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MEH * > S6 Haemotological Changes in Systemic Disease > Flashcards

S6 Haemotological Changes in Systemic Disease Flashcards

1
Q

What is the physiological life cycle of blood cells?

A
  1. Haemopoiesis in bone marrow
  2. Peripheral blood cells
  3. Removal by RES
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2
Q

What factors can changes to the blood in systemic disease be due to?

A
  • underlying physiological or external cause e.g. abnormal cytokines
  • complications of the disease
  • treatment - adverse effects
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3
Q

What are 3 contributors to anaemia of chronic disease? What are they all caused by?

A
  • iron dysregulation - availed iron isn’t released for use in bone marrow
  • marrow shows a lack of erythropoietin
  • reduced lifespan of red cells

Inflammatory cytokines

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4
Q

What are some diseases that can cause anaemia of chronic disease?

A
  • rheumatoid arthritis
  • inflammatory bowel disease e.g. ulcerative colitis/Crohn’s disease
  • chronic infections e.g. TB
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5
Q

What sort of iron deficiency is anaemia of chronic disease?

A

A functional iron deficiency

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6
Q

What is a functional iron deficiency?

A

There is sufficient iron in the body but it’s not available to be used in the bone marrow to develop erythroid cells

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7
Q

What is the main iron exporter out of macrophages and gut cells?

A

Ferroportin

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8
Q

What is hepcidin regulated by?

A

HFE, transferrin receptor and inflammatory cytokines

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9
Q

What does hepcidin do?

A

Degrades ferroportin to prevent iron release from macrophages and the gut

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10
Q

How does an inflammatory condition cause anaemia, in steps?

A
  1. Cytokines released by immune cells e.g. IL6
  2. Increased production of hepcidin by the liver
  3. This inhibits ferroportin
  4. Decreased iron release from RES or decreased iron absorption in gut
  5. Plasma iron is reduced
  6. Inhibition of erythropoiesis in bone marrow
  7. Anaemia
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11
Q

What 5 factors can cause chronic kidney disease?

A
  • reduced erythropoietin production due to damage to kidneys
  • raised cytokines
  • reduced clearance of hepcidin and increased hepcidin production due to inflammatory cytokines
  • dialysis can cause damage to red blood cells
  • reduced lifespan of RBCs as a direct effect of uraemia
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12
Q

What does uraemia also inhibit as well as reducing RBC lifespan

A

Inhibits megakaryocytes leading to low platelets count

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13
Q

How do you treat anaemia of chronic disease?

A
  • if associated with renal failure, use recombinant human EPO and ensure adequate supplies of vitamin B12, folate and iron
  • transfusion of RBCs if all else fails and patient is symptomatic
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14
Q

How do you test to see if someone has anaemia of chronic disease?

A

Reticulocyte Hb content (CHr) to assess for functional iron deficiency

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15
Q

How do you manage anaemia of chronic disease?

A

Give iron if low in ferritin or low CHr - should be given as IV because absorption is impaired

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16
Q

What cells can be abnormal in kidney disease?

A
  • red blood cells
  • neutrophils
  • platelets
17
Q

What can cause red blood cells to be abnormal in kidney disease?

A
  1. Anaemia - chronic kidney disease, blood loss, dietary causes
  2. Secondary polycythaemia - renal transplant, renal tumour, polycystic kidneys
18
Q

What can cause neutrophils to be abnormal in kidney disease?

A
  1. Neutropenia - immunosuppression (post renal transplant), drugs, autoimmune kidney disease
  2. Neutrophilia - inflammation, infection, drugs e.g. steroids
19
Q

What can cause platelets to be abnormal in kidney disease?

A
  • thrombocytopenia - uraemia inhibits platelet production, drugs, haemolytic uraemia syndrome
  • thrombocytosis - inflammation, bleeding, iron deficiency
20
Q

What is rheumatoid arthritis?

A

A chronic immune mediated inflammatory condition

21
Q

How is rheumatoid arthritis treated?

A
  • pain relief e.g. NSAIDs
  • disease modifying agents e.g. corticosteroids, chemotherapy, biological agents (monoclonal antibodies against cytokines)
22
Q

What is Felty’s syndrome?

A

A triad of conditions/symptoms/signs that link together

  • splenomegaly, neutropenia, rheumatoid arthritis
23
Q

What can cause neutropenia?

A
  • splenomegaly contributing to destruction of neutrophils

* failure of bone marrow to produce neutrophils due to an insensitivity of myeloid cells to the stimulator G-CSF

MEH * (22 decks)

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