Page 410 - Essential Haematology

396 / Chapter 28 Haematological changes in systemic disease

CRP – antigen complexes can substitute for anti- fibrinogen may not occur until 24 – 48 hours fol-

body in the fixation of Clq and trigger the comple- lowing injury. Immunoassays of CRP are now

ment cascade initiating the infl ammatory response widely used for early detection of acute infl am-
to antigens or tissue damage, Subsequent binding mation or tissue injury and for the monitoring
of C3b on the surface of micro - organisms opsonizes of remission (e.g. response of infection to an
them for phagocytosis. antibiotic).
After tissue injury, an increase in CRP, Table 28.6 lists the advantages and disadvan-
SAA protein and other acute phase reactants tages of the tests used to assess the acute phase
may be detected within 6 – 10 hours. Increase in response.

SUMMARY ■ Chronic infl ammation or malignant ■ Eosinophilia occurs with certain infections,

leukaemoid reactions, and in viral and

connective tissue diseases, neutropenia.

disorders cause anaemia with low serum
iron and iron binding capacity, normal or

raised serum ferritin, an inadequate
particularly parasitic and allergic disease.
Monocytosis is associated with chronic
response to erythropoietin and reduced
bacterial infections (e.g. tuberculosis,
red cell lifespan. The degree of anaemia
relates to the severity of the underlying

brucellosis).

disease. It does not respond to iron

infections and some bacterial infections
therapy. ■ Lymphocytosis is a feature of viral

■ This anaemia may be complicated by e.g. Bordetella pertussis.

other causes of anaemia (e.g. iron or ■ Platelets may be increased or low in

folate defi ciencies, renal failure, bone malignant, infectious and other systemic
marrow infi ltration, haemolysis, diseases. Disseminated intravascular
hypersplenism). coagulation is a major cause of
■ Polycythaemia is a much less frequent thrombocytopenia and fall in coagulation

complication of systemic diseases (e.g. factors.

renal). ■ C - reactive protein can be used for non -

■ White cell changes are also frequent in specifi c monitoring of systemic disease for

systemic diseases. These include short term (hours or days) and erythrocyte
neutrophil leucocytosis especially in sedimentation rate (or plasma viscosity)
bacterial infections, leucoerythroblastic or over weeks or months.

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