Podcast
Questions and Answers
What is the primary function of red blood cells?
What is the primary function of red blood cells?
- Deliver oxygen to tissues (correct)
- Regulate blood pressure
- Form blood clots
- Primarily involved in immune response
What is the main concern for a 2-year-old boy with multiple bruises on his shins and hands?
What is the main concern for a 2-year-old boy with multiple bruises on his shins and hands?
- Anemia
- Cancer
- Infectious disease
- Bleeding disorder (correct)
What is the function of platelets?
What is the function of platelets?
- Deliver oxygen to tissues
- Regulate blood pressure
- Primarily involved in immune response
- Form blood clots (correct)
What is a common symptom of anemia?
What is a common symptom of anemia?
What is the main component of blood involved in immune response?
What is the main component of blood involved in immune response?
What is the term for a lack of red blood cells or hemoglobin?
What is the term for a lack of red blood cells or hemoglobin?
What is the primary role of plasma?
What is the primary role of plasma?
What is the main concern for a 66-year-old woman with fatigue, dyspnea, and mild dizziness?
What is the main concern for a 66-year-old woman with fatigue, dyspnea, and mild dizziness?
What symptom is likely to be associated with anemia?
What symptom is likely to be associated with anemia?
What disease process can be suspected if a patient presents with fatigue, hair loss, dry skin, and constipation?
What disease process can be suspected if a patient presents with fatigue, hair loss, dry skin, and constipation?
What is a possible cause of anemia in a patient with a history of cancer or cancer treatment?
What is a possible cause of anemia in a patient with a history of cancer or cancer treatment?
What is a possible cause of anemia in a vegan patient?
What is a possible cause of anemia in a vegan patient?
What is an important question to ask in the Review of Systems to identify the cause of anemia?
What is an important question to ask in the Review of Systems to identify the cause of anemia?
What is a possible underlying condition that can cause anemia?
What is a possible underlying condition that can cause anemia?
What is an important aspect to consider in the Social History of a patient with anemia?
What is an important aspect to consider in the Social History of a patient with anemia?
What physical examination finding may indicate anemia?
What physical examination finding may indicate anemia?
What is a possible lab test to evaluate a patient with weakness and fatigue?
What is a possible lab test to evaluate a patient with weakness and fatigue?
What is a possible treatment for a patient with vitamin B12 deficiency?
What is a possible treatment for a patient with vitamin B12 deficiency?
What is a possible physical examination finding in a patient with anemia?
What is a possible physical examination finding in a patient with anemia?
What is a possible imaging study to evaluate abdominal symptoms?
What is a possible imaging study to evaluate abdominal symptoms?
For your plan- what are some things you can do to further evaluate and/or treat a patient with anemia?
For your plan- what are some things you can do to further evaluate and/or treat a patient with anemia?
What is a possible follow-up plan for a patient with anemia?
What is a possible follow-up plan for a patient with anemia?
What is the most likely diagnosis for the 66-year-old postmenopausal woman?
What is the most likely diagnosis for the 66-year-old postmenopausal woman?
What is the significance of the patient's habit of chewing on ice cubes?
What is the significance of the patient's habit of chewing on ice cubes?
What is the Coagulation Cascade?
What is the Coagulation Cascade?
What happens if the Coagulation Cascade goes wrong?
What happens if the Coagulation Cascade goes wrong?
What are the two main categories of bleeding disorders?
What are the two main categories of bleeding disorders?
What is Menorrhagia?
What is Menorrhagia?
What is Petechiae?
What is Petechiae?
What is a possible cause of decreased platelet production?
What is a possible cause of decreased platelet production?
What is a type of congenital bleeding disorder due to platelet function defects?
What is a type of congenital bleeding disorder due to platelet function defects?
What is a type of acquired clotting factor abnormality?
What is a type of acquired clotting factor abnormality?
What is a possible cause of bleeding in a 2-year-old boy with multiple bruises?
What is a possible cause of bleeding in a 2-year-old boy with multiple bruises?
What is a possible consequence of platelet disorders?
What is a possible consequence of platelet disorders?
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Study Notes
Hematological Patient Assessment
- Objective: Describe the clinical evaluation of a patient with a hematologic disorder, including taking an appropriate History, conducting a Physical Exam, and offering a basic Assessment and Plan.
Key Components of Blood
- Plasma
- Red Blood Cells (RBCs)
- White Blood Cells (WBCs)
- Platelets
- Clotting factors
Functions of Blood Components
- RBCs: Deliver oxygen to tissues
- WBCs: Primarily involved in immune response
- Platelets: Involved in blood clotting
Patient Cases
Case 1: Anemia
- 66-year-old postmenopausal woman presents with fatigue, dyspnea on exertion, and mild dizziness with standing
- Physical examination reveals mild tachycardia and pallor of conjunctiva and mucous membranes
- Key features: Fatigue, dyspnea, dizziness, and pallor
- Likely diagnosis: Anemia
History Taking
- Past Medical History (PMH): Ask about chronic diseases, cancer, infections, and prosthetic heart valves
- Family History (FH): Ask about thalassemia, sickle cell, and early gallstones
- Social History (SH): Ask about diet, alcohol use, and occupational exposures
- Review of Systems (ROS): Ask about symptoms of anemia, depression, and non-anemia causes of the chief complaint
Physical Exam (PE)
- Vital signs: Check for hypotension and tachycardia
- General appearance: Check nutritional status
- Skin/eyes: Check for pallor, petechiae, and jaundice
- Mouth: Check for glossitis
- Heart: Check for murmurs and prosthetic valve
- Abdomen: Check for splenomegaly
- Rectal: Check for gross or occult blood
- Lymph Nodes: Check for enlarged lymph nodes
Bleeding Disorders
- Symptoms: Excessive ecchymoses, petechiae, purpura, and bleeding gums
- Classification: Platelet-related or clotting factor-related disorders
Bleeding due to Platelet Disorders
- Disorders of platelet number (thrombocytopenia):
- Decreased production of platelets (medications, bone marrow replacement, aplasia, and alcohol)
- Disorders of platelet function (congenital, acquired)
- Disorders of platelet function:
- Congenital (von Willebrand disease, other rare genetic abnormalities)
- Acquired (medications, myeloproliferative disorders, coating of platelets by abnormal proteins, and uremia)
Bleeding due to Clotting Factor Abnormalities
- Congenital: Hemophilia A and other clotting factor deficiencies
- Acquired:
- Deficiency of a factor or factors (liver disease, vitamin K deficiency, warfarin therapy)
- Abnormal adsorption of a factor (e.g., factor X adsorption to amyloid fibrils)
- Consumption of factors (e.g., DIC)
- Dilution of factors (e.g., massive transfusion)
- Acquired inhibitor to clotting factor or factors
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