The document discusses various hematological manifestations that can occur in systemic diseases. It covers how diseases like chronic disorders, malignancies, autoimmune diseases, renal diseases, liver diseases, and infections can impact red blood cells, white blood cells, platelets, and coagulation. The hematological effects are often related to the stage and chronicity of the underlying disease, and can present as anemias, leukocytosis, thrombocytopenia, or coagulation disorders. Treatment may be aimed at the underlying disease or specific hematological abnormalities.

1. Hematological aspects in systemic diseases Dr.Tanyarat Jomgeow

2. 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

3. 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

4. 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

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. 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. 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. 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. 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. 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. 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. 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. Infection Hematological manifestation Malaria - Hemolysis - DIC - Thrombocytopenia - Chronic disorder => anemia - Splenomegaly