S6 L1 - Haematology in Systemic disease

Question 1

• *Changes to blood in systemic disease**
• 3 factors that will have the blood

Answer 1

• *Changes to blood in systemic disease**
• 3 factors that will have the blood
• • Underlying physiological or external cause
• • Complications of the disease
• • Treatment - adverse effects

Question 2

Anaemia of chronic disease
(refer back to session 4 or 5 notes on this)
- What do the cytokines cause (3 things)
- Examples of diseases

Recap:
‘Functional’ iron deficiency, surfficient iron in the body, but not available to the developing erythroid cells

Answer 2

Anaemia of chronic disease
(refer back to session 4 or 5 notes on this)
- What do the cytokines cause (3 things)
— Iron dysregulation: available iron is not release for use in bone marrow
— The marrow show a lack of response to erythropoietin
— There is reduced lifespan of red cells
- Examples of diseases
Rheuamtoid arthiritis, Inflammatory disease (ulcerative colitis, crohns disease, chronic infections e.g. TB, bronchiectasis

ALWAYS TREAT UNDERLYING CONDITION

Question 3

• *Anaemia of Chronic Kidney Disease**
• 5 reasons for the development of anaemia

Treatment:

Answer 3

1. Reduced erythropoietin production due to damage to kidneys
2. A of CD caused by raised cytokines
3. Reduced clearance of hepcidin
4. Dialysis - damage to RBC
5. Reduced lifespan of RBC as a direct effect of uraemia

Uraemia - also inhibits megakaryocytes leading to low platelet counts

Treatment:
pic

Question 4

Possible haemotological abnormalities in kidney disease

Answer 4

Question 5

• *Rheumatoid arthiritis**
• Treated with…
• Anaemia is multifactoral - 3 reasons
• When disease is active, what will the blood work show… sometimes opposite because (part of Felty’s syndrome)
• What is Felty’s Syndrome - describe the reason for each component

Answer 5

- Treated with…
— Pain relief, often NSAIDS
— Disease modifying agents: Corticosteroids, chemotherapy drugs
- Anaemia is multifactoral - 3 reasons
Anaemia of Chronic Disease, bleeding due to NSAIDs, risk of autoimmune haemolytic anaemia
- When disease is active, what will the blood work show … sometimes opposite because (part of Felty’s syndrome)
high neutrophils, high platelets. Due to splenomegaly: may have low neutrophils and low platelets
- What is Felty’s Syndrome - describe the reason for each component
(pic)
—> ADDITIONAL QUESTION: Why neutropenia?
(pic)

Question 6

• *Chronic liver disease**
• How does this lead to anaemia
• Problems with bleeding and liver disease
• Other haematological feature of liver disease are dependent on the underlying cause:
• > Alcohol excess
• > Viral hepatitis
• > Autoimmune liver disease

Answer 6

• *How does this lead to anaemia:**
  1. Portal hypertension: this leads to back pressure which causes splenomegaly with leads to splenic sequesteration of cells and overactive removal of cells = low blood counts -> pancytopenia
• *Problems with bleeding:**
  1. Complications of portal hypertension - this also leads to oesophageal and gastric varices - dilated veins prone to bleeding due to higher than normal pressure
  2. Many clotting factors made in the liver
  3. Low platelets (thrombocytopenia) - Thrombopoietin is also made in the liver
  4. Defective platelet function
  5. Endothelial dysfucntion

Other haematological feature of liver disease are dependent on the underlying cause:
-> Alcohol excess:
- Directly toxic to bone marrow - can contribute to pancytopenia
- Secondary malnutrition (esepcially folate deficiency)
-> Viral hepatitis:
- Bone marrow failure (hypoplastic/asplastic marrow) can develop after an episode of hepatitis
-> Autoimmune liver disease:
Immune mediated anaemia, thrombocytopenia or neutropenia

Question 7

Post-operative reactive changes

Answer 7

Question 8

• *Haematological changes with infection:**
• What type of anaemia can malaria cause?
• Bacterial infections haematological change…
• Severe bacterial infections haematological change…
• Parasitic infections haematological change…
• Viral infections haematological change…
• Infection can cause…
• Severe infection can cause…

Answer 8

- What type of anaemia can malaria cause?
Haemolytic anaemia
- Bacterial infections haematological change…
Neutrophilia
- Severe bacterial infections haematological change…
Neutropenia
- Parasitic infections haematological change…
Eosinophilia
- Viral infections haematological change…
Lymphocytosis and neutropenia
- Infection can cause…
Reactive thrombocytosis
- Severe infection can cause:
Thrombocytopenia (esepcially associated with DIC in severe sepsis)

Question 9

Sepsis can lead to clotting abnormalities
- Dissiminated Intravascular Coagulation (DIC)
What happens in DIC?
What is the patient at risk of?

Answer 9

Pathological activation of coagulation
Numerous microthrombi are formed in the circulation
This leads to consumption of clotting factors and platelets, and a consequent microangiopathic haemolytic anaemia (MAHA)
Clotting tests are affected - usually long clotting times, low fibrinogen and raised D-dimers or fibrin degradation products

Risk of both bleeding and thrombosis

Question 10

Haematological changes in cancer (e.g. liver, lung, prostate - not bone marrow or blood stream cancer)

Answer 10

Question 11

• *Leucoerythroblastic film**
• What is this?
• What conditions do you see this in?

Answer 11

Leucoerythroblastic film
- What is this?
Granulocyte precursors and nucleated RBC seen on blood film
- What conditions do you see this in?
Sepsis/shock, Bone marrow infiltration by carcinoma, or haematological malignancy, Severe megaloblastic anaemia, Primary Myelofibrosis (with tear drop RBCs), Leukaemia, Storage disorde