HAEMOTOLOGY

1) Nasal bleeding-hx

- How do you feel now ? Is it ok if I ask you some questions and then
examine you?

- OCD – when did it start?

- - Is this the first time?

- - How long it lasted?

- - Does it come and go?

- COCA (Color, Odor, Consistency & amount) & Severity– Do you feel
dizzy? Pale? SOB, heart racing?

D/D BILT

 Bleeding blocks-BELT

-Bleeding from any other site? Urine/stool/heavy

menstruation/gums

-Blood thinners/ easy bruising/ Liver d/s/ Trauma/rubbing of nose

 ITP-sore throat/sick before this/ Abd pain( if abd pain-place-LUQ/RUQ)

/pain killers

 Leukemia-Joint pain/Swelling/fever/change in weight/lump or bump

 Therapy-Chemo/Radiation/BT

PF MASH SAD GLOSS/HEADDSSS

F/Hx of blood disorder-V.IMP

ITP-M/m

-no bleeding, count>30,000-no Rx

 -mild bleeding, count<30,000-steroids

Dexamethasone 40mg/d x 4wks or prednisone 1mg/kg/d

-severe bleeding, count<10,000-IVIG,Anti RHO

-failed Rx- splenectomy, immunosuppresents.

2) Fatigue with Hb-70g,WBC &PLT Normal (ANEMIA)

OCD-Is this the first time you got these tests done?

-Why were these tests done?

Specific Sx- OCD

- Do you feel dizzy? Since when(general for anemia)

- Heart racing?SOB?Pale?(general for anemia)

- Any tingling or numbness?-Vit B12 Def

- yellowness of skin/eyes- hemolysis

D/d of anemia- TAILS-B

Iron def anemia- DOB

 Diet-how is your diet? Any restrictions?vegetarian

 Obs-Is it possible that you are pregnant?LMP?beastfeding?

 Bleeding blocks-BEL(T)

-are you bleeding from any site? urine/stool/heavy periods.

- easy bruising/ liver d/s

Thalassemia- origin

Include some d/d of fatigue

MEDIA2 DUNLOPS
  Muscle d/s- PMR/Dermatomyositis/CFS

 Endo- DM/Hypothyroidism/Cushing's

 Depression

 Infection (UTI/Pyelonephritis)

 Anemia

 Abuse

 Diuretics (causes Hypokalemia)

 Uremia (any kidney d/s)

 Neoplasm (constitutional symptoms)

 Liver d/s

 OSA

 Pregnancy

 Substance Abuse

PF MASH SAD GLOSSS

Past hx – any chronic d/s-stomach d/s / celiac d/s/ liver or kidney d/s

Family hx- blood d/s eg. thalassemia

Meds-MTX/Sulfa/antiepileptics/vit B12 inj

Allergy

Surgery-any sx to stomach/bowel

Hosp- multiple blood transfusions

Alcohol-
Gynae-already asked

Lifestyle-diet already asked

Occupation-lead poisoning

Social- origin?

Stress- How's your mood

Sexual- not required

Anemia- P/E

 Intro, Explain, Consent

 Vitals- look for tachycardia, orthostatic hypotension, wide pulse pressure

 Hands- look for pallor of palmar creases, koilonychia (spoon shaped nails in
iron def anaemia)

 Eyes- look for pallor and jaundice

 Mouth- look for glossitis/ angular stomatitis/ dehydration

 Cardiac-systolic flow murmur/ s/o CHF (displaced apex beat, raised JVP,
hepatojugular reflex)

 Neuro- paraesthesia/ wide stepped gait (Vit B12 def)

 DRE- for blood loss

Investigations

CBC with diff, Retic ct., Blood film, Ferritin, TIBC, Serum Iron levels, Folate, Vitamin
B12

3) Swelling on the body

OCD- when did it start?

-Is it increasing in size or same?

specific ques-a) for swelling

SL-SHIPS- Single or multiple/ Location/ Size/ Hard or soft/ Immobile or mobile/

Painful or painless/Skin changes over it

b) for anaemia- dizzy/SOB/ heart racing/ pale

D/d- SAHIL CTT

Sarcoidosis- cough/skin rash

AIDS- diarrhea/ mouth ulcers/ sexual hx/ penile d/c

Hodgkin's and NHL- multiple swellings/ non tender, rubbery/ weight loss/ fever/
night sweats

Infections- Inf mononucleosis and bact pharyngitis- sore throat, runny nose/ eye
discharge and redness/ abd pain

Leukemia- joint pain or selling/ constitutional symptoms (already asked)

Cat scratch disease- do you have a cat at home?

TB- travel/ sick contact/ occupation

Toxoplasmosis- did you eat any uncooked meat recently?

PF MASH GLOSS SAD/ HEADDSSS

Investigations- CBC, CXR, throat swab, mono spot, CD4 count, AIDS serology, LN
biopsy