HAEMATOLOGY PLENARY

7/29/2019 HAEMATOLOGY PLENARY

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Dr.Ramanathan Subramanian

HAEMATOLOGY HISTORY TAKING &

PHYSICAL EXAMINATION


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Haematological diseases- Bone marrow

RBC (Red cell)

WBC (white cell)

Platelets (Yellow cell)- Coagulation Pathway

Extrinsic or intrinsic


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A) Anemia can present with following Tiredness/fatigue

Headache

Lack of concentration

Fainting / Dizziness Dyspnoea on exertion

Palpitations

Angina on effort

Int. claudication


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B) History in Bleeding Disorders Abnormal bruising - petechiae/ ecchymosis / purpura

Abnormal bleeding from cuts and abrasions

Nose bleeds / Menorrhagia / Haemarthrosis

Bleeding - Dental extrn / childbirth / surgery Previous anemia and transfusions

Drug history

Family history


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History taking Identify the patient's symptoms + duration

Questioning - open ended

Obtain as much relevant information

Review previous records, useful & add important data for understanding theonset or progression

Hereditary and environmental factors

Medications, Diet and sexual behavior

Breathlessness

Weight loss

Fever, Fatigue, malaise, and lassitude

Weakness / Headache / Paraesthesia / Confusion

Vision

Vertigo, tinnitus

Palpitations

Dysphagia :

Chronic iron-deficiency anemia

Abdominal pain :

Lymphoma

Retroperitoneal bleeding

Sickle cell disease


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History taking Diarrhoea - Pernicious anemia / malabsorption

Steatorrhoea - Malabsorption

Haematuria - Haemophilia

Red urine - Haemoglobinuria, myoglobinuria Priapism - leukemia or sickle cell disease.

Back pain / bone pain Multiple myeloma

Joint swellings RA, secondary to increased uric acid production in hematologicmalignancies

Joint pain & swelling - Haemarthroses in haemophilia

Itching - Hodgkin lymphoma / polycythemia vera


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Past medical history Hx of gastric surgery or malabsorption

Anaemia in patients with systemic disease

eg. Rheumatoid arthritis, SLE, uraemia

Frequent hospital admissions , blood transfusions


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Family pedigree


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Chemical / Nutritional history Chemicals : Lead

Nutrition : Breast-fed children without healthy diet may develop IDA

Strict vegetarians : Megaloblastic anaemia


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Physical signs

Face

Eyes

Mouth (angle / Tongue )

Lymph nodes Skin

Hands

Skeleton (Bone tenderness)

PA : Liver/ Spleen enlargement

Legs

Nervous system ( Optic fundus )


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PURPURA Purple-colored spots on the skin, organs, and in mucus membranes

Occurs when small blood vessels join together or leak blood under the skin.

Very small purpura spots are called petechiae.

Large purpura are called ecchymoses.


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Face : Frontal bossing e.g. Thalassaemia

Eyes

Pallor / Jaundice

Mouth / tongueGum Hypertrophy/ bleeding

Angular-stomatitis /glossitis


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Angular stomatitis

Glossitis


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Purpura

Petechial Rash


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LUMPS / BUMPS :

How long has it been present?

Has the lump changed in size?

Is the lump painful ?

Have you lost weight recently? Are you generally well?

Any Trauma?


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Lymph nodes

Enlarged lymph nodes cervical, supraclavicular, axillary etc..

Description of lymph nodes

Localized / Generalized

Size : large usually abnormal - >1cm

Consistency : hard , rubbery- lymphoma

Tenderness Fixation

Overlying skin tethered to overlying skin


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Examination :

Must be gentle

Size, shape, and consistency

Lymph nodes that are smooth and relatively soft, but slightlyenlarged, may be normal (hyperplasia)

Irregular shape and a rubbery, hard consistency - malignancy

Tender nodes suggest an inflammatory process.

Matted nodes - malignancy

Movable -benign.


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Lymph nodes of the axilla


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Lymph adenopathy

Infections Localized / Generalized:

Immunologic conditions R.A or S.L.E

MalignancyDiffuse involvement, as in lymphomas and leukemias

Diffuse invasion, as in diffuse carcinomatosis

Localized invasion, as in head and neck tumors

B t d


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Bone tenderness Increased rib or sternal tenderness

Sternal tenderness leukaemia

Bone pain

Generalized eg. Leukemia

Plasma cell myeloma or metastatic tumors.


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Hepato - splenomegaly


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Legs

Leg ulcers - sickle cell anemia, thalassaemia,

hereditary spherocytosis

Any bruising, scratch marks, palpable purpura eg.Henoch-Schonlein purpura

Haemarthroses

Unilateral oedema


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CNS

Vitamin B12 deficiency - impairs cerebral, olfactory, spinalcord, and peripheral nerve function

Lead poisoning foot or wrist drop

Fundi haemorrhages

papilloedema due to increased viscosity of the blood


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Summary

Iron def ( IDA) - most common

Chronic disorders- most of the others

Remember Thalassemia & Hb

Ferritin- Ix

DDX Fatigue + Palpitations + Exertional dyspnea = Anaemia


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Bleeding Disorders :Important

Its implications for surgery

Pregnancy

Medication Genetic counselling


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Preventing bleeds

Stay fit. Strong muscles support joints and contribute to

reducing the number of joint bleeds

Use appropriate gear for the sporting activity; e.g helmet,

knee and elbow pads, good ankle support

Rest after a joint or muscle bleed to help healing and prevent

another bleeding incident.

Avoid alcohol (affects platelet function) Prevent dental problems and gingivitis

Never take Aspirin

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HAEMATOLOGY PLENARY