Clinical assessment


Haematological illness leads to a range of symptoms and signs. An accurate history, careful clinical examination and appropriate laboratory assessment are essential for successful management of patients.




History



Anaemia


This is a reduction in the concentration of haemoglobin which leads to reduced oxygen carriage and delivery.



  • Symptoms: shortness of breath on exertion, tiredness, headache or angina, more marked if anaemia is severe, of rapid onset and in older subjects.
  • Causes: e.g. bleeding, dietary deficiency, malabsorption, systemic illness, haemolysis (i.e. accelerated destruction), bone marrow failure of red cell production.


Leucopenia


This is a reduction in white cell number which, if severe, predisposes to infection. It may be due to the following:



  • Neutropenia, particularly if neutrophils are <0.5 × 109/L, which frequently leads to bacterial or fungal infection in skin, mouth, throat and chest. Pus is lacking.
  • Infection is often atypical, caused by organisms non-pathogenic for normal individuals, rapidly progressive and difficult to treat.
  • Lymphopenia due to a reduction in B and/or T cell (humoral and T-cell-mediated) immunity predisposes particularly to viral infection (e.g. herpes zoster), tuberculosis, protozoal and fungal infections.
  • Functional defects of neutrophils and lymphocytes also predispose to infection.


Thrombocytopenia


This is a reduction in blood platelets which, if severe, leads to spontaneous bruising and bleeding (Figs 6.1 and 6.2).


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Jun 12, 2016 | Posted by in HEMATOLOGY | Comments Off on Clinical assessment

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