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Haematological Examination

Haematological Examination. General appearance. Pt. lies flat, one pillow under head. Race, gender: Mediterranan descent (thalassemia). African descent (sickle-cell anemia , SLE). Northern European descent, blue eyes, premature grey hair (autoimmune disease: pernicious anemia ).

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Haematological Examination

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  1. Haematological Examination

  2. General appearance • Pt. lies flat, one pillow under head. Race, gender:Mediterranan descent (thalassemia). • African descent (sickle-cell anemia, SLE). • Northern European descent, blue eyes, premature grey hair (autoimmune disease: pernicious anemia). • Colours: pale (anaemia), jaundice (haemolytic anaemia), bruising (thrombocytopoenia) • Dyspnoea (anaemia, enlarged hylar lymph nodes)

  3. Nails • Nicotine stains. • Koilonychia (iron deficiency). • Pale nails (anemia). • Splinter haemorrages (haemotological neoplasm)

  4. Hands • Pallor of palmar creases (anemia 2° to blood loss). • Tophi (Gout 2° to myeloproliferative dz). • Pulse: rate (anaemia has tachycardia), rhythm, character.

  5. Arms • Blood pressure. • Scratch marks (lymphatic CA, myeloproliferative dz).

  6. Trochlear Nodes • Cup R hand below pt's R elbow. • While holding pt's elbow, thumb reaches over pt's cubital fossa to palpate a spot anterior and proximal to pt's medial epicondyle. • Palpate enlargement (drains the forearm)

  7. Axillary Nodes • Perform initially on both sides to compare • If abnormality is found, perform separate examination noting (SHARP mnemonic) • Size: Pathologic nodes are generally greater than 1 cm • Hard: Firmness indicates malignancy • Amount: The greater the number of nodes felt , the more likely pathology exists • Relation to other nodes and surrounding tissue: Nodes fixed to each other or adjacent structures are worrisome for malignancy • Pain: Often associated with inflammation (e.g. infection)

  8. Examine Waldeyer’s Ring Looking for enlargement and possible NH lymphoma • Pharyngeal tonsil • Tubal tonsil • Palatine tonsils • Lingual tonsils

  9. Cervical and supraclavicular nodes

  10. Particularly interested in the supraclavicular nodes • Dx is Virchow's node, usually L one:• Classically, stomach CA• GI CA• Pelvic CA• Other CAs

  11. Chest • Trachea for deviation from nodes • Assess bone pain (bone CA):• Compress sternum with hands.• Compress clavicle with hands.• Tap spine with fist.

  12. Abdomen • Palpate along the abdominal aorta for grossly enlarged para-aortic nodes

  13. Inguinal Nodes • Palpate:• Superficial inguinal and femoral nodes• Deep inguinal • Inguinal Node Examination

  14. Popliteal Nodes

  15. Legs examination • Legs showing same symptoms as arms • Ulcers. • Peripheral neuropathy (Wernicke's encephalopathy 2° to B12 deficiency). • Toenails and foot showing same symptoms as fingernails and hands

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