Hematology Patient Evaluation

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Questions and Answers

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?

Anemia

Cancer

Infectious disease

Bleeding disorder (correct)

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?

Fatigue Signup and view all the answers

What is the main component of blood involved in immune response?

White Blood Cells Signup and view all the answers

What is the term for a lack of red blood cells or hemoglobin?

Anemia Signup and view all the answers

What is the primary role of plasma?

Transportation of hormones and nutrients Signup and view all the answers

What is the main concern for a 66-year-old woman with fatigue, dyspnea, and mild dizziness?

Anemia Signup and view all the answers

What symptom is likely to be associated with anemia?

Fatigue Signup and view all the answers

What disease process can be suspected if a patient presents with fatigue, hair loss, dry skin, and constipation?

Hypothyroidism Signup and view all the answers

What is a possible cause of anemia in a patient with a history of cancer or cancer treatment?

Cancer treatment Signup and view all the answers

What is a possible cause of anemia in a vegan patient?

Vitamin B12 deficiency Signup and view all the answers

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? Signup and view all the answers

What is a possible underlying condition that can cause anemia?

Chronic Renal Disease Signup and view all the answers

What is an important aspect to consider in the Social History of a patient with anemia?

Vegan Diet Signup and view all the answers

What physical examination finding may indicate anemia?

Glossitis Signup and view all the answers

What is a possible lab test to evaluate a patient with weakness and fatigue?

Complete Blood Count (CBC) Signup and view all the answers

What is a possible treatment for a patient with vitamin B12 deficiency?

Intramuscular B12 injections Signup and view all the answers

What is a possible physical examination finding in a patient with anemia?

Pallor Signup and view all the answers

What is a possible imaging study to evaluate abdominal symptoms?

Abdominal Ultrasonography (US) Signup and view all the answers

For your plan- what are some things you can do to further evaluate and/or treat a patient with anemia?

CBC lab Signup and view all the answers

What is a possible follow-up plan for a patient with anemia?

Return to clinic in 2 weeks Signup and view all the answers

What is the most likely diagnosis for the 66-year-old postmenopausal woman?

Iron deficiency anemia Signup and view all the answers

What is the significance of the patient's habit of chewing on ice cubes?

It is a symptom of iron deficiency anemia Signup and view all the answers

What is the Coagulation Cascade?

A process that regulates blood clotting Signup and view all the answers

What happens if the Coagulation Cascade goes wrong?

Either too much bleeding or too much clotting occurs Signup and view all the answers

What are the two main categories of bleeding disorders?

Platelet disorders and coagulation factor disorders Signup and view all the answers

What is Menorrhagia?

Heavy menstrual bleeding Signup and view all the answers

What is Petechiae?

Small red or purple spots on the skin Signup and view all the answers

What is a possible cause of decreased platelet production?

Bone marrow replacement by malignancy Signup and view all the answers

What is a type of congenital bleeding disorder due to platelet function defects?

Von Willebrand disease Signup and view all the answers

What is a type of acquired clotting factor abnormality?

Vitamin K deficiency Signup and view all the answers

What is a possible cause of bleeding in a 2-year-old boy with multiple bruises?

Von Willebrand disease Signup and view all the answers

What is a possible consequence of platelet disorders?

Easy bruising Signup and view all the answers

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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Description

Evaluate a patient with a hematologic disorder, including taking a thorough history and conducting a physical exam to assess anemia and other hematologic complaints.