Prof. Andrzej

Prof. Andrzej

Hellmann

Hellmann

History

History

taking

taking

and

and

physical

physical

examination

examination

in

in

haematology

haematology

Department

Department

of

of

Haematology

Haematology

and

and

Transplantology

Transplantology

.

.

●

●

History

History

taking

taking

–

–

anamnesis

anamnesis

●

●

Physical

Physical

examination

examination

●

●

Auxillary

Auxillary

investigations

investigations

-

-

Laboratory

Laboratory

tests

tests

-

-

complete

complete

Blood

Blood

Count

Count

-

-

CBC

CBC

-

-

coagulation

coagulation

tests

tests

-

-

bone

bone

marrow

marrow

examination

examination

-

-

immunophenotyping

immunophenotyping

-

-

cytogenetics

cytogenetics

-

-

molecular

molecular

investigations

investigations

(PCR)

(PCR)

-

-

histopatology

histopatology

-

-

Noninvasive

Noninvasive

imaging

imaging

-

-

radiology

radiology

techni

techni

q

q

ue

ue

:

:

-

-

ultrasonography

ultrasonography

-

-

computed

computed

tomography

tomography

(CT)

(CT)

-

-

positron

positron

emission

emission

tomopraphy

tomopraphy

(PET

(PET

)

)

-

-

scyntypraphy

scyntypraphy

Consulting the

Consulting the

results

results

•

•

Anaemia

Anaemia

(

(

Hb

Hb

<

<

11g/dl.)

11g/dl.)

↓

↓

90%

90%

↓

↓

10%

10%

non

non

–

–

haematological

haematological

haematological

haematological

causes diseases

causes diseases

Leucocytosis

Leucocytosis

probability

probability

of

of

causes

causes

>

>

15G/l

15G/l

~

~

53%

53%

infections

infections

~

~

24%

24%

stress

stress

~

~

11%

11%

drugs

drugs

~

~

6%

6%

necrosis

necrosis

~

~

6%

6%

leucaemias

leucaemias

>

>

30G/l

30G/l

~

~

40%

40%

infekctions

infekctions

10%

10%

tumors

tumors

8%

8%

drugs

drugs

42%

42%

leucaemias

leucaemias

>

>

100G/l

100G/l

~

~

95%

95%

leucarmias

leucarmias

3%

3%

tumors

tumors

2%

2%

tuberculosis

tuberculosis

Thrombocytosis

Thrombocytosis

PLT

PLT

>

>

450 G/l

450 G/l

50%

50%

infections

infections

25%

25%

sideropenia

sideropenia

25%

25%

tumors

tumors

10%

10%

thrombocythaemia

thrombocythaemia

PLT

PLT

>

>

600 G/l

600 G/l

10%

10%

infections

infections

10%

10%

sideropenia

sideropenia

20%

20%

tumors

tumors

60%

60%

thrombocythaemia

thrombocythaemia

PLT

PLT

>

>

1000 G/l

1000 G/l

95%

95%

thrombocythaemia

thrombocythaemia

3%

3%

splenectomy

splenectomy

2%

2%

other

other

reasons

reasons

History

History

taking

taking

•

•

Family

Family

history

history

•

•

Social

Social

history

history

•

•

Past

Past

medical

medical

history

history

•

•

Present

Present

complains

complains

Family

Family

history

history

●

●

haematology

haematology

is

is

rich

rich

in

in

heritable

heritable

diseases

diseases

,

,

hemophilia

hemophilia

,

,

non

non

-

-

immune

immune

haemolytic

haemolytic

anaemias

anaemias

●

●

Patern

Patern

of

of

inheritance

inheritance

Family

Family

history

history

(

(

continue

continue

)

)

in

in

acute

acute

leucaemias

leucaemias

and

and

other

other

haematologial

haematologial

disorders

disorders

we

we

have

have

to

to

look

look

for

for

potential

potential

donors

donors

for

for

bone

bone

marrow

marrow

transplantation

transplantation

.

.

