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Diabetes and hematology is there a link.pptx
- 1. Dr/ Marwa MahmoudKhalifa Internal Medicine and Hematology Consultant
- 2. Anemia in DM Patients with T2DM are twice more likely to have anemia than non diabetics Anemia is more common in poorly controlled DM than well controlled 7.2% of diabetics with normal renal function 20% of diabetics with renal insufficiency Normochromic, normocytic anemia
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- 6. Complications of Anemiain Diabetes Anemia is a risk factor for cardiovascular and ESRD in diabetic patients. It has direct mitogenic and fibrogenic effects on the kidney and the heart “The deadly triangle” Anemia is associated with expression of growth factors, hormones and vasoactive agents implicated in the diabetic microvascular disease Anemia is associated with rapid progression of renal disease in diabetics
- 7. Complications of Anemiain Diabetes Anemia is an independent risk factor for diabetic retinopathy Anemic patients with T1DM were more than twice as likely to have IHD Reduced Hb level identified diabetic patients at increased risk for hospitalization and premature death
- 9. Fallacies in HbA1cmeasurement in Anemia HbA1c is altered in : Hemolytic anemia Pregnancy Hemoglobinopathies Vitamin B12 deficiency Caution must be taken when diagnosing diabetes and pre diabetes among people with high erythrocyte turnover
- 10. Fallacies in HbA1cmeasurement in Anemia Iron deficiency may artificially increase HbA1c by 1- changing the shape of hemoglobin molecule, promoting terminal valine glycation 2- lowering erythrocyte turnover, allowing more time for hemoglobin glycation EPO therapy artificially lowers HbA1c while blood glucose levels remained unchanged
- 11. Comparison between thetwo periods according to HbA1c in Iron deficiency anemia before and after treatment
- 13. Leukocytic changes inDiabetes Total WBC count is higher in T2DM than non diabetics Higher leukocyte count is correlated with macro and micro vascular complications (nephropathy& retinopathy) and can predict the severity of complications Monocyte and neutrophil counts also increased in parallel with the progression of complications.
- 14. Leukocytic changes inDiabetes HOWEVER, The chemotactic, phagocytic and bactericidal activities of neutrophils are impaired. Lysosomal enzymes release, myeloperoxidase activity and ROS production by neutrophils are all decreased. These changes increase the susceptibility to infection.
- 16. Platelets Changes inDiabetes Increased platelet aggregability and adhesiveness (reduced membrane fluidity, increased intracellular calcium mobilization, decreased intracellular magnesium, increased arachidonic acid metabolism, increased TXA2 synthesis, decreased prostacyclin and nitric oxide production, decreased antioxidant levels and increased expression of GPIIb-IIIa and P-selectin ) Impaired sensitivity to prostacyclin and NO that normally blunt platelet activation Inflammation mediated tissue damage in the vasculature (Micro & Macro)
- 17. Platelets Changes inDiabetes MPV is higher in o diabetics >> non diabetic o complicated (micro and macro vascular) >> non complicated DM o poor glycemic control >> good glycemic control. MPV is a beneficial prognostic marker of DR in T2DM patients
- 18. Effect of Hyperglycemiaon Coagulation and Fibrinolysis
- 20. Effect of hypoglycemiaon blood constituents Hypoglycemia results in 1. Platelet hyperaggregability 2. Increase in fibrinogen and factor VIII. 3. Activated partial thromboplastin time is shortened, 4. Induces proinflammatory changes including an increase in the IL-6, TNFα, IL-1β, and IL-8. 5. Inhibitory effect on fibrinolytic mechanisms.
- 21. OHDs and BloodConstituent Changes Metformin, sulfonylureas, glitazones and acarbose exert a favorable effect on platelet function. Among incretin therapies, only sitagliptin has been demonstrated to have a beneficial effect on platelet aggregation Thiazolidinediones and metformin lower FVII, fibrinogen and PAI-1, enhance fibrinolysis
- 22. OHDs and BloodConstituent Changes Metformin is associated with decrease absorption of folic acid and vitamin B12 when used on a continuous basis leading to megaloblastic anemia. Thiazolidinediones dilutional anemia
- 23. Iron overload andDiabetes Iron overload is a risk factor for diabetes. hereditary hemochromatosis and thalassemia mediated both by β-cell failure and insulin resistance Iron is also a factor in the regulation of metabolism in most tissues involved in fuel homeostasis
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- 26. Nilotinib useappears to be associated with dysglycemia to a greater extent than other TKIs in adult CML patients. Glycemic and metabolic outcomes in CML patients should be closely monitored,