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Hematological Abnormalities in Systemic Diseases

Explore anemia, platelet dysfunction, coagulation abnormalities & more in renal, liver, endocrine, connective tissue disorders & malignant diseases, infections.

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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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