PRINCIPLES OF HEMATOLOGICAL DIAGNOSIS 1.HISTORY I-Medical history A.The present illness, focus on the following: 1.Bleeding. 2.Infection or symptoms related to enlargement of L.N, LIVER or the SPLEEN. 3.Non-specific symptoms related to ANAEMIA:Malaise, weakness, headache & weight loss. B. Any exposure to drugs or chemical. C. Review of systems; including the nervous system, is necessary as blood dyscrasia effect many, if not all, organ systems. II- Family history; information about the health of other family members as well as the ethnic background.

2- PHYSICAL EXAMINATION A- Thorough physical exam. Should focus on; SKIN, MOUTH,MUCOUS MEMBRANE,& EYES. JAUDICE PALLOR PETECHIAE & ECCYMOSIS. ULCERS B- Hepatomegaly, splenomegaly,enlarged or tender L.N,soreness over the ribs or sternum & variety of neurological abnormalities.

ANAEMIA A-Symptoms & signs pertaining to anaemia. 1-Non-specific symptoms include; fatigue, weakness, shortness of breath & symptoms of CHF 2-Signs include ; Pallor,tachycardia, splenomegaly in minority of cases.Venous hum in severe anaemia ( Hb < 4 gm/dl).Functional systolic murmur.

SYMPTOMS & SIGNS Specific To IRON deficiency Pica: compulsive ingestion of non-nutrient substance (clay/ ice-pagophagia) 1- Atrophic changes in the epithelium; - oral lesions; I- Angular cheilosis; soreness & cracking in the corners of the lips. II-Atrophy of the tongue papillae with intermittent glossitis III-Stomatitis ; inflammation & soreness of of the tongue & mouth. 2-DYSPHAGIA. 3- Nail lesions; thinning & flattening of the nails progress to brittle & spoon-shaped nail ( koilonychia)

ANEMIA Clinical: Weakness, Fatigue, Pallor Decreased Oxygen Carrying Capacity of Blood Result of: Decreased Number, Size, or HgB Content of RBC’s or of Defective HgB Secondary to: –Nutritional / Iron Defeciency –RBC loss or destruction (Chronic Bleeding) –Failure of RBC formation (Leukemia) –Hereditary HgB malformation Oral Features: –Pallor –Bald Tongue Possible Association with other Disease: Leukemia, Kidney Disease, etc.

Thalassemic facies

Anemia Classification Size of RBC’s –Microcytic (Small) –Macrocytic (Large) –Normocytic (Normal Size) Concentration of Hgb –Hypochromic (Less) –Hyperchromic (More) –Normochromic (Normal) Microcytic / Hypochromic –Chronic Blood Loss, Iron Deficiency, Thalassemia Macrocytic (Megaloblastic) / Hyperchromic –Vit B12 (Pernicious) or Folic Acid Deficiency Normocytic / Normochromic –Hemolytic, Aplastic, Myelophthisic, Acute Blood Loss, Chronic Renal Failure

PLATELETS NORMAL PLATELET COUNT X109/L PLATELET disorders; Defect in count  THROMBOCYTOPENIA Defect in function  THROMBOASTHENIA. CLINICAL MANIFESTATIONS; 1-PETECHIAE. 2-PURPURA 3-ECCHYMOSIS(BRUSIES) 4- HAEMATOMA

Clinical Bleeding Petechiae Petechiae and Ecchymoses Ecchymoses

Clinical Photos Bleeding (and sometimes Swollen) Gums Leukemia Hemophilia Leukemia Leukemia

Other Clinical Features of Blood Disorders Ulceration Atrophy and Pallor Ulceration

Oral Ulceration and Infection Secondary to Leukopenia or Leukemia