Page 406 - Essential Haematology

392 / Chapter 28 Haematological changes in systemic disease

(a)

Figure 28.7 Human immunodefi -
ciency virus (HIV) infection: bone
marrow trephine biopsy. (a)
Granuloma showing positivity with
Ziehl – Nielsen stain. (b) Higher
power shows large numbers of
(b) acid - fast bacilli.

variety of genes affecting osteoclast function. Th e nents and CRP (see p. 395 ), haptoglobin, serum
bones are brittle, there is extramedullary haemopoi- amyloid A (SAA) protein, ferritin and others. Th e
esis with enlargement of the liver and spleen. Th e rise in these liver - derived proteins is part of a wider
only cure is by stem cell transplantation. response which includes fever, leucocytosis and
increased immune reactivity. The acute phase

Non - s pecifi c m onitoring of response is mediated by cytokines (e.g. IL - 1; see Fig.

8.4 ) and TNF, released from macrophages and pos-
s ystemic d isease
sibly other cells. Patients with chronic disease may

Th e inflammatory response to tissue injury includes show periodic or continuous evidence of the acute
changes in plasma concentrations of proteins known phase response depending upon the extent of
as acute phase proteins. These include fi brinogen inflammation. Quantitative measurements of acute

and other clotting factors, complement compo- phase proteins are valuable indicators of the