Page 402 - Essential Haematology

388 / Chapter 28 Haematological changes in systemic disease

Figure 28.5 Liver disease:
peripheral blood fi lm showing:
(a) macrocytosis and target cells;
and (b) marked acanthocytosis
and echinocytosis in Zieve ’ s
(a) (b) syndrome.

’
atitis (usually non - A, non - B, non - C) is associated or Hashimoto s disease, is associated with pernicious
with aplastic anaemia. anaemia. Iron deficiency may also be present, par-

The acquired coagulation abnormalities associ- ticularly in women with menorrhagia.
ated with liver disease are described on p. 355 .

There are deficiencies of vitamin K - dependent
factors (II, VII, IX and X) and, in severe disease, Infections
of factor V and fi brinogen. Th rombocytopenia
may occur from hypersplenism or from Haematological abnormality is usually present in
immune complex - mediated platelet destruction. patients with infections of all types (Table 28.5 ).
Abnormalities of platelet function may also be Th e effect of inflammation as a prothrombotic

present. Dysfibrinogenaemia with abnormal fi brin stimulus is also discussed on p. 369 .

polymerization may occur as a result of excess sialic
acid in the fibrinogen molecules. A consumptive

coagulopathy may be superimposed. Th ese haemo- Bacterial i nfections
static defects may contribute to major blood loss
from bleeding varices caused by portal Acute bacterial infections are the most common
hypertension. cause of neutrophil leucocytosis. Toxic granulation,
D ö hle bodies and metamyelocytes may be present
in the blood. Leukaemoid reactions with a white
Hypothyroidism
9
cell count > 50 × 10 /L and granulocyte precursors
A moderate anaemia is usual and may be caused by in the blood may occur in severe infections, particu-
lack of thyroxine. T 3 and T 4 potentiate the action larly in infants and young children. Mild anaemia
of erythropoietin. There is also a reduced oxygen is common if the infection is prolonged. Severe

need and thus reduced erythropoietin secretion. haemolytic anaemia occurs in bacterial septicae-

The anaemia is often macrocytic and the mean mias, particularly those caused by Gram - negative
corpuscular volume falls with thyroxine therapy. organisms, where there is usually associated DIC
Autoimmune thyroid disease, especially myxoedema (see p. 355 ). DIC dominates the clinical picture