Approach to a Patient – Investigation and Diagnosis of Blood Disorders

00:01 Hello. At this lecture I'd 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.

00:20 Blood count, blood film and blood clotting are basic investigation used in many patients with hematological disorders.

00:30 But sometimes a bone marrow may be required.

00:33 Genetic analysis is now essential in many cases for the diagnosis of hematological disorders.

00:41 And finally, a range of additional specialized tests may be needed and that can often include the imaging such as x-rays.

00:49 Now the clinical approach to the diagnosis in the patient with blood disorders involves three major approaches.

00:57 This is true for any clinical condition.

01:00 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.

01:12 Secondly, perform an examination.

01:15 Finally, if necessary, do some investigations.

01:20 And in this lecture we will be largely focusing on those investigations and their appropriate use within the management of patients with hematological disorders.

01:31 Let's just spend a minute talking about taking a history in a patient with a blood disorders.

01:39 Of course there's all sorts of things that one might need to ask and the patient may tell you.

01:46 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.

01:58 If it's a problem with white cells, that might lead to unusual or prolonged infections.

02:05 Whereas, excess of white cells, too many cells can happen in malignant diseases such as leukemia and lymphoma - patients may notice swellings or lumps.

02:17 Finally, anything that affects platelet function can lead to bruising and bleeding.

02:23 And particularly looking for unusual bruising or bleeding that makes us suspicious.

02:30 Now let's turn to the potential examination of a patient with a blood disorder.

02:36 There's a range of things that you may wish to examine, but a broad examination is required in most cases.

02:43 You might want to look at the nails and skin or the mucous membranes to see if there's anemia or bleeding.

02:50 Examination of the lymph nodes may suggest leukemia or lymphoma.

02:55 And of course excessive bruising may be seen in platelet disorders.

03:00 Got a couple of photographs for you here - on the top right, the patient with anemia, typically, iron deficiency anemia.

03:09 You’ll notice a slight ulceration of the corner of the mouth.

03:13 The bottom, the doctor is examining the spleen in the patient.

03:17 Spleen lives under the left hand side of your ribs and if you feel in that area you shouldn't feel your spleen.

03:24 It only becomes palpable when it's enlarged.