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390 / Chapter 28 Haematological changes in systemic disease

Figure 28.6 Peripheral blood fi lm
in a patient with haemolytic
anaemia in clostridial septicaemia
showing red cell contraction and
spherocytosis.

Chronic bacterial infections are associated with survival (e.g. in hereditary spherocytosis or sickle

the anaemia of chronic disorders. In tuberculosis, cell disease; see p. 78, Fig. 22.5 ).
additional factors in the pathogenesis of anaemia Acute thrombocytopenia is not uncommon in
include marrow replacement and fi brosis associated rubella, morbilli and varicella infections. Rubella
with miliary disease and reactions to antitubercu- and cytomegalovirus (CMV) infections may cause
lous therapy (e.g. isoniazid is a pyridoxine antago- a reactive lymphocytosis similar to that found in
nist and may cause sideroblastic anaemia). infectious mononucleosis. CMV may be responsi-
Disseminated tuberculosis is associated with leu- ble for a post - transfusion mononucleosis - like syn-
kaemoid reactions and patients with involvement of drome, CMV being transmitted by leucocytes.
bone marrow may show leucoerythroblastic changes CMV infections in infants are associated with
in the peripheral blood film (see Fig. 8.9 ). massive hepatosplenomegaly. In bone marrow

transplant recipients or other immunosuppressed
patients, CMV infections may cause pancytopenia
Viral i nfections
as well as other severe disorders (e.g. pneumonitis

Acute viral diseases are often associated with a mild or hepatitis; see p. 309 ).
anaemia. An immune haemolytic anaemia with an
anti - i autoantibody is associated with infectious
HIV i nfection
mononucleosis (see p. 138 ). Viral infections, as well
as syphilis, have been associated with paroxysmal This is associated with a wide range of haematologi-

cold haemoglobinuria (see p. 84 ). Viruses have also cal changes. These are caused by marrow defects and
been linked to the pathogenesis of the haemolytic immune cytopenias directly resulting from HIV

uraemic syndrome, thrombotic thrombocytopenic infection, the effects of opportunistic infections or

purpura (see p. 337 ) and the haemophagocytic lymphoma and the side - effects of drugs used to treat
syndrome (see p. 121 ). Aplastic anaemia may HIV itself or drugs for the complicating infection

occur with viral A or more usually non - A, non - B, or lymphoma.
non - C hepatitis. Transient red cell aplasia is associ- Thrombocytopenia and neutropenia may be

ated with human parvovirus infection and this may immune or secondary to marrow dysfunction. Th e
result in severe anaemia in patients with a haemo- marrow may be hypercellular with prominent
lytic anaemia because of the shortened red cell plasma cells and lymphocytes, normocellular,