Screening for Hematologic Disease

Question 1

What are common general signs and symptoms of hematologic disease?

• Exertion = ?
• Nervous system = ?
• Integumentary = ?

Answer 1

a) Exertion

• Dyspnea
• Palpitations
• Weakness
• Fatigue

b) Nervous system

• Headaches
• Drowsiness
• Syncope
• Polyneuropathy

c) Integumentary

• Pallor
• Cyanosis, clubbing (distal)
• Easy bruising/bleeding (no reported trauma, sponatanous)

Question 2

What hematologic conditions commonly result in fatigue and dyspnea?

Answer 2

• Anemia: Not having enough healthy red blood cells or hemoglobin to carry oxygen to the body’s tissues
• Polycythemia: there are too many red blood cells.

Question 3

What is polycythemia, and what are its clinical signs?

Answer 3

Increased RBC count and hemoglobin concentration,

• Clinical signs include peripheral vascular occlusion, fatigue, decreased mental acuity and increased BP.
• Hallmark Signs = Fatigue/Malaise

Cause: Unknown etiology, genetic mutation, neoplastic disease of bone marrow.

Question 4

What are the causes of secondary polycythemia?

Answer 4

Decreased oxygen to tissues from smoking, altitude changes, or chronic heart/lung disorders.

Question 5

What is leukocytosis, and what causes it?

Answer 5

• WBC count > 10,000/mm3,
• Caused by pregnancy, bacterial infections, or pneumonia.
• Clinical signs = Fever and signs of infection or inflammation.

Question 6

What is thrombocytosis, and what are its signs and symptoms?

Answer 6

• Excess platelets
• Clinical signs include increased clotting and blood viscosity.

• Primary Cause: Abnormal bone marrow cells.
• Secondary: compensatory due to surgery or iron deficiency.

Question 7

What is anemia, and what are its common causes?

Answer 7

• Decreased oxygen transport due to a lack of erythrocytes
• Caused by blood loss, destruction, or reduced production

Question 8

What clinical signs are associated with anemia in physical therapy practice?

Answer 8

• fatigue
• dyspnea
• decreased exercise tolerance
• dizziness

Question 9

What is…

• pernicious anemia = ?
• what causes it = ?
• neurological symptoms = ?

Answer 9

• A deadly lack of vitamin B12
• Malabsorption or diet deficiency
• Neurological symptoms = Headache, dementia, depression, impaired concentration, seizures

Question 10

What is…

• leukopenia = ?
• causes = ?
• clinical signs = ?

Answer 10

• WBC count < 5,000/mL
• Caused by viral diseases, autoimmune conditions, or radiation.
• Clinical Signs = Fever, sore throat, cough, frequent infections, and mucosal ulcers.

Question 11

What precautions should be taken in PT practice with patients who have leukopenia?

Answer 11

Use caution with infection control; avoid high-intensity exercise and mechanical compression.

Question 12

What is…

• thrombocytopenia
• causes
• clinical signs

Answer 12

• Platelet count < 150,000 mm3
• caused by increased destruction or decreased production
• clinical signs = bleeding after minor trauma, petechiae, purpura, nosebleeds, and gingival bleeding.

Question 13

What precautions should be taken in PT practice with patients who have thrombocytopenia?

Answer 13

• Avoid strenuous exercise, mechanical compression, and soft tissue manipulation.
• Strenuous exercises – exercise damages muscle and there is some bleeding that occurs with that.

Question 14

What is sickle cell anemia, and how does it affect red blood cells?

Answer 14

An inherited autosomal recessive disorder causing RBCs to deform and block blood flow.

Question 15

What are common triggers for sickle cell crises?

Answer 15

Extreme temperature, dehydration, physical exertion, or emotional disturbance, infection

Question 16

What clinical signs are associated with sickle cell anemia?

Answer 16

Pain from ischemia, cognitive impairments, and vasoocclusion.

Question 17

What is leukemia, and how does it affect the body?

Answer 17

• A bone marrow disease causing uncontrolled growth of immature/dysfunctional WBCs.

Question 18

What is…

• hemophilia
• clinical manifestations
• pt considerations

Answer 18

• A hereditary condition affecting clotting proteins
• Leading to prolonged bleeding.
• PT considerations = Monitor for bleeding, avoid vigorous manual therapy, and use caution with exercise.

Question 19

What conditions are associated with excessive bleeding in hematologic disease?

Answer 19

• hemophilia,
• thrombocytopenia,

Question 20

What conditions are associated with excessive clotting in hematologic disease?

Answer 20

• polycythemia,
• thrombocytosis,
• deep vein thrombosis (DVT)

Question 21

What are the clinical signs of polycythemia vera?

Answer 21

• gout
• intolerable itching

Question 22

What are the primary complications associated with thrombocytopenia?

Answer 22

Spontaneous bleeding and bruising.

Question 23

What are petechiae and purpura, and how are they related to thrombocytopenia?

Answer 23

Small red or purple spots indicating bleeding under the skin, associated with thrombocytopenia.

• Petechiae and purpura spot warrant additional questioning
  (physician referal)

Question 24

What hematologic condition increases the risk of infections significantly?

Answer 24

Leukopenia (WBC count < 5,000/mL) significantly increases infection risk.

Question 25

What hematologic disease results in abnormal blood clotting due to dysfunctional proteins?

Answer 25

Hemophilia results in abnormal clotting due to defective clotting proteins.

Question 26

What are the PT precautions for patients with clotting disorders?

Answer 26

Use caution with exercises that risk trauma or bleeding.

Question 27

What signs should trigger physician referral for hematologic disease screening?

Answer 27

Spontaneous bleeding, bruising, petechiae, and purpura require physician referral.

Question 28

Anemia in PT Practice

Four broad categories = ?

Answer 28

1. Iron deficiency from chronic GI blood loss (NSAID use?)
2. Chronic or inflammatory diseases (cancer, RA, SLE)
3. Neurologic conditions (pernicious anemia)
4. Infectious diseases (e.g., TB, AIDS) and neoplastic disease or cancer (bone marrow failure)