Changes in Systemic Disease

Question 1

What causes the problem in anaemia of chronic disease?

Answer 1

Inflammatory cytokines

Question 2

What is the effect of inflammatory cytokines on erythropoiesis?

Answer 2

Iron dysregulation - iron not released for use
Marrow doesn’t respond to EPO
Reduced life span of RBCs

Question 3

What happens in anaemia of chronic renal failure?

Answer 3

Reduced EPO production due to kidney damage
Raised cytokines - increased hepcidin production
Reduced clearance of hepcidin
Uraemia - reduced lifespan of RBC

Question 4

How is anaemia of chronic disease managed?

Answer 4

Treat underlying condition

Ensure B12, folate and iron levels all sufficient

Question 5

How is anaemia of chronic renal failure managed?

Answer 5

Recombinant human erythropoietin

Question 6

What is Felty’s syndrome?

Answer 6

Triad of

• RA
• splenomegaly
• neutropenia

Question 7

Why does liver disease cause splenomegaly?

Answer 7

Portal hypertension

Question 8

What is Zieve’s syndrome?

Answer 8

Acute haemolytic anaemia during withdrawal from alcohol abuse

Question 9

Why is there thrombocytopenia in liver disease?

Answer 9

Splenic pooling - splenomegaly
Reduced coagulation factors
Reduced thrombopoietin

Question 10

What is DIC?

Answer 10

Disseminated intravascular coagulation

Pathological activation of coagulation - numerous microthrombi formed in circulation