Approach to a Patient – Investigation and Diagnosis of Blood Disorders

by Paul Moss, PhD

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    00:00 Hello, In this lecture, I would like to concentrate on investigation and diagnosis of the blood system.

    00:07 Learning outcomes of this lecture will include the fact that a diagnosis is made by combining the history, examination and investigation. Blood count, blood film and blood clotting are basic investigations used in many patients with hematological disorders, but sometimes a bone marrow may be required. Genetic analysis is now essential in many cases for the diagnosis of hematological disorders. And finally a range of additional specialized tests may be needed and that can often include imaging such as x-rays.

    00:50 Now the clinical approach to the diagnosis in the patient with blood disorders involves three major approaches.

    00:59 This is true for any clinical condition, diagnosing an infection, rheumatoid arthritis, its always the same.

    01:07 Firstly take a medical history, listen to the patient and listen to the symptoms they describe.

    01:15 Secondly, perform an examination. And finally, if necessary use of investigations.

    01:23 and in this lecture, we will be largely focusing on those investigations and their appropriate use within the management of patients with haematological disorders.

    01:34 Let's just spend a minute talking about taking a history in a patient with a blood disorder.

    01:42 Of course there's all sorts of things that one might need to ask and the patient may tell you.

    01:48 If it is a red cell problem, that will usually mean anaemia, in which patient will be fatigued, or short of breath because they are not getting enough oxygen to their tissues.

    02:01 If it is a problem with white cells, that might lead to unusual or prolonged infections.

    02:08 Whereas excess white cells, too many cells can happen in malignant diseases such as leukaemia and lymphoma.

    02:15 The patients may notice swellings or lumps.

    02:19 Finally, anything that affects platelet function can lead to bruising and bleeding and particularly looking for unusual bruising or bleeding that makes us suspicious.

    02:33 Now let us turn to the potential examination of a patient with a blood disorder.

    02:38 There's a range of things that you may wish to examine, but a broad examination is required in most cases.

    02:44 You might want to look at the nails and skin or the mucous membranes to see if there's anaemia or bleeding.

    02:52 Examination of the lymph nodes may suggest leukaemia or lymphoma and of course, excessive bruising may be seen in platelet disorders.

    03:03 I have a couple of photographs for you here in the top right, a patient with anaemia-iron deficiency anaemia.

    03:10 You will notice a slight ulceration at the corner of the mouth.

    03:16 At the bottom, the doctor is examining the spleen in the patient.

    03:21 Spleen lives under the left-hand side of your ribs and if you feel in that area, you shouldn't feel your spleen.

    03:27 It only becomes palpable when it's enlarged. But for the rest of this lecture, I want to focus on

    About the Lecture

    The lecture Approach to a Patient – Investigation and Diagnosis of Blood Disorders by Paul Moss, PhD is from the course Hematology: Basics.

    Author of lecture Approach to a Patient – Investigation and Diagnosis of Blood Disorders

     Paul Moss, PhD

    Paul Moss, PhD

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