hematology

PRINCIPLES OF HEMATOLOGICAL DIAGNOSIS

1.HISTORY I-Medical history A.The present illness, focus on the following: 1.Bleeding. 2.Infection or symptoms related to enlargement of L.N , LIVER or the SPLEEN. 3.Non-specific symptoms related to ANAEMIA:Malaise , weakness, headache & weight loss. B. Any exposure to drugs or chemical. C. Review of systems; including the nervous system, is necessary as blood dyscrasia effect many, if not all, organ systems . II- Family history; information about the health of other family members as well as the ethnic background .

2- PHYSICAL EXAMINATION

A- Thorough physical exam. Should focus on; SKIN, MOUTH ,MUCOUS MEMBRANE,& EYES. JAUDICE PALLOR PETECHIAE & ECCYMOSIS. ULCERS B- Hepatomegaly, splenomegaly,enlarged or tender L.N ,soreness over the ribs or sternum & variety of neurological abnormalities.

ANAEMIA

A-Symptoms & signs pertaining to anaemia. 1-Non-specific symptoms include; fatigue, weakness, shortness of breath & symptoms of CHF 2-Signs include ; Pallor ,tachycardia , splenomegaly in minority of cases.Venous hum in severe anaemia ( Hb < 4 gm/dl).Functional systolic murmur.

SYMPTOMS & SIGNS Specific To IRON deficiency

Pica: compulsive ingestion of non-nutrient substance (clay/ ice-pagophagia) 1- Atrophic changes in the epithelium; - oral lesions; I- Angular cheilosis; soreness & cracking in the corners of the lips. II-Atrophy of the tongue papillae with intermittent glossitis III-Stomatitis ; inflammation & soreness of of the tongue & mouth. 2-DYSPHAGIA. 3- Nail lesions; thinning & flattening of the nails progress to brittle & spoon-shaped nail ( koilonychia)

ANEMIA

Clinical: Weakness, Fatigue, PallorDecreased Oxygen Carrying Capacity of BloodResult of: Decreased Number, Size, or HgB Content of RBC’s or of Defective HgBSecondary to:Nutritional / Iron DefeciencyRBC loss or destruction (Chronic Bleeding)Failure of RBC formation (Leukemia)Hereditary HgB malformationOral Features:PallorBald TonguePossible Association with other Disease: Leukemia, Kidney Disease, etc.

Thalassemic facies

Anemia Classification
Size of RBC’sMicrocytic (Small)Macrocytic (Large)Normocytic (Normal Size)Concentration of HgbHypochromic (Less)Hyperchromic (More)Normochromic (Normal)Microcytic / HypochromicChronic Blood Loss, Iron Deficiency, ThalassemiaMacrocytic (Megaloblastic) / HyperchromicVit B12 (Pernicious) or Folic Acid DeficiencyNormocytic / NormochromicHemolytic, Aplastic, Myelophthisic, Acute Blood Loss, Chronic Renal Failure

PLATELETS

NORMAL PLATELET COUNT 150-400X109/LPLATELET disorders; Defect in countTHROMBOCYTOPENIA Defect in function THROMBOASTHENIA.CLINICAL MANIFESTATIONS;1-PETECHIAE.2-PURPURA3-ECCHYMOSIS(BRUSIES)4- HAEMATOMA

Clinical Bleeding

Petechiae
Petechiae and Ecchymoses
Ecchymoses

Clinical PhotosBleeding(and sometimes Swollen) Gums

Leukemia
Hemophilia
Leukemia
Leukemia

Other Clinical Features of Blood Disorders

Ulceration
Atrophy and Pallor
Ulceration

Oral Ulceration and Infection Secondary to Leukopenia or Leukemia