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 Photos Bleeding(and sometimes Swollen) Gums

Leukemia
Hemophilia
Leukemia
Leukemia

Other Clinical Features of Blood Disorders

Ulceration
Atrophy and
Pallor
Ulceration