hemato in systemic diseases

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hemato in systemic diseases

  1. 1. Hematological aspects in systemic diseases Dr.Tanyarat Jomgeow
  2. 2. Hematological manifestation in systemic diseases <ul><li>WBC </li></ul><ul><li>RBC </li></ul><ul><li>Platelet </li></ul><ul><li>Coagulation </li></ul><ul><li>Fibrinolysis </li></ul><ul><li>Etc. </li></ul><ul><li>Stage of disease related </li></ul><ul><li>with hematopoiesis or </li></ul><ul><li>blood cells life cycle </li></ul><ul><li>Clinical manifestation </li></ul><ul><li>related to hematological </li></ul><ul><li>manifestation </li></ul><ul><li>Treatment or drug related to </li></ul><ul><li>hematological manifestation </li></ul>
  3. 3. Chronic disorders <ul><li>* Anemia of chronic disease </li></ul><ul><li>patients with variety of chronic </li></ul><ul><li>inflammatory or malignancy </li></ul><ul><li>Normochromic normocytic anemia or </li></ul><ul><li>mildly microcytic indices (MCV 75-85 fL) </li></ul><ul><li>SI, TIBC reduced </li></ul><ul><li>Serum ferritin normal or raised </li></ul><ul><li>BM storage iron normal, erythroblast iron reduced </li></ul><ul><li>ESR, CRP raised </li></ul>
  4. 4. Pathogenesis of chronic disorders Inflammatory in chronic diseases Decreased release iron from macrophage Increased release cytokines, IL-6, IL-1, TNF <ul><li>Reduced erythropoiesis </li></ul><ul><li>Reduced erythropoietin </li></ul>
  5. 5. 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
  6. 6. 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
  7. 7. 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
  8. 8. Hematological manifestation Platelet - autoimmune thrombocytopenia Coagulation - lupus anticoagulant interfere blood coagulation Autoimmune diseases and other connective tissue disorders *LE, ANF/ANA positive, ESR raised
  9. 9. 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
  10. 10. 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)
  11. 11. 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
  12. 12. 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
  13. 13. Infection Hematological manifestation Malaria - Hemolysis - DIC - Thrombocytopenia - Chronic disorder => anemia - Splenomegaly

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