Hematologic Disease Screening PDF

Screening for Hematologic Disease — RUTH LYONS HANSEN, PT, MS, DPT, PHD PHTR 619 Why consider hematologic conditions? • Hematologic symptoms are common in patients taking NSAIDS • Neurologic symptoms associated with pernicious anemia • Complications of chemotherapy and radiation • Bleeding and cl...

Screening for Hematologic Disease — RUTH LYONS HANSEN, PT, MS, DPT, PHD PHTR 619 Why consider hematologic conditions? • Hematologic symptoms are common in patients taking NSAIDS • Neurologic symptoms associated with pernicious anemia • Complications of chemotherapy and radiation • Bleeding and clotting issues are of concern in post surgical clients and • anyone immobilized Hypo and hypercoagulation can impact choice of interventions and response to activity Signs & Symptoms of Hematologic Disorders S & S seen with exertion Nervous system symptoms • • • • • • • • • Dyspnea Chest pain Palpitations Weakness & fatigue Integumentary • Cyanosis /fingernail clubbing • Pallor • Bruising/bleeding Headache Dizziness Drowsiness Syncope Polyneuropathy Hematology Red Blood Cells (RBC) Erythrocytes • M:4.7 – 6.1 million/mm3 F:4.1‐5.4million/mm3 Hematocrit (HCT): percent RBC in blood • 37‐47% Females, 42‐52% Males Hemoglobin (Hb or HGB) • M:4.7 – 6.1 million/mm3 F:4.1‐5.4million/mm3 • Oxygen carrying capacity of RBC’s • Amount of hemoglobin in 100 ml of blood Leukocytes (WBC) • total number of WBC/µL blood • 5,000‐10,00/mm3 Platelets • 150,00‐400,000/mm3 • clotting Blood disorders: classification • Erythrocyte disorders • Leukocyte disorders • Platelet disorders Erythrocyte Disorders Reference: M:4.7 – 6.1 million/mm3 F:4.1-5.4million/mm3 • Anemia • Polycythemia • Poikilocytosis • Anisocytosis • Hypochromia Anemia • • • Reduced oxygen carrying capacity Not a disease but a symptom of many other disorders Symptoms: • May have no symptoms if gradual • Dyspnea, palpitations, weakness, fatigue and palpitations • Skin changes: pallor • Drop in resting DBP with rise in resting HR • Decreased exercise tolerance Polycythemia • Increase in RBC and Hg concentrations • Increased blood volume and viscosity • Primary Polycythemia/Polycythemia vera – primary – disease of bone marrow • Secondary – decreased oxygen supply S & S Polycythemia • • • • • • • • Fatigue SOB Itchy skin Headache Dizziness Irritability Blurred vision Fainting • • • • • • • Sensory changes in hands and feet Easy bruising Cyanosis Clubbing Enlarged spleen Gout Hypertension Sickle Cell Disease • A group of inherited (autosomal recessive) disorders that result in • • • abnormal shape of hemoglobin. Cell loses its ability to squeeze through smaller blood vessels due to abnormal shape and results in inadequate blood supply to tissues. • Hemolytic anemia • Vaso‐occlusion Series of crisis, often characterized by pain due to clotting that can affect any organ, joint. Crisis often precipitated by illness, stress, strenuous activity etc. Leukocyte Disorders (reference range: 5,000‐10,000/mm3 Leukocytosis • >10,000 leukocytes/mm3 • Body’s response to infection and attempt to fight it • S & S: • Fever, symptoms if local or systemic infection, inflammation Leukopenia • Reduced number of leukocytes below 5,000/mL • • • • Never beneficial Seen in chemotherapy, radiation, large‐scale systemic infection, autoimmune diseases Fever, chills, sweats warrant referral Nadir – lowest point WBC reaches typically 7‐14 days post chemo or radiation Platelet Disorders (reference range 150,000‐400,000/mm3) Thrombocytosis • Platelets are abnormally high Primary – abnormality in bone marrow Secondary – compensatory to surgery, iron deficiency, polycythemia vera, Ca • Clotting, splenomegaly, bruising Thrombocytopenia • Decreased platelets <150,000 • Many causes • S & S: • • • • • • Petechia Bruising Hematomas Joint swelling GI bleed ‐ melena CNS bleeds Hemophilia