Siblings

Siblings

not

not

stepsiblings

stepsiblings

formula

formula

1

1

–

–

(0,75)

(0,75)

n

n

-

-

number

number

of

of

brothers

brothers

or

or

sisters

sisters

1

1

brother

brother

or

or

sister

sister

-

-

25,0%

25,0%

2

2

siblings

siblings

-

-

43,7%

43,7%

3

3

„

„

-

-

67,2%

67,2%

4

4

„

„

-

-

68,4%

68,4%

5

5

„

„

-

-

76,3%

76,3%

6

6

„

„

-

-

82,2%

82,2%

7

7

„

„

-

-

86,6%

86,6%

Social

Social

history

history

Profession

Profession

:

:

environmental

environmental

exposures

exposures

Living

Living

conditions

conditions

:

:

disstance

disstance

to

to

the

the

hospital

hospital

Nutrition

Nutrition

habits

habits

:

:

vegetarian

vegetarian

,

,

veganian

veganian

habits

habits

alcohol

alcohol

consumption

consumption

tabacco

tabacco

Past

Past

medical

medical

history

history

●

●

surgical

surgical

procedures

procedures

-

-

cholecystectomy

cholecystectomy

-

-

splenectomy

splenectomy

-

-

gastrectomy

gastrectomy

-

-

jejunectomy

jejunectomy

●

●

radiotherapy

radiotherapy

,

,

cytostatics

cytostatics

●

●

farmacotherapy

farmacotherapy

:

:

anticonvulsant

anticonvulsant

drugs

drugs

nonsteroidal

nonsteroidal

antiinflammatory

antiinflammatory

agents

agents

gold

gold

Transfusion

Transfusion

history

history

●

●

blood

blood

donation

donation

(1

(1

~

~

200

200

–

–

250 mg Fe)

250 mg Fe)

●

●

history

history

of

of

blood

blood

taking

taking

-

-

haemosyderosis

haemosyderosis

–

–

after

after

(50j ME

(50j ME

–

–

10g Fe)

10g Fe)

●

●

Jehovah

Jehovah

`s

`s

witnesses

witnesses

Present

Present

complains

complains

●

●

fatigue

fatigue

,

,

weakness

weakness

–

–

may

may

be

be

related

related

to

to

anaemia

anaemia

●

●

headache

headache

–

–

may

may

be

be

due

due

to

to

anaemia

anaemia

or

or

polycythemia

polycythemia

or

or

may

may

by

by

caused

caused

infiltration

infiltration

of

of

CNS

CNS

●

●

weight

weight

loss

loss

–

–

may occur

may occur

in

in

leucaemias

leucaemias

and

and

lymphomas

lymphomas

,

,

but

but

more

more

prominent

prominent

is

is

rather

rather

due

due

to

to

nonhaematological

nonhaematological

malignancies

malignancies

Present

Present

complains

complains

(

(

continue

continue

).

).

●

●

fever

fever

:

:

usually

usually

is

is

due

due

to

to

secondary

secondary

infections

infections

, but

, but

quite

quite

offen

offen

may

may

be

be

caused

caused

by

by

the

the

disease

disease

itself

itself

(NHL, HL,

(NHL, HL,

ALL)

ALL)

●

●

night

night

sweats

sweats

:

:

may

may

occur

occur

in

in

patients

patients

with

with

lymphoma

lymphoma

●

●

chills

chills

:

:

may

may

accompany

accompany

severe

severe

haemolytic

haemolytic

anaemia

anaemia

Present

Present

complains

complains

(

(

continue

continue

)

)

●

●

itching

itching

–

–

may

may

occur

occur

in

in

HL, NHL (

HL, NHL (

Sezary

Sezary

syndrome

syndrome

)

)

PV (

PV (

after

after

bathing

bathing

)

)

●

●

erythromelalgia

erythromelalgia

–

–

burning

burning

pain

pain

increased

increased

skin

skin

temperature

temperature

and

and

redness

redness

of

of

the

the

feet

feet

less

less

often

often

hands

hands

–

–

often

often

in

in

thrombocythaemia

thrombocythaemia

●

●

lef

lef

upper

upper

quadrant

quadrant

of

of

abdomen

abdomen

pain

pain

,

,

fullness

fullness

is

is

due

due

splenomegaly

splenomegaly

●

●

left

left

shoulder

shoulder

aching

aching

Physical

Physical

examination

examination

●

●

examination

examination

of

of

the

the

skin

skin

and

and

mucous

mucous

membrances

membrances

(

(

oral

oral

cavity

cavity

)

)

●

●

examination

examination

of

of

the

the

lymph

lymph

-

-

nodes

nodes

●

●

examination

examination

of

of

the

the

spleen

spleen

●

●

Examination

Examination

of

of

the

the

skin

skin

and

and

mucous

mucous

membrences

membrences

-

-

pallor

pallor

-

-

jaundice

jaundice

-

-

flusing

flusing

(

(

plethora

plethora

)

)

-

-

petechiae

petechiae

-

-

ecchymoses

ecchymoses

ecchymoses

ecchymoses

petechiae

petechiae

Infiltration

Infiltration

of

of

the

the

gums

gums

Skin

Skin

in

in

GvHD

GvHD

Examination

Examination

of

of

lymph

lymph

nodes

nodes

Lymphadenopathy

Lymphadenopathy

∅

∅

≥

≥

1 cm.

1 cm.

Reactive

Reactive

-

-

soft

soft

and

and

tender, mobile

tender, mobile

usually

usually

less

less

than

than

2 cm

2 cm

∅

∅

Malignant

Malignant

–

–

large

large

,

,

rubbery

rubbery

,

,

painless

painless

,

,

matted

matted

and

and

fixed

fixed

Lymphadenopaty

Lymphadenopaty

may

may

be

be

–

–

isolated

isolated

(single)

(single)

-

-

regional

regional

-

-

genaralised

genaralised

supraclavicular

supraclavicular

supraclavicular

supraclavicula
r

preauricular

submental

inguinal

axillary

cervical

epitrochlear

popliteall

supracla
vicular

submental

paraaortic

Expression

Expression

of

of

the

the

lymph

lymph

–

–

node

node

size

size

diametr

diametr

volume

volume

3.,0 cm

3.,0 cm

9,4 cm

9,4 cm

3

3

3,5 cm

3,5 cm

22,0 cm

22,0 cm

3

3

4,0 cm

4,0 cm

33,5 cm

33,5 cm

3

3

wg

wg

Wiseman

Wiseman

et al.,

et al.,

Blood

Blood

2001

2001

Differential

Differential

diagnosis

diagnosis

of

of

lymphadenopathy

lymphadenopathy

I

I

Infections

Infections

:

:

a.

a.

Bacterial

Bacterial

:

:

tuberculosis

tuberculosis

,

,

syphilis

syphilis

,

,

staphylococcal

staphylococcal

,

,

streptococcal

streptococcal

b.

b.

Viral

Viral

:

:

CMV, HIV, EB

CMV, HIV, EB

c.

c.

Parasitic

Parasitic

:

:

toxoplasmosis

toxoplasmosis

d.

d.

Rickettsial

Rickettsial

:

:

II

II

Inflamatory

Inflamatory

:

:

sarcoidosis

sarcoidosis

,

,

rheumatoid

rheumatoid

arthritis

arthritis

,

,

systemic

systemic

lupus

lupus

erythematosus

erythematosus

III

III

Malignant

Malignant

:

:

HL, NHL, CLL, ALL

HL, NHL, CLL, ALL

Conditions

Conditions

Metastatic

Metastatic

disease

disease

●

●

Examination

Examination

of

of

the

the

spleen

spleen

normally

normally

is

is

not

not

palpable

palpable

if

if

detected

detected

it

it

means

means

that

that

the

the

size

size

is

is

increased

increased

1,5

1,5

–

–

3

3

times

times

Massive

Massive

Splenomegaly

Splenomegaly

> 10 cm

> 10 cm

Differential

Differential

diagnosis

diagnosis

of

of

splenomegaly

splenomegaly

I

I

Infections

Infections

disease

disease

a.

a.

Bacterial

Bacterial

:

:

endocarditis

endocarditis

tuberculosis

tuberculosis

, malaria,

, malaria,

bacterial

bacterial

b.

b.

Vi

Vi

ral

ral

: CMV,

: CMV,

viral

viral

hepatitis

hepatitis

c

c

.

.

Parasitic

Parasitic

: malaria,

: malaria,

toxoplasmosis

toxoplasmosis

II

II

Hemolytic

Hemolytic

anaemias

anaemias

III

III

Myeloproliferative

Myeloproliferative

-

-

disorders

disorders

:

:

MF, CML,PV, TE, CEL

MF, CML,PV, TE, CEL

IV

IV

Lymphoproliferative

Lymphoproliferative

:

:

HCL,CLL,

HCL,CLL,

splenic

splenic

lymphoma

lymphoma

V

V

Acute

Acute

leukemias

leukemias

VI

VI

Storage

Storage

diseases

diseases

:

:

Gaucher

Gaucher

,

,

Niemann

Niemann

-

-

Pick

Pick

disease

disease

,

,

amyloidosis

amyloidosis

VII

VII

Portal

Portal

vein

vein

obstruction

obstruction

:

:

Budd

Budd

-

-

Chiarie

Chiarie

VIII

VIII

Autoimmunological

Autoimmunological

diseases

diseases

:

:

rheumatoid

rheumatoid

artritis

artritis

,

,

Felty

Felty

`s

`s

syndrome

syndrome

systemic

systemic

lupus

lupus

erythematosus

erythematosus

IX

IX

Others

Others