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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