Hello, In this lecture, I would 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 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.
Now the clinical approach to the diagnosis in the patient
with blood disorders involves three major approaches.
This is true for any clinical condition, diagnosing
an infection, rheumatoid arthritis, its always the same.
Firstly take a medical history, listen to the patient
and listen to the symptoms they describe.
Secondly, perform an examination. And finally,
if necessary use of investigations.
and in this lecture, we will be largely focusing
on those investigations and their appropriate use
within the management of patients with
Let's just spend a minute talking about taking
a history in a patient with a blood disorder.
Of course there's all sorts of things that one
might need to ask and the patient may tell you.
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.
If it is a problem with white cells, that might
lead to unusual or prolonged infections.
Whereas excess white cells, too many cells can happen
in malignant diseases such as leukaemia and lymphoma.
The 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 us 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 anaemia or bleeding.
Examination of the lymph nodes may suggest
leukaemia or lymphoma
and of course, excessive bruising may be seen
in platelet disorders.
I have a couple of photographs for you here in the top
right, a patient with anaemia-iron deficiency anaemia.
You will notice a slight ulceration at the
corner of the mouth.
At 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.
But for the rest of this lecture, I want to focus on