Systemic Causes of Haematological Changes #3

Liver Disease

Bleeding
 - deficiency of vitamin K factors (II, VII, IX, X), Factor V, fibrinogen
 - functional abnormalities of fibrinogen
 - increased fibrinolytic activity
 - decreased plts (Hsplen, direct alcohol effect)
 - portal HT - varices

Anaemia
 - bleeding & iron deficiency
 - alcohol - direct toxic effect
 - folate def (megaloblastic An)

 - Hsplen
 - Hlysis - alcohol, Copper (Wilson's), AI (a/w hepatitis)

Red cell changes (macrocytosis, target cells, spur cells)


Chronic Renal Failure

Bleeding

 - abn plt function
 - thrombocytopenia (AI, HUS)

Anaemia
 - decrsd erythropoetin production
 - Fe def (dialysis, venesection, poor plt function)
 - aluminium toxicity
 - folate def (chr dialysis)
 - Hlysis (HUS)
 - anaemia of chronic disease

Red cell changes (Burr cells, fragmented cells in HUS)

Anaemia
 - chronic disease
 - Fe deficiency (Chronic bleeding, *GI tract tumours)
 - immune haemolytic anaemia *NHL
 - pure RC aplasia a/w/ thymoma
 - BM infiltration (extensive)
 - folate deficiency (anorexia, drugs)


Polycythaemia
 - erythropoietin-producing tumours eg kidney, cerebellum, liver

Platelets & coagulation
 - thrombocytosis - eg GI bleeding, reactive
 - DIC - eg mucin-secreting carcinoma
 - coagulation factor aB - eg to factor VIII


Hsplenism
Incrsd pooling, sequestration, destruction

Causes An, Leucop, Tbcytop

Hyposplenism

- splenectomy
- sickle cell dis

- essential thrombocythaemia
- adult coeliac dis

Splenic function impaired by
- corticosteroids
- radiation

Haematological changes
RCCs:
- Target cells

- Howell-Jolly bodies (DNA remnants)

- siderotic granules (iron-containing)

- nucleated RBCs

WCCs:
- early after splenectomy = Nphilia
- ltr = lymphocytosis, monocytosis

Plts:

- early post-splen = marked tbcytosis
- ltr = plts slightly elevated

Cxs:
Increased risk of fulminant infection (*encapsulated bact, malaria)
- S Pneumoniae
- N meningitidis
- H influenzae

Tx

Life-long prophylactic penicillin/erythromycin (prior to splenectomy if poss)
Immunisation - pneumococcus, HiB, meningococcus