Chapter 29: Haematological Changes in Systemic Diseases

Haematological Changes in Systemic Diseases begins with a detailed examination of the anaemia of chronic disorders (ACD), a prevalent condition where inflammation or malignancy disrupts the body’s ability to utilize its iron stores for red cell production, despite those stores being adequate or even elevated. The discussion transitions into the specific challenges faced by the elderly, noting a high incidence of anaemia due to factors like nutritional deficiencies and renal impairment, alongside a significant increase in thrombotic risks linked to aging and reduced mobility. Malignant diseases are shown to drastically alter blood profiles through mechanisms such as direct marrow infiltration, chemotherapy-induced suppression, and life-threatening coagulation issues like disseminated intravascular coagulation (DIC). Furthermore, the chapter explores the haematological consequences of connective tissue diseases like rheumatoid arthritis and systemic lupus erythematosus (SLE), where immune-mediated destruction of blood cells is common. The impact of organ failure is also prioritized, specifically looking at how chronic renal failure reduces erythropoietin secretion—leading to anaemia characterized by unique cell shapes like echinocytes—and how liver disease causes coagulation factor deficiencies and abnormal red cell membranes. Infectious diseases, including bacterial, viral (notably HIV), and parasitic infections like malaria, are reviewed for their roles in triggering everything from reactive white cell changes to severe pancytopenia. Finally, the text evaluates the clinical diagnostic utility of acute-phase reactants, comparing C-reactive protein (CRP) for assessing rapid inflammatory changes against the erythrocyte sedimentation rate (ESR) and plasma viscosity for monitoring chronic disease progression.