Session 6 -Haematology in systemic disease Flashcards
what is the physiological life cycle of blood cells
from the bone marrow to peripheral blood cells to the reticulo-endothelial system
what things contribute to the changes to blood in systemic disease
IL-6 - underlying physiological or external cause
complications of disease
treatmemt- adverse effects
what contributes to anaemia of chronic disease
iron dysregulation- iron isnt released for use in bone marrow
lack of response to erythropoeietin
reduced life span of red cells
what dieases can lead to anaemia of chronic disease
rheumatoid diseases
inflammatory bowel disease
chronic infections- TB
why is anemia of chronic disease a functional iron deficiency
sufficient iron in the body but not available to the developing erythroid cells
what is the main exporter of iron out of a macrophage
ferroportin
what regulates hepcidin
HFE
Transferrin receptor
inflammatory cytokines
what does Hepcidin do
prevents iron release from macrophages
by degrading ferroportin the protein involved in moving iron out of cells
prevents iron absorption from the gut
how does an inflammatory condition cause anaemia
cytokines- IL-6- are released by immune cells
increased production of Hepcidin by liver
inhibition of ferroportin
decreased iron release and absorption
plasma iron reduced
inhibition of erythropoiesis in bone marrow
what factors lead to anaemia of chronic kidney disease
raised cytokines
reduced clearance of hepcidin and increased hepcidin production due to inflammatory cytokines
dialysis- damage to RBC
reduced lifespan of RBC as a direct effect of uraemia
reduced erythropoietin production due to damage to kidneys
what effects can uraemia have
inhibits megakaryocytes leading to low platelet counts
reduced lifespan of RBC
what is needed for EPO therapy to work
iron vit B12 and folate
how can you treat anaemia of chronic disease
treat the underlying condition
-recombinant human erythropoietin
if fails- transfuse red cells
How is rheumatoid arthritis usually treated
Pain relief- NSAIDs
Disease modifying agents- DMARDS
- corticosteroids
- chemotherapy
- biological agents
What is feltys syndrome
Triad of syndromes
- Rheumatoid arthritis
- splenomegaly
- neutropenia
Why is neutropenia a part of feltys syndrome
- due to splenomegaly contributing to peripheral destruction of neutropenia
- failure of bone marrow to produce neutrophils as there is insensitivity of the myeloid cells to the stimulator GCSF
In liver disease why can gastric varices develop
Portal hypertension leads to oesophageal and gastric varices because the dilated vessels prone to bleeding due to hig than normal pressure
What are clotting factors dependant on
Vitamin K
Why is thrombocytopenia seen in liver disease
Impaired production of thrombopoietin- made in liver
Splenic pooling
Increased destruction
What type of red blood cells are seen liver disease
Target cells
What is disseminated intravascular coagulation
Pathological activation of coagulation
Numerous microthromi are formed in the circulator
Consumption of clotting factors and platelets and a consequent micrangiopathic haemolytic anaemia
Long clotting times
Low fibrinogen
Raised D-Dimers or fibrin degradation products
Risk of bleeding and thrombosis
What is leucoerythroblastic film
Spilling out from the marrow into the blood when the marrow is under stress
Granulocyte precursors and uncleared RBCs seen on blood film
What can cause leucoerythroblastic film
Sepsis/shock
Bone marrow infiltration by carcinoma or haematological malignancy
Severe megaloblastic anaemia
Primary myeofibrosis (with tear drop RBCs)
Leukaemia
Storage disorders
