Chapter 1: Approach to the Patient

FINDINGS THAT MAY LEAD TO A HEMATOLOGY CONSULTATION

Table 1–1 lists abnormalities that often require an evaluation by a hematologist.

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.