34 Questions
What is the primary function of red blood cells?
Deliver oxygen to tissues
What is the main concern for a 2-year-old boy with multiple bruises on his shins and hands?
Bleeding disorder
What is the function of platelets?
Form blood clots
What is a common symptom of anemia?
Fatigue
What is the main component of blood involved in immune response?
White Blood Cells
What is the term for a lack of red blood cells or hemoglobin?
Anemia
What is the primary role of plasma?
Transportation of hormones and nutrients
What is the main concern for a 66-year-old woman with fatigue, dyspnea, and mild dizziness?
Anemia
What symptom is likely to be associated with anemia?
Fatigue
What disease process can be suspected if a patient presents with fatigue, hair loss, dry skin, and constipation?
Hypothyroidism
What is a possible cause of anemia in a patient with a history of cancer or cancer treatment?
Cancer treatment
What is a possible cause of anemia in a vegan patient?
Vitamin B12 deficiency
What is an important question to ask in the Review of Systems to identify the cause of anemia?
Do you have blood in your urine?
What is a possible underlying condition that can cause anemia?
Chronic Renal Disease
What is an important aspect to consider in the Social History of a patient with anemia?
Vegan Diet
What physical examination finding may indicate anemia?
Glossitis
What is a possible lab test to evaluate a patient with weakness and fatigue?
Complete Blood Count (CBC)
What is a possible treatment for a patient with vitamin B12 deficiency?
Intramuscular B12 injections
What is a possible physical examination finding in a patient with anemia?
Pallor
What is a possible imaging study to evaluate abdominal symptoms?
Abdominal Ultrasonography (US)
For your plan- what are some things you can do to further evaluate and/or treat a patient with anemia?
CBC lab
What is a possible follow-up plan for a patient with anemia?
Return to clinic in 2 weeks
What is the most likely diagnosis for the 66-year-old postmenopausal woman?
Iron deficiency anemia
What is the significance of the patient's habit of chewing on ice cubes?
It is a symptom of iron deficiency anemia
What is the Coagulation Cascade?
A process that regulates blood clotting
What happens if the Coagulation Cascade goes wrong?
Either too much bleeding or too much clotting occurs
What are the two main categories of bleeding disorders?
Platelet disorders and coagulation factor disorders
What is Menorrhagia?
Heavy menstrual bleeding
What is Petechiae?
Small red or purple spots on the skin
What is a possible cause of decreased platelet production?
Bone marrow replacement by malignancy
What is a type of congenital bleeding disorder due to platelet function defects?
Von Willebrand disease
What is a type of acquired clotting factor abnormality?
Vitamin K deficiency
What is a possible cause of bleeding in a 2-year-old boy with multiple bruises?
Von Willebrand disease
What is a possible consequence of platelet disorders?
Easy bruising
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
Evaluate a patient with a hematologic disorder, including taking a thorough history and conducting a physical exam to assess anemia and other hematologic complaints.
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