Hematological aspects

in systemic diseases

Dr.Tanyarat Jomgeow

Hematological manifestation

in systemic diseases

-WBC

-RBC

-Platelet

-Coagulation

-Fibrinolysis

Etc.

-Stage of disease related

with hematopoiesis or

blood cells life cycle

-Clinical manifestation

related to hematological

manifestation

-Treatment or drug related to

hematological manifestation

Chronic disorders

* Anemia of chronic disease

patients with variety of chronic

inflammatory or malignancy

-Normochromic normocytic anemia or

mildly microcytic indices (MCV 75-85 fL)

-SI, TIBC reduced

-Serum ferritin normal or raised

-BM storage iron normal, erythroblast iron reduced

-ESR, CRP raised

Pathogenesis of chronic disorders

Inflammatory in chronic diseases

Decreased release iron from macrophage

Increased release cytokines, IL-6, IL-1, TNF

-Reduced erythropoiesis

-Reduced erythropoietin

Malignant diseases

Hematological manifestation

RBC - Anemia

chronic disorders, blood loss,

iron deficiency, folate deficiency, hemolysis

marrow infiltration, marrow suppression

from chemotherapy or radiotherapy

- Leukoerythroblasic blood film (NRBC and

immature granulocyte )

- Polycythemia => tumor of renal, hepatic,

cerebellar, uterine

Malignant diseases

Hematological manifestation

WBC - Leukemoid reaction

wide spread of tumor necrosis and

inflammation

Platelet and blood coagulation

- Thrombocytosis or thrombocytopenia

- Metastasis tumor => DIC, hemostasis failure

Autoimmune diseases and

other connective tissue disorders

Hematological manifestation

RBC - Anemia , RBC agglutination, rouleaux formation

autoimmune hemolytic anemia

chronic disorders

iron deficiency by GI bleeding associated

with salicylates, anti-inflammatory drugs,

corticosteroid

WBC - Leukocytosis or leukopenia

Hematological manifestation

Platelet

- autoimmune thrombocytopenia

Coagulation

- lupus anticoagulant interfere blood coagulation

Autoimmune diseases and

other connective tissue disorders

*LE, ANF/ANA positive, ESR raised

Renal diseases

Hematological manifestation

RBC - Anemia

Chronic diseases => chronic renal failure

Uremia => inhibit erythroid proliferation

=> burr cells

Dialysis => blood loss, aluminium excess

Erythropoietin

HUS (hemolytic uremic syndrome)

- Microangiopathic hemolytic anemia,

fragmented RBC, hematuria

- thrombocytopenia

Liver diseases

Hematological manifestation

RBC - Anemia

*macrocytic anemia with target cells

(increased of choresterol in membrane)

*hemolytic anemia in chronic immune

hepatitis

* Viral hepatitis associated with aplastic

anemia

Coagulation

Deficiency of Vit-K dependent coagulation factor

(factor II, VII, IX, X)

Infection

Hematological manifestation

Bacteria

Acute bacterial infection

- neytrophil leukocytosis, toxic granulation

- Dohle bodies, shift to the left of granulocyte

Septicemia

- severe hemolytic anemia

- Leukemoid reaction

- DIC

Infection

Hematological manifestation

Viral infection

- mildly anemia (acute viral infection)

- Infectious mononucleosis , atypical lymphocyte

- Some patients develop PNH, TTP-HUS

- Aplastic anemia may occur in viral hepatitis, EBV,

CMV

- Thrombocytopenia and platelet clumping

Infection

Hematological manifestation

Malaria

- Hemolysis

- DIC

- Thrombocytopenia

- Chronic disorder => anemia

- Splenomegaly