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Hematological Abnormalities in Systemic Diseases

By Fatin Al-Sayes MD, MSc, FRCPath Consultant Hematology Assistant Professor. Hematological Abnormalities in Systemic Diseases. Anemia in renal disease. Seen in chronic renal failure Severity relates to the degree of renal impairment Due to inadequate EPO secretion

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Hematological Abnormalities in Systemic Diseases

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  1. By Fatin Al-Sayes MD, MSc, FRCPath Consultant Hematology Assistant Professor Hematological Abnormalities in Systemic Diseases

  2. Anemia in renal disease • Seen in chronic renal failure • Severity relates to the degree of renal impairment • Due to inadequate EPO secretion • Other contributory factors • Bone marrow suppression secondary to uraemia •  RBCs survival • Uraemia cause platelets dysfunction leading to anaemia secondary to blood loss • Iron, folate loss during dialysis  anemia • Aluminum toxicity

  3. Platelet and coagulation abnormalities: • Platelets dysfunction occur in CRF secondary to uraemia • HUS & TTP are associated with thrombocytopenia • Nephrotic syndrome is associated with thrombosis.

  4. Laboratory changes: • Mostly normocytic-normochromic anemia. • Specific abnormalities in WBC, platelets

  5. Anemia in liver disease Causes • Common • Chronic disorder • Alcohol  with all direct effect on erythropoeisis • Folate deficiency • Alcohol  on folate metabolism • Nutritional deficiency • Blood loss from oesophagealvarices • Hypersplenism

  6. cont. of Causes • Hemolytic anemia • Zieve’s syndrome • Autoimmune in association with chronic active hepatitis • Viral hepatitis may provoke oxidative hemolysis • Acute liver failure Coagulation abnormalities • DIC and microangiopathic hemolytic anemia

  7. Endocrine disease • Hypopituitarism • Normocytic-normochromic anemia • Leucopenia • Thyroid disorders • Hypothyroidism can cause normocytic-normochromic anemia, microcytic or macrocytic type of anemia • Adrenal disorders • Hypoadrenalism result in normochromic, normocytic anemia • Cushing’s disease result in erythrocytosis

  8. Connective tissue disordersHematological changes: • Anemia of chronic disorders • GIT blood loss leading to iron deficiency anemia • Bone marrow suppression • Autoimmune hemolytic anemia occurs in SLE

  9. Platelets and Coagulation Abnormalities Autoimmune thrombocytopenia Antiphospholipid antibodies are described in SLE

  10. Metastatic malignant diseases • Anemia • Anemia of chronic disorders • Blood loss and iron deficiency • Marrow infiltration • Folate deficiency • Marrow suppression from radiotherapy or chemotherapy • hemolysis

  11. cont. of Metastatic malignant diseases • White cell changes • Leukaemoid reaction • Malignant cells may circulate in the blood • WBC’s changes associated with eg. Hodgkin’s disease • Coagulation and platelets abnormalities • Thrombocytosis • DIC • Acquired inhibitors to coagulation factors

  12. Infection • Bacterial infection • Leukaemoid reaction • Severe haemolytic anemia • DIC • Chronic bacterial infection • E.g. TB  anemia, secondary to marrow replacement and fibrosis

  13. cont. of Infection • Viral infection • Infectious mononucleosis is associated with cold type autoimmune hemolytic anemia • Aplastic anemia secondary to hepatitis A, C, etc. • Acute thrombocytopenia occur in viral infection, e.g. EB, MCV • Parvovirus-B19 is usually accompanied by pure red cell aplasia

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