Lecture 9 (Part 1) - Haematology in Systemic Disease Flashcards
What are the effects of cytokines (IL6) in anaemia of chronic disease? E.g of disease
- ⬆️hepicidin production, but functional iron deficiency (iron dysregulation)
- ⬇️EPO –> lack of response from BM
- Reduced lifespan of RBC
- E.g: RA, TB, Crohn’s
What is hepcidin regulated by? What are its functions?
- Regulated by: IL6/Cytokines, transferrin receptor, HFE *mutation in HFE gene that normally interacts w hepcidin —> hereditary haemochromatosis (excess hemosiderin)
- Function: degrade ferroportin, downregulate DMT1 expression
(prevent uptake from gut and iron release from macrophages)
What are some causes of anaemia of chronic KIDNEY disease?
- Raised IL6
- Reduced EPO due to kidney dmg
- Increased hepcidin
- Dialysis causes dmg to RBC
- Reduced lifespan of RBC due to uraemia
[also inhibits megakaryocytes –> thrombocytopenia]
What is the treatment for anaemia of chronic disease?
- Treat underlying condition
- If associated w kidney failure: recombinant human erythropoietin
i) must make sure Vit B12/Folate suf. - Blood transfusion if no other option
What is management for anaemia of chronic RENAL disease?
- Use reticulocyte hb count (CHr) test for func. iron D.
- Given iron if ferritin below normal range: given intravenously
What is RA treated with? What does it increase/decrease does it cause?
- NSAID: anti-inflammatory
- DMARDs (Disease Modifying Agents): corticosteroids. monoclonal antibodies against cytokines
- Causes high platelets and neutrophils and CRP (C-Reactive protein)
- Low platelets n neutrophils due to treatment, AI reaction or hypersplenism (Felty’s Syndrom)
3 conditions of Felty’s Syndrome are? Why is * caused?
- RA, Neutropenia*, Splenomegaly
- caused because of splenomegaly = ⬆️destruction + failure of bone marrow to produce neutrophils due to insensitivity of myeloid cells to GCSF (Granulocyte colony stimulating factor)
What will chronic liver disease cause? What would that subsequently lead to?
- Cause portal hypertension –> splenomegaly
- Leads to splenic pooling/sequestration of cell and ⬆️removal of cell –> pancytopenia
How does portal hypertension affect oesophageal and gastric veins?
- Leads to varices (leak) = dilated veins prone to bleeding coz of higher pressure
Why does liver disease lead to thrombocytopenia? How does it affect clotting factors?
- Most clotting factors made n liver (Vit K) - patients will become deficient in clotting factors
- Impaired production of thrombopoietin
- Splenic pooling: ⬆️destruction
Why are target cells often seen in liver disease?
Increased cholesterol: phospholipid ratio
How does alcohol affect blood test
- Directly toxic to BM cells –> pancytopenia
- Secondary malnutrition –> folic acid deficiency
Viral hepatitis cause liver disease. What is the effect of this?
- BM failure –> aplastic marrow (invasion of parvovirus)
What is effect of AI liver disease?
Pancytopenia
What are the changes of RBC in relation to infection?
- Cause anaemia of chronic disease
- Malaria –> HA
