Haematology in systemic disease Flashcards
what could cause changes to blood in systemic disease?
- underlying physiological or external cause.
- complications of disease.
- adverse effects.
in anaemia of chronic disease caused by chronic inflammation there are 3 contributors all by cytokines. name them.
- iron dysregulation : not released for BM.
- marrow lack of response to EPO.
- reduced lifespan of RBC.
eg: rheumatoid arthritis, inflammatory bowel disease.
what is ‘functional iron deficiency’?
- sufficient iron in body but not available to developing erythroid cells.
what is the significance pf Hepcidin?
- produced in liver and degrades ferroportin which exports iron out of macrophages, hence prevents iron release and absorption.
- in turn erythropoiesis in BM affected.
- regulated by inflammatory cytokines etc.
- treat underlying not give more iron!
how does anaemia of chronic kidney disease come about?
- CKD and associated raised cytokines.
- reduced EPO due to kidney damage and reduced hepcidin clearance and increased levels due to cytokines anyway.
- dialysis - damage to RBC due to shear stress, reduced lifespan of RBC as uraemia which also inhibits platelets indirectly.
how is kidney disease anaemia treated?
- recombinant human EPO.
- ensure vitamin B12, Folate and iron stores adequate.
- transfuse red cells only as last resort is symptomatic.
what other possible haematological abnormalities can be seen in kidney disease?
- anaemia, secondary polycythaemia, neutropenia, neutrophilia, thrombocytopenia.
- look at slides!
what is rheumatoid arthritis?
- chronic immune mediated inflammatory condition.
- treated with NSAID, corticosteroids, chemo.
- anaemia happens due to chronic disease, steroids, haemolytic risk.
what is felty’s syndrome?
triad of rheumatoid arthritis, splenomegaly, neutropenia (due to splenomegaly) causing repeated infections.
- BM failure to produce neutrophils as insensitivity of myeloid cells to GCSF.
how would chronic liver disease lead to haematological abnormalities?
- portal hypertension which causes splenomegaly which leads to splenic sequestration of cells, overactive removal of cells.
- low blood counts.
- target cells.
what haematological features liver disease?
- portal hypertension : oesophageal and gastric varices (dilated veins prone to bleeding due to higher pressure).
- blood loss by coagulation deficiencies, endothelial dysfunction, thrombocytopenia, defective platelets.
- AS MOST CLOTTING FACTORS MADE IN LIVER.
- thrombocytopenia as thrombopoeitin made in liver.
- alcohol excess, viral hepatitis, autoimmune liver disease.
what are the post-operative haematological changes seen?
- anaemia as blood loss and temporary relative polycythaemia dehydration (anaesthetist prevents).
- neutropenia in sepsis, neutrophillia as post-op reaction.
- thrombocytopenia due to sepsis or drugs, thrombocytosis as post-op reaction.
- if HB down and platelets increased blood loss suggested.
what are haematological changes seen with infection?
- chronic infection : cause anaemia of chronic disease, haemolytic in malaria.
- bacterial neutrophilia, severe bacterial/ sepsis in neuropenia.
- parasitic eosinophilia.
- viral infection lymphocytosis and neutropenia.
- reactive thrombocytosis as infection, severe infection cause thrombocytopenia and DIC in severe sepsis.
how can sepsis lead to clotting abnormalities?
- DIC : pathological activation coagulation, microthrombi in circulation, clotting factors consumed at high rate.
- longer clotting times risk both bleeding and thrombosis.
what are the haematological changes seen in cancer?
- anaemia : bleeding, iron deficiency, ACD, chemo.
- polycythaemia : EPO tumours.
- neutropenia : chemo, marrow infiltration.
- neutrophilia : inflammation, infection.
- thrombocytopenia : chemo, sepsis, DIC, marrow infiltration
- thrombocytosis : inflammation, infection, bleeding, iron deficiency.
- VENOUS THROMBOSIS RISK.
