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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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