History in Hematologic

Disorders

Dr. ZAFER BAŞLAR

Division of Hematology
Department of Internal Medicine
OUTLINE OF HISTORY TAKING
IN HEMATOLOGY

A - PERSONAL HISTORY

B - FAMILY HISTORY

C - GENERAL SYMPTOMS

D - SPECIFIC SYMPTOMS
 A - PERSONAL HISTORY
• Personal identification:
name-surname, sex, age, race/ethnic
background, place of birth, place(s) lived
• History of present illness:
chief complaint and other complaints
• History of previous illness(es):
complaint(s) / diagnos(es), treatment(s),
operation(s), outcome(s)
A - PERSONAL HISTORY (cont.)
• Social history:
occupation, marital status, sexual life,
hobbies, pets, recent travels, blood
donation
• Drug history:
prescribed, OTC, “vitamins”, illicit /
recreational; alcohol consumption;
exposure to chemicals
• Dietary habits:
B - FAMILY HISTORY

• Any relative with similar symptoms / signs

• Relation of the affected relative(s)

(mode of inheritance)
C - GENERAL SYMPTOMS

• Weight loss

• Fever - chills - night sweats

• Fatigue - malaise - lassitude

• Weakness
D - SPECIFIC SYMPTOMS
Nervous system:
• Headache
• Paresthesias
• Confusion
• Impairment of consciousness
D - SPECIFIC SYMPTOMS (cont.)
Eye:
• Abnormalities of vision

• Diplopia - disturbances of ocular movement

• Blindness
D - SPECIFIC SYMPTOMS (cont.)
Ears:
• Vertigo - tinnitus - “roaring in the ears”

Neck:
• Painless/painful swelling
• Diffuse swelling
D - SPECIFIC SYMPTOMS (cont.)
Nasopharynx and mouth:
• Epistaxis
• Anosmia - olfactory hallucinations
• Sore tongue
• Macroglossia
• Bleeding gums - hypertrophied gums
• Oral ulcers
• Dryness of the mouth
D - SPECIFIC SYMPTOMS (cont.)
Chest and heart:
• Dyspnea - palpitation
• Angina pectoris
• Cough
• Chest pain
• Tenderness of the sternum
D - SPECIFIC SYMPTOMS (cont.)
Gastrointestinal system:
• Dysphagia
• Indigestion - abdominal fullness - belching -
“discomfort”
• Abdominal pain
• Vomiting
• Diarrhea
• Gastrointestinal bleeding
• Constipation
D - SPECIFIC SYMPTOMS (cont.)

Genitourinary system:
• Impotence
• Bladder dysfunction
• Hematuria - “red urine”
• Amenorrhea
• Menorrhagia
D - SPECIFIC SYMPTOMS (cont.)
Back and extremities:
• Back pain
• Arthritis - arthralgia
• Swollen and painful joints
• Shoulder pain
• Bone pain
• Edema (of the lower extremities)
• Leg ulcers
D - SPECIFIC SYMPTOMS (cont.)
Skin:
• Texture changes
• Jaundice
• Pallor
• Erythroderma
• Hyperpigmentation
• Cyanosis
• Itching
• Easy bruising - petechiae - ecchymoses
• Infiltrative lesions
• Necrotic lesions
 History as a part of the diagnostic
approach to anemia
A- Symptoms that may be attributable to anemia
itself (depending on the rate of onset: rapid or slow)
• palpitation, dyspnea, chest pain (at rest / exertional),
syncope, light-headedness;
• claudicatio intermittens, cold intolerance;
• headache, vertigo, tinnitus, difficulty concentrating;
• fatigue, weakness;
• anorexia, nausea, diarrhea, constipation
• menorrhagia, dysmenorrhea, amenorrhea;
• decreased libido, impotence;
 History as a part of the diagnostic
approach to anemia
B - Blood loss
• hematemesis, melena, hematochezia,
hemorrhoidal bleeding
• hematuria
• epistaxis, hemoptysis
• menorrhagia, metrorrhagia, or both
• bleeding during surgery / childbirth
 History as a part of the diagnostic
approach to anemia
C - Bleeding tendency
• spontaneous petechiae or ecchymoses
• bleeding after trauma ( accident,
operation, childbirth, tooth extraction,
circumcision, etc. )
• umbilical cord bleeding
• hemarthrosis
• menorrhagia, metrorrhagia, or both
 History as a part of the diagnostic
approach to anemia
D - Medications-Toxins
• alcohol
• drugs ( previous and current uses;
prescribed, OTC, “vitamins”, illicit /
recreational )
• environmental exposures ( past and
present; occupational and at home)
E - Dietary habits
 History as a part of the diagnostic
approach to anemia

F - Specific symptoms
• pica, geophagia, glossitis, paresthesias,
difficulty gait, darkened urine, jaundice

G - General symptoms
• anorexia, weight loss, fever, chills,
night sweats, fatigue, malaise, lassitude
 History as a part of the diagnostic
approach to anemia
H - Menstrual and pregnancy history

• menstrual history in detail: menarche,

intervals and durations of menstruations

• pregnancy history in detail: number and

intervals, miscarriages,anemia?
 History as a part of the diagnostic
approach to anemia
I - Past history

• previous anemia
– diagnosis, treatment, response

• surgery ( esp. gastric, gall bladder)

 History as a part of the diagnostic
approach to anemia
J - Family history
• anemia
• jaundice, gallstones at an early age,
enlarged spleen
• splenectomy, cholecystectomy
• origin ( ethnic, geographic )
History as a part of the clinical evaluation
of a bleeding patient
A- Type of bleeding
• Mucocutaneous purpura:
suggests platelet disorder or
vascular pathology
• Delayed onset bleeding, recurrent
