Hello. At this lecture I'd like to concentrate on investigation and diagnosis of the blood system.
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 investigation
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 the imaging such as x-rays.
Now the clinical approach to the diagnosis in the patient with blood disorders involves three major approaches.
This is true for any clinical condition.
From diagnosing an infection, rheumatoid arthritis - it's always the same,
Firstly, take a medical history. Listen to the patient and listen to the symptom they described.
Secondly, perform an examination.
Finally, if necessary, do some investigations.
And in this lecture we will be largely focusing on those investigations and their appropriate use
within the management of patients with hematological disorders.
Let's just spend a minute talking about taking a history in a patient with a blood disorders.
Of course there's all sorts of things that one might need to ask and the patient may tell you.
If it's a red cell problem that will usually mean anemia which could the patients will be fatigued
or short of breath because they're not getting enough oxygen into their tissues.
If it's a problem with white cells, that might lead to unusual or prolonged infections.
Whereas, excess of white cells, too many cells can happen in malignant diseases
such as leukemia and lymphoma - patients may notice swellings or lumps.
Finally, anything that affects platelet function can lead to bruising and bleeding.
And particularly looking for unusual bruising or bleeding that makes us suspicious.
Now let's turn to the potential examination of a patient with a blood disorder.
There's a range of things that you may wish to examine, but a broad examination is required in most cases.
You might want to look at the nails and skin or the mucous membranes
to see if there's anemia or bleeding.
Examination of the lymph nodes may suggest leukemia or lymphoma.
And of course excessive bruising may be seen in platelet disorders.
Got a couple of photographs for you here - on the top right, the patient with anemia,
typically, iron deficiency anemia.
You’ll notice a slight ulceration of the corner of the mouth.
The bottom, the doctor is examining the spleen in the patient.
Spleen lives under the left hand side of your ribs and if you feel in that area you shouldn't feel your spleen.
It only becomes palpable when it's enlarged.