1. Table 28.1 Causes of anaemia of chronic
disorders.
Chronic inflammatory diseases
Infectious (e.g. pulmonary abscess,
tuberculosis, osteomyelitis, pneumonia,
bacterial endocarditis)
Non-infectious (e.g. rheumatoid arthritis,
systemic lupus erythematosus and other
connective tissue diseases, sarcoid, Crohn’s
disease, cirrhosis)
Malignant disease
(e.g. carcinoma, lymphoma, sarcoma, myeloma)
Table 28.2 Haematological abnormalities in malignant disease.
Haematological abnormality Tumour or treatment associated
Pancytopenia
Marrow hypoplasia Chemotherapy, radiotherapy
Myelodysplasia Chemotherapy, radiotherapy
Leucoerythroblastic Metastases in marrow
Megaloblastic Folate deficiency
B12 deficiency (carcinoma of stomach)
Red cells
Anaemia of chronic disorders Most forms
Iron deficiency anaemia Especially gastrointestinal, uterine
Pure red cell aplasia Thymoma
Immune haemolytic anaemia Lymphoma, ovary, other tumours
Microangiopathic haemolytic anaemia Mucin-secreting carcinoma
Polycythaemia Kidney, liver, cerebellum, uterus
White cells
Neutrophil leucocytosis Most forms
Leukaemoid reaction Disseminated tumours, those with necrosis
Eosinophilia Hodgkin lymphoma, others
Monocytosis Various tumours
Platelets and coagulation
Thrombocytosis Gastrointestinal tumours with bleeding, others
Disseminated intravascular coagulation Mucin-secreting carcinoma, prostate
Activation of fibrinolysis Prostate
Acquired inhibitors of coagulation Most forms
Paraprotein interfering with platelet function Lymphomas, myeloma
Tumour cell procoagulants – tissue factor and cancer
Especially ovarian, pancreas, brain, colon
procoagulant (activates factor X)

2. Table 28.3 Haematological abnormalities in
renal failure.
Anaemia
Reduced erythropoietin production
Aluminium excess in dialysis patients
Anaemia of chronic disorders
Iron deficiency
blood loss (e.g. dialysis, venesection, defective
platelet function)
Folate deficiency
chronic haemodialysis without replacement
therapy
Abnormal platelet function
Thrombocytopenia
Immune complex-mediated (e.g. systemic lupus
erythematosus, polyarteritis nodosa)
Some cases of acute nephritis and following
allograft
Haemolytic uraemic syndrome and thrombotic
thrombocytopenic purpura
Thrombosis
Some cases of the nephrotic syndrome
Polycythaemia
In renal allograft recipients
Rarely in renal cell carcinoma, cysts, arterial
disease
Table 28.4 Haematological abnormalities in
liver disease.
Liver failure ± obstructive jaundice ± portal
hypertension
Refractory anaemia– usually mildly macrocytic,
often with target cells; may be associated with:
Blood loss and iron deficiency
Alcohol (± ring sideroblastic change)
Folate deficiency
Haemolysis (e.g. Zieve’s syndrome, Wilson’s
disease, immune hypersplenism from portal
hypertension)
Bleeding tendency
Deficiency of vitamin K-dependent factors; also of
factor V and fibrinogen
Thrombocytopenia hypersplenism, immune
platelet function defects
Functional abnormalities of fibrinogen
Increased fibrinolysis
Portal hypertension – haemorrhage from varices
Viral hepatitis
Aplastic anaemia
Tumours
Polycythaemia
Neutrophil leucocytosis and leukaemoid reactions

3. Table 28.5 Blood abnormalities associated with infections.
Haematological abnormality Infection associated
Anaemia
Anaemia of chronic disorders Chronic infections especially tuberculosis
Aplastic anaemia Viral hepatitis
Transient red cell aplasia Human parvovirus
Marrow fibrosis Tuberculosis
Immune haemolytic anaemia Infectious mononucleosis, Mycoplasma
pneumoniae
Direct red cell damage or microangiopathic Bacterial septicaemia (associated DIC),
Clostridium perfringens, malaria, bartonellosis
Viruses – haemolytic uraemic syndrome and TTP
Hypersplenism Chronic malaria, tropical splenomegaly
syndrome, leishmaniasis, schistosomiasis
White cell changes
Neutrophil leucocytosis Acute bacterial infections
Leukaemoid reactions Severe bacterial infections particularly in infants
Tuberculosis
Eosinophilia Parasitic diseases (e.g. hookworm, filariasis,
schistosomiasis, trichinosis)
Recovery from acute infections
Monocytosis Chronic bacterial infections: tuberculosis,
brucellosis, bacterial endocarditis, typhoid
Neutropenia Viral infections – HIV, hepatitis, influenza
Fulminant bacterial infections (e.g. typhoid,
miliary tuberculosis)
Lymphocytosis Infectious mononucleosis, toxoplasmosis,
cytomegalovirus, rubella, viral hepatitis,
pertussis, tuberculosis, brucellosis
Lymphopenia HIV infection
Legionella pneumophila
Thrombocytopenia
Megakaryocytic depression, immune complex-mediated
and direct interaction with platelets
Acute viral infections particularly in children (e.g.
measles, varicella, rubella, malaria, severe
bacterial infection)
Prothrombotic state All with prolonged inflammation
DIC, disseminated intravascular coagulation; HIV, human immunodeficiency virus; TTP, thrombotic thrombocytopenic purpura.

4. Table 28.6 Advantages and disadvantages of
the tests used to monitor the acute phase
response.
Advantages Disadvantages
CRP*
Specific test of acute
phase protein
More than one protein
required to measure
acute (CRP) and
chronic inflammation
Fast response (6
hours) to change in
disease activity
Costly when assayed
in small numbers
High sensitivity – owing
to large incremental
change
Sophisticated
equipment and
antisera required
Can be measured on
stored serum
Small sample
volumes
Automated analysis
ESR and plasma viscosity
Useful in chronic
disease
Not sensitive to acute
changes (<24 hours)
ESR inexpensive,
easy, no electrical
power required
Not specific for acute
phase response
Plasma viscosity –
result obtained
quickly (15 min)
Slow to change with
alteration in disease
activity and
insensitive to small
changes in activity
Plasma viscosity not
affected by anaemia
Fresh samples (<2
hours) required for
ESR
ESR, erythrocyte sedimentation rate.
* C-reactive protein (CRP) is normally present in low
concentrations (<5 mg/L). Levels are not influenced by
anaemia, pregnancy or heart failure. During severe acute
infection the plasma concentration may rise 100-fold.