FINDINGS THAT MAY LEAD TO A HEMATOLOGY CONSULTATION
Table 1–1 lists abnormalities that often require an evaluation by a hematologist.
TABLE 1–1FINDINGS THAT MAY LEAD TO A HEMATOLOGY CONSULTATION ||Download (.pdf) TABLE 1–1 FINDINGS THAT MAY LEAD TO A HEMATOLOGY CONSULTATION
|Decreased hemoglobin concentration (anemia) and/or abnormal red cell indexes |
|Increased hemoglobin concentration (polycythemia) |
|Elevated serum ferritin level |
|Accelerated sedimentation rate |
|Leukopenia or neutropenia |
|Immature granulocytes or nucleated red cells in the blood |
|Granulocytosis: neutrophilia, eosinophilia, basophilia, or mastocytosis |
|Hypergammaglobulinemia: monoclonal or polyclonal |
|Exaggerated bleeding: spontaneous or trauma related |
|Prolonged partial thromboplastin or prothrombin coagulation times |
|Venous thromboembolism |
|Obstetrical adverse events (e.g., recurrent fetal loss, stillbirth, and HELLP * syndrome). |
The care of a patient with a hematologic disorder begins with eliciting a medical history and performing a thorough physical examination. Certain parts of the history and physical examination that are of particular interest to the hematologist are presented here.
HISTORY OF THE PRESENT ILLNESS
Estimation of the "performance status" helps establish the degree of disability and permits assessment of the effects of therapy (Tables 1–2 and 1–3).
Drugs and chemicals often induce or aggravate hematologic diseases; drug use or chemical exposure, intentional or inadvertent, should be evaluated. One should inquire about professionally prescribed and self-prescribed drugs, such as herbal remedies. Occupational exposures should be defined.
Fever may result from hematologic disease or, more often, from an associated infection. Night sweats suggest the presence of fever. It is especially prevalent in lymphomas.
Weight loss may occur in some hematologic diseases.
Fatigue, malaise, lassitude, and weakness are common but are nonspecific symptoms and may be the result of anemia, fever, or muscle wasting associated with hematologic malignancy or neurologic complications of hematologic disease.
Symptoms related to specific organ systems or regions of the body may arise because of involvement in the basic disease process, such as spinal cord compression from a plasmacytoma, ureteral or intestinal obstruction from abdominal lymphoma, or stupor from exaggerated hyperleukocytosis in chronic myelogenous leukemia.
TABLE 1–2CRITERIA OF PERFORMANCE STATUS (KARNOVSKY SCALE) ||Download (.pdf) TABLE 1–2 CRITERIA OF PERFORMANCE STATUS (KARNOVSKY SCALE)
|Able to carry on normal activity; no special care is needed. |
|100% ||Normal; no complaints, no evidence of disease |
|90% ||Able to carry on normal activity; minor signs or symptoms of disease |
|80% ||Normal activity with effort; some signs or symptoms of disease |
|Unable to work; able to live at home, care for most personal needs; a varying amount of assistance is needed. |
|70% ||Cares for self; unable to carry on normal activity or to do active work |
|60% ||Requires occasional assistance but is ...|