Haematology in systemic disease

Question 1

What is the effect of a chronic release of cytokines on the liver and what effect does this have

Answer 1

Causes increase production of hepcidin by the liver

Increased production causes less iron absorption from the gut and less release of iron by decreasing ferroportin expression

This then causes aneamia

Question 2

What diseases are associated with anaemia of chronic disease

Answer 2

They are associated with chronic inflammatory conditions

R.A.

Chronic infections - TB

Renal disease

Systemic lupus erythematosus

Inflammatory bowel disease

Malignancies

Question 3

What can anaemia of chronic disease develop into

Answer 3

Microcytic anaemia

Question 4

What type of anaemia can patients with chronic kidney disease develop, what happens if there’s an iron deficiency

Answer 4

Develop normochromic normocytic anaemia

Anaemia can become microcytic with an iron deficiency

Question 5

How does chronic kidney disease cause anaemia

Answer 5

Deficiency in erythropoietin production due to damaged kidneys

Reduced clearance of hepcidin from blood

Increased hepcidin production due to inflammatory response

Ureamia due to dysfunctional kidney results in RBC lifespan reduction and inhibition of erythropoiesis

Question 6

What is given to treat renal anaemia and what are the conditions required for it to be successful

Answer 6

Erythropoietin

Patient must have sufficient iron, folate and B12 levels

Question 7

What investigations can be done to check for anaemia of chronic disease

Answer 7

Ferritin - if raised it shows patient has chronic disease but it is also raised in infection

Reticulocyte haemoglobin count (CHr) - if raised it shows patient has anaemia

CRP - raised in inflammation

Question 8

Why might co-existing iron-deficiencies occur in R.A.

Answer 8

Because of NSAIDs and corticosteroids used by the patient which can cause gastrointestinal blood loss

Question 9

What might RA cause if the disease flares up

Answer 9

Neutrophilia and thrombocytosis

Question 10

What is Felty’s syndrome

Answer 10

Triad of RA, splenomegaly and thrombocytopaenia

Question 11

What is the triad of RA, splenomegaly and thrombocytopaenia

Answer 11

Felty’s syndrome

Question 12

What does chronic excessive alcoholism affect in the body

Answer 12

Bone marrow

Spleen

Liver

Blood cells

Question 13

What is excessive alcohol consumption’s affect on bone marrow

Answer 13

Suppresses haematopoiesis

Produces structurally abnormal blood cell precursors that cannot mature

Question 14

What is excessive alcohol consumption’s affect on BCs

Answer 14

RBCs become macrocytic

Thrombocytopaenia is common

Acetaldehyde from ethanol metabolism forms acetaldehyde adducts on RBCs causing immune response against them

Question 15

What is excessive alcohol consumption’s affect on the liver

Answer 15

Cirrhosis which results in abnormal production of some clotting factors

Question 16

What is excessive alcohol consumption’s affect on the spleen

Answer 16

Can cause portal hypertension which leads to congestive splenomegaly and splenic trapping of all blood cells resulting in pancytopaenia

Question 17

What infection causes neutrophilia

Answer 17

Bacterial

Question 18

What infection causes neutropaenia

Answer 18

Post-viral infection

Sepsis

Severe infection

Question 19

What infection causes lymphocytosis

Answer 19

Viral infection in children

Question 20

What infection causes lymphopaenia

Answer 20

HIV

Question 21

What infection causes eosinophilia

Answer 21

Parasitic infection

Question 22

What infection causes DIC

Answer 22

Sepsis

Question 23

What infection causes splenomegaly

Answer 23

Malaria

Glandular fever

Question 24

What infection causes aplastic anaemia

Answer 24

Viral hepatitis

Question 25

What infection causes haemolysis

Answer 25

Malaria

Question 26

What infection causes thrombocytopaenia

Answer 26

Severe infection

Question 27

Which patients are at increased risk of DVT and what factors increase their risk

Answer 27

Immobile patients post-operatively Cancer, dehydration and/or pelvic or orthopadic surgery increases risk

Question 28

What factors are patients likely to present with after minor surgery

Answer 28

Mild thrombocytosis or neutrophilia

Question 29

What will most likely be seen post-splenectomy

Answer 29

Thrombocytosis and lymphocytosis Howelll-jolly bodies in red cells

Question 30

What blood film is seen if the bone marrow is infiltrated with a metastatic cancer

Answer 30

Leucoerythroblastic blood film - immature white cells and nucleated RBCs

Question 31

How can cancer cause a fall in Hb

Answer 31

Chemotherapy interrupts blood cell production

Question 32

Why might liver disease cause splenomegaly

Answer 32

Portal hypertension can lead to blood not flowing correctly from the spleen to the liver, so it backs up in the spleen causing splenomegaly

Question 33

What does splenomegaly cause

Answer 33

Splenic sequestration of cells Overactive removal of cells

Question 34

Why might you get blood loss in a patient with liver disease

Answer 34

Deficiences in coagulation factors Endothelial dysfunction - biochemical changes Thrombocytopaenia - due to splenomegaly Defective platelet function

Question 35

Why does liver disease increase susceptibility to bleeding

Answer 35

Loss of clotting factors that are produced by the liver, also makes bleeding harder to stop

Question 36

What sort of RBC might you see in a patient with liver disease and why

Answer 36

Macrocytosis and target cell formation Due to altered lipid content of the blodd causing abnormalities in the RBC membrane