Block 10 - Haematology Flashcards
Haematological History Protocol? (7)
Haematological History Protocol
1. Presenting symptoms
2. Past medical history
3. Treatment/Medications
4. Allergies
5. Family History
6. Review of Systems
7. Social History
Haematological History Protocol - What are the major presenting complaints?
7 Haematological disorders?
14 QUESTIONS TO ASK THE PATIENT WITH ANAEMIA?
10 Questions to ask the patient with HAEMOPHILIA?
Risk Factors for Thrombosis:
- Patient?
- Surgery?
- Medical illnesses?
- Haematological prothrombotic abnormalities?
5 DIFFERENTIAL DIAGNOSIS OF SUSPECTED LYMPHADENOPATHY?
Haematological History Protocol - What questions should you ask about Past Medical History? (9)
Haematological History Protocol - Past Medical History
1. General: medical/surgical
2. Obstetric/gynae
3. Active/inactive
4. Treatment for any of the above in the past?
5. GI conditions/surgery causing malabsorption?
6. Previous blood transfusions or venesections?
7. Systemic conditions – RA, Renal failure?
8. Malignancies – current/ ’cured’/ remission?
9. Sexually transmitted infections?
Haematological History Protocol - What questions should you ask about Medications/Treatments? (6)
Haematological History Protocol - Medications/Treatments
1. Anticoagulants/antiplatelets?
2. Bone marrow toxic medications?
3. Drugs causing malabsorption?
4. Herbal medications
5. NSAIDS - bleeding?
6. Immunosuppressive drugs - eg. Corticosteroids?
Haematological History Protocol - What questions should you ask about Allergies? (3)
Haematological History Protocol - Allergies
1. Medication allergies.
2. Food allergies.
3. Bite/sting reactions (hypersensitivity in CLL)
Haematological History Protocol - What questions should you ask about Family History? (8)
Haematological History Protocol - Family History
1. DVT/PE?
2. Inherited haemaglobinopathies
3. Sickle cell?
4. Thalassaemia?
5. Von willebrand?
6. Haemophilia?
7. Sudden death/unexplained deaths?
8. Malignancies?
Haematological History Protocol - Review of Systems? (9)
Haematological History Protocol - Review of Systems
- General ROS PLUS
Specifically cardinal symptoms for each system:
1. Haemoptysis?
2. Melaena?
3. Rectal bleeding?
4. Vaginal bleeding?
5. Weight loss?
6. Symptoms of hypothyroidism/ hyperthyroidism?
7. Mood assessment?
8. Travel history and risk of tropical infections?
9. Blood donations?
Haematological History Protocol - What questions should you ask about Social History? (6)
Haematological History Protocol - Social History
1. Racial origin - Thalassaemia? (Mediterranean), Sickle cell, G6PD deficiency?
2. Smoking- Pack years?
3. Alcohol?
4. Diet (strict vegetarian/vegan B12 deficiency)?
5. Occupation -exposure to Benzene (leukaemia)?
6. Functional assessment – independent ADL’s, home help, driving?
Haematological Exam Protocol? (13)
Haematological Exam Protocol
1. Introduction
2. Exposure and positioning
3. Inspection
4. Hands
5. Forearms
6. Axillary Nodes
7. Face
8. Cervical and Supraclavicular Nodes
9. Bone tenderness
10. Abdominal examination
11. Legs
12. Other - optic fundi, Temp, Urine Dipstick
13. Blood Film
Haematological Exam Protocol - Introduction, Expsoure & Positioning?
Haematological Exam Protocol - General Inspection? (6)
Haematological Exam Protocol - General Inspection
1. General appearance: Well/ ill?
2. Racial origin?
3. Bruising/petechiae/purpura and the distribution pattern?
4. Jaundice?
5. Scratch marks?
6. Pallor?
Haematological Exam Protocol - Hands? (7)
Haematological Exam Protocol - Hands
1. Nails – Koilonychia (Fe deficiency
2. Nails - digits infarcts (cryoglobulinaemia)
3. Palmar crease pallor
4. Palm tethering (connective tissue diseases)
5. Joints changes of RA
6. Gouty changes of joints
7. Pulse – tachycardia in anaemia, cardiac failure, sepsis
Haematological Exam Protocol - Forearms? (4)
Haematological Exam Protocol - Forearms
1. Purpura?
2. Echymoses?
3. Scratch marks?
4. Epitrochlear nodes elbow at 90degrees, thumb palpate nodes just proximal and anterior to medial epicondyle (syphilis, local infection, non-Hodgkin’s lymphoma)
Haematological Exam Protocol - Axillary Nodes? (4)
5 groups – central, lateral, pectoral (medial), infraclavicular and subscapular
Haematological Exam Protocol - Face? (7)
Haematological Exam Protocol - Face
1. Eyes - jaundice
2. Eyes - haemorrhage, injection
3. Conjunctival pallor
4. Mouth – tongue hypertrophy (amyloid)?
5. Gum hypertrophy (leukaemia)
6. Oral infection, ulceration, haemorrhage of buccal mucosa, telangiectasia (hereditary haemorrhagic telangiectasia)?
7. Waldeyer’s ring – ring of lymphoid tissue at posterior of oropharynx, includes tonsils and adenoids (can be involved in non-Hodgkin’s lymphoma)?
Haematological Exam Protocol - Cervical and Supraclavicular Nodes? (8)
Haematological Exam Protocol - Cervical and Supraclavicular Nodes
* Examine nodes with patient sitting up, from behind pt after informing them this is what you are doing.
* 8 groups – submental, submandibular, jugular chain (ant to sternomastoid), posterior triangle (posterior to sternomastoid), occipital, post auricular, preauricular, supraclavicular fossae
* Need to understand where each set of lymph nodes drain to and hence the resultant pathology site.
Haematological Exam Protocol - Bone tenderness?
Haematological Exam Protocol - Bone tenderness
While the patient is sitting up, gently but firmly tap over the spine with your fist for bony tenderness. This may be caused by an enlarging marrow due to infiltration by multiple myeloma, lymphoma or carcinoma, or due to malignant disease of the bony skeleton. Also gently press the sternum and both clavicles with the heel of your hand and then test both shoulders by pushing them towards each other with your hands.
Haematological Exam Protocol - Abdomen examination? (5)
Haematological Exam Protocol - Abdomen examination
1. Hepatosplenomegaly?
2. Para-aortic nodes?
3. Inguinal lymph nodes – (along inguinal ligament, along femoral vessels?
4. DRE and pelvic examination for bleeding problems and possible malignancy?
5. In paediatric male patient, examination of testes is vital, especially relevant when considering diagnosis of leukaemia.
Haematological Exam Protocol - Legs? (7)
Haematological Exam Protocol - Legs
1. Bruising?
2. Pigmentation?
3. Scarring?
4. Swelling?
5. Ulceration
6. Popliteal lymph nodes?
7. Neuro examination if suspect peripheral neuropathy secondary to underlying cause for anaemia (B12 deficiency, hypothyroidism)
Haematological Exam Protocol - Other? (3)
Haematological Exam Protocol - Other
1. Optic fundi: signs of hyperviscosity, retinal haemorrhage, papilloedema (don’t do lumbar puncture if present)
2. Temperature chart (infection, lymphoma with B symptoms)
3. Urine dipstick (haemolysis, renal failure, coagulopathies)
Causes of Petechiae?
Causes of Purpura and Bruising/Bleeding?
CHARACTERISTICS OF LYMPH NODES - SSCTFO?
6 CAUSES OF LOCALISED
LYMPHADENOPATHY?
CAUSES OF LYMPHADENOPATHY - Generalised/Localised?
Causes of Splenomegaly?
Signs of polycythaemia vera?
Causes of polycythaemia?
