principles of hematological diagnosis 1.history i-medical history a.the present illness, focus on...
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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.TRANSCRIPT
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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 .
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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.
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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.
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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)
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ANEMIA• Clinical: Weakness, Fatigue, Pallor• Decreased Oxygen Carrying Capacity of
Blood• Result of: Decreased Number, Size, or HgB
Content of RBC’s or of Defective HgB• Secondary to:
– Nutritional / Iron Defeciency– RBC loss or destruction (Chronic Bleeding)– Failure of RBC formation (Leukemia)– Hereditary HgB malformation
• Oral Features:– Pallor– Bald Tongue
• Possible Association with other Disease: Leukemia, Kidney Disease, etc.
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Thalassemic facies
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Anemia Classification• Size of RBC’s
– Microcytic (Small)– Macrocytic (Large)– Normocytic (Normal Size)
• Concentration of Hgb– Hypochromic (Less)– Hyperchromic (More)– Normochromic (Normal)
• Microcytic / Hypochromic– Chronic Blood Loss, Iron Deficiency, Thalassemia
• Macrocytic (Megaloblastic) / Hyperchromic– Vit B12 (Pernicious) or Folic Acid Deficiency
• Normocytic / Normochromic– Hemolytic, Aplastic, Myelophthisic, Acute Blood Loss, Chronic Renal
Failure
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PLATELETS
• NORMAL PLATELET COUNT 150-400X109/L• PLATELET disorders; Defect in
countTHROMBOCYTOPENIA• Defect in function
THROMBOASTHENIA.• CLINICAL MANIFESTATIONS;• 1-PETECHIAE.• 2-PURPURA• 3-ECCHYMOSIS(BRUSIES)• 4- HAEMATOMA
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Clinical BleedingPetechiaePetechiae Petechiae and EcchymosesPetechiae and Ecchymoses
EcchymosesEcchymoses
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Clinical PhotosBleeding(and sometimes Swollen) Gums
LeukemiaLeukemia HemophiliaHemophilia
LeukemiaLeukemia
LeukemiaLeukemia
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Other Clinical Features of Blood Disorders
UlcerationUlceration Atrophy and Atrophy and PallorPallor
UlcerationUlceration
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Oral Ulceration and Infection Secondary to Leukopenia or Leukemia