L11 - Haematological Changes In Systemic Disease

Question 1

What would be the typical picture of a patient with anaemia of chronic disease?

Answer 1

Associated chronic inflammatory condition/infectious condition or malignancy
Raised cytokines
Normal whole body iron
Microcytic/normocytic anaemia
decreased ferroportin

Question 2

Hepcidin production is increased due to inflammatory cytokines in ACD but it’s clearance is reduced in chronic kidney disease, what would symptoms be

Answer 2

Reduced GFR
normocytic/microcytic anaemia
Normal/high ferritin
elevated CRP 
Uraemia (High urea due to kidney dysfunction) which causes a reduce in RBC lifespan (inhibits megakaryocytes leading to thrombocytopenia
Potential GI bleed due to low platelets 
low ferroportin

Question 3

How would you treat an anaemia in a patient with chronic kidney disease?

Answer 3

Treat the kidney disease and give erythropoietin

Question 4

Rheumatoid arthritis can be seen by a rheumatoid hand, what common haematological symptoms do we often see in a patient due to taking NSAID’s for the illness

Answer 4

Anaemia
Thrombocytopenia
Neutropenia

Question 5

Feltys syndrome is a long term complication of RA, what is the triad consisting of

Answer 5

Rheumatoid arthritis
Splenomegaly
Neutropenia

Question 6

Alcohol is toxic to the liver, what haematological symptoms can it cause

Answer 6

Thrombocytopenia (due to impaired thrombopoietin production which is made in the liver)/
Splenomegaly due to portal hypertension/
anaemia (due to splenic pooling) which could progress to a pancytopenia/
Coagulation factor deficiency/
Target cells

Question 7

What haematological features would you see in someone post-operatively?

Answer 7

anaemia, mild ‘reactive’ thrombocytosis or neutrophilia

Question 8

What kind of infection would you expect if you saw a lymphocytosis

Answer 8

Viral

Question 9

How can sepsis lead to DIC

Answer 9

Sepsis can allow bacteria to enter the epithelium, pathological activation of coagulation -> microthrombi formed in circulation -> clotting factors used up -> DIC

(DIC is a widespread pathological clot which leads to thrombosis of small vessels and bleeding due to using up all the clotting factors)

Question 10

What kind of blood film can be seen in patients with a malignancy that has entered the bone marrow?

Answer 10

Leucoerythroblastic film - granulocyte precursors and nucleated RBC’s on blood film

Question 11

Describe common causes of

a) neutropenia
b) neutrophilia
c) lymphocytosis
4) eosinophilia

Answer 11

A)severe sepsis/post viral infection
B) bacterial infection
C) viral infection
D) parasitic infection

Question 12

Briefly explain anaemia of chronic disease

Answer 12

Chronic inflammatory condition causes release of cytokines such as IL-6 -> this causes a reduction in eryhtropoietin production -> it also causes the upregulation of hepcidin from the liver -> this inhibits the translocation of ferroportin -> this means we have a functional lack of iron as it is traped in ferritin form within the enterocytes and recycling macrophages (as they have ferroportin too). Note ACD also results in a reduced lige span of RBC’s

Question 13

Give some examples of diseases causing ACD

Answer 13

Chronic kidney disease/RA/Ulcerative colitis/crohn’s etc.

Question 14

Name one thing to do with the kidneys that coudl cause the following:

a) anaemia
b) polycythaemia
c) neutropenia
d) neutrophilia
e) thrombocytopenia
f) thrombocytosis

Answer 14

a) ACD
b) renal tumour
c) immunosuppression post renal transplant/myeloma
d) inflammation/infection/steroids
e) uraemia/drugs
f) iron deficiency

Question 15

Distinguish between ACD and iron deficiency

Answer 15

In iron deficiency total body iron will be low, in ACD it is a functional lack due to increased activity of cytokines and macrophages meaning that iron can’t be absorbed

Question 16

What haematological abnormalities would suggest sepsis?

Answer 16

neutrophilia initially and in severe a neutropenia and a thrombocytopenia