting tumours

Infections lead to high platelets and neutrophils while chemotherapy and sepsis will reduce them

Question 10

What is leucoerythroblastic film?

Answer 10

When due to sepsis, bone marrow infiltration with carcinoma or myelofibrosis etc immature blood cells spill out from marrow into blood

Question 11

Best way to work out haematological changes that stem from disease?

Answer 11

Consider the cause of the disease

Consider the complications caused by the disease

Consider the treatments used against the disease