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Hemato in systemic diseases

Hemato in systemic diseases






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    Hemato in systemic diseases Hemato in systemic diseases Presentation Transcript

    • 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