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Haematological History
History of Presenting Complaint
Associated Symptoms:
o Bruise easily?
o Fevers, shivers or shakes (rigors)?
o Difficulty stopping a small cut from bleeding?
o Lumps under your arms, in your neck or groin?
Richard Shaw
HAEMATOLOGY
Richard Shaw
HAEMATOLOGY
Richard Shaw
Cong
DIC
Infec
Vasc
Inflam
Malaria
Liver disease
Degen
Sepsis
Vitamin K deficiency
Meta
Malnutrition
Aplastic anaemia
Drugs
Osler-Weber-Rendu syndrome
Cong
Megaloblastic anaemic
DIC
Inflam
Degen
Hypersplenism (sequestration)
Renal failure
Drugs
Heparin (HITS)
Antimalarials
Marrow Suppression (chemo, radio)
Chemotherapy
Anti-epileptics
Poor Function
Neo
Myeloproliferative Disease
Meta
Hyperuraemia
Drugs
NSAIDs
CT disorder (Ehlers-Danlos)
Psuedoxanthoma elasticum
Meningococcal
Infec
Measles
Dengue fever
Henoch-Schonlein purpura
Inflam
Trauma
Senile purpura
Degen
Scurvy
Meta
Steroids
Drugs
Vascular Disorders
Platelet Disorders
Neo
Vasc
Coagulopathy
Clinical Features
Hx
OE - Bruises
HPC
o Trauma
o Pattern of bleeding
Extensiveness and severity
3
Prolonged cut bleeding, bleeding
into skin and bleeding from
mucuous membranes suggest
vascular platelet problems
Distribution
o Truncal/Back/Face bleeding
should raise suspicion of
bleeding diathesis or abuse
o Type
Petechiae
Pinhead size
Usually platelet
HAEMATOLOGY
Richard Shaw
OE Other findings
Investigations
FBC
o Thrombocytopoenia
LFTs
o Liver disease
Bloods
Coag panel
o INR
Dependent on Fs V, VII, X and fibrinogen
Sensitive to warfarin
o APTT
Dependent on Fs V, VIII, IX, X, XI, XII, prothrombin and fibrinogen
Sensitive to heparin
HAEMATOLOGY
Richard Shaw
Lymphadenopathy
Causes
Infec
o
o
o
o
o
o
o
o
o
o
o
o
o
Inflammatory
Bacterial
Streptococcal pharyngitis
Pyogenic
TB
Brucella
Syphillis
Viral
EBV
HIV
Adenovirus
CMV
HZV
Infectious hepatitis
Others
Toxoplasmosis
Trypanosomiasis
Sarcoidosis
Amyloidosis
Berylliosis
CT disease (RA, SLE)
Dermatological (eczema, psoriasis)
Neoplastic
Malignant
Haematological
Lymphoma
Breast
Lung
Bowel
Prostate
Kidney
Drugs
Phenytoin
Retrovirals
Clinical Features
Hx
Localising signs of
infection/malignan
cy
Constitutional
symptoms (fever,
night sweats, wt
loss)
Medications
Nodes
Exposures
Injury
Undercooked
meat (toxo)
o Tick bite (lyme)
o High risk
behaviour (sex,
drugs)
o Travel
o
o
Location
Size
Shape
Consistency
Fixation
Investigations
Biopsy if lump hasnt resolved over 4 weeks or with findings suggestive of malignancy
Bloods
FBC
Imaging
Tenderness
CXR
Invasive
FNA
Core needle biopsy
Open biopsy
HAEMATOLOGY
Richard Shaw
Examination
General Observation
Thrombocytopenia/platelet
dysfunction
Infection
o IE, septicaemia,
viral exanthemata
Vasculitis
o Polyarteritis
nodosa
o HSP
o Ecchymoses
Thrombocytopenia/platelet
dysfunction, trauma
Senile Ecchymoses
Jaundice
o Haemolytic anaemia
Excoriations/Scratch Marks (Pruritus)
o Lymphoma
o Myeloproliferative disease
Hands/Wrists
Nails
o
Tachycardia anaemia
Arms
Face
Koilonychia
Fingers
o Digital Gnfarction
Abnormal globulin
o Rheumatoid Arthritis
Tophi + arthropathy
Myeloproliferative diseases
Palms
o Palmar crease pallor
Anaemia
Pulse
o
Eyes
o
Scleral icterus
Haemolytic anaemia
o Haemorrhage
o Conjunctival pallor
Anaemia
Lips/Mouth
o Hypertrophic gingivae
Scurvy
o Gingivae, buccal, pharyngeal mucosa
Megaloblastic anaemia
Hereditary haemorrhagic
telangiectasia
o Enlarged tonsils (Waldeyer's ring)
Non-Hodgkin's lymphoma
Neck
Sit patient up
HAEMATOLOGY
Richard Shaw
Generalised Lymphadenopathy
o Lymphoma (rubbery and firm)
o Leukaemia (CLL, ALL)
o Infections (e.g. EBV, CMV, HIV, TB)
o Connective Tissue Diseases e.g. RA, SLE
o Infiltration e.g. sarcoidosis
o Drugs e.g. phenytoin
Axial Skeleton
o Press on sternum and clavicles w/ heels of hands
o Press both shoulders together
o Tap over each vertebrae with fist
Bony tenderness
Infiltration of metastases
Abdomen
Liver Palpation/Percussion
o Hepatomegaly
Metabolic
Infective
Infective monocleosis,
hepatitis A, B, malaria, liver
abscess or cyst
Neoplastic
Rectal Examination
leukaemia, lymphoma
o Evidence of bleeding
Infiltrative
o Carcinoma
Amyloidosis, sarcoidosis,
Legs
haemachromatosis,
Inspection
Purpura
Vascular
o Palpable purpura over legs/buttocks
Henoch-Schonlein purpura
Spleen Palpation
Leg Ulcers
Infection
o Haemolytic anaemia (above both malleoli)
Congestive
Hereditary spherocytosis
Haematological
o Polycythaemia
Lymphoma, leukaemia,
o Felty's syndrome
myeloproliferative, congenital
Palpation
Inflammatory
Neoplastic
Haematological Examination Summary
Met., haemangioma
Infiltrative
who is a X old male/female who presented with X.
Amyloidosis, Gaucher's
Hepatosplenomegaly
o Most significant finding second most
o Chronic liver disease with portal hypertension
significant or findings related to most
significant finding (positive and negative)
HAEMATOLOGY
Lead poisoning
o Anaemia
o Foot (+wrist) drop
Fundoscopy
Haemorrhage
Hess test
o If thrombocytopenia or capillary fragility
suspected
o BP cuff inflated on forearm between SBP and
DBP for 10 minutes. After removing cuff the
number of petechiae is counted within a 5cm
diameter of area under pressure. > or = 15
indicates a positive test.
Richard Shaw