Examining the patient


Examining the patient

Abnormalities of the blood may arise as a result of a primary disorder of the bone marrow (e.g. leukaemia) or from a wide range of systemic disorders. A thorough clinical examination is vital both to confirm a likely diagnosis and to exclude coexistent problems. There is not space here to detail all the elements of clinical examination; we have concentrated on aspects of the examination most relevant to patients with a primary blood disorder.

Look at the patient!

It is easy to examine a patient carefully without properly observing them. A deliberate inspection of the patient’s face while taking the history may reveal vital clues even before the formal examination is commenced. Common examples include the pallor of iron deficiency anaemia, the lemon tint of megaloblastic anaemia, the jaundice of a haemolytic anaemia, and the plethora of polycythaemia. Before laying a hand on the patient, a careful inspection of the mouth and skin may also point to particular blood abnormalities or disorders (Table 8.1). The patient’s ethnic origin can be of relevance. Sickle cell anaemia is an unlikely diagnosis in a patient with white skin while pernicious anaemia is equally unlikely in a patient with black skin. Children with chronic blood disorders such as haemoglobinopathies are frequently thinner and shorter than their healthy peers.

Examination of the lymph nodes

Lymph nodes may be enlarged in primary blood disorders and systemic diseases. Enlargement is referred to as ‘lymphadenopathy’ or just ‘adenopathy’. The differential diagnosis differs in generalised and localised forms of lymphadenopathy (Table 8.2). In practice, palpable lymphadenopathy is usually limited to the cervical, axillary and inguinal areas.

Jun 12, 2016 | Posted by in HEMATOLOGY | Comments Off on Examining the patient

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