6.5.1 Eval Suspected Heme Disorder Flashcards
1
Q
Your patient presents with concern for bleeding or clotting disorder. What PMH will you be sure to screen for?
What subjective clues might clue you in to DDx r/t bleeding vs clotting?
What labs will you send for your initial workup?
A
- PMHx
- Hematologic d/o
- Malignancy
- Lvier dz
- Renal dz
- SLE / autoimmune
- Trauma
- Medication - Rx and OTC
- Symptoms/clues
- Dizziness/lightheadedness
- Encephalopathy
- Fevers/subjective chills
- Fatigue, weakness, malaise
- Chest pain/discomfort
- Palpitations
- SOB
- Abd pain / discomfort
- Abd distension / nausea / anorexia
- Easy brusing
- Jaundice
- Labs
- CBC - H/H, plt
- Reticulocyte count - new rbcs?
- PT/INR, PTT, Fibrinogen
- Chemistry - renal fct, chronic anemia?
- LFT - liver fail > synthetic dysfct
- Hemoccult stool
2
Q
Describe the following physical findings of your patient with concern for bleeding vs clotting:
- Shock
- Active hemorrhage
- Evidence of clotting
A
- Shock
- Hotn / orthostatics
- Tachycardia
- Decreased signs of perfusion
- Weak, thready pulses
- Decrease cap refill
- Diaphoresis
- Decreased UOP/AKI
- Pallor/mottling
- Active hemorrhage
- 5 Bleed Locations that can Affect H/H
- Chest/hemothorax: each hemithorax can hold 1-1.5L blood
- Abd/Retroperitoneal/Lumen of GI
- Pelvis: 1.5-2L blood
- Thighs: 0.75-1L each
- The floor
- Evidence of hemorrhage
- Ecchymosis, petechiae, purpura
- Epistaxis
- Gingival bleeding
- Hemarthrosis
- Hematuria
- Hematemesis
- Hematochezia
- Menorrhagia
- 5 Bleed Locations that can Affect H/H
- Evidence of Clotting
- Limb swelling, esp assymetric, whether acute or insidious
- Limb discoloration
- Mild redness
- Blue/purple: phlemasia cerulea dolens (pre-gangrene) - indicates severe venous outflow obstruction
- White: phlegmasia cerulea albla - indicates restricted arterial flow caused by large venous clot
- Warming skin, esp 1 extremity
- Hypoxia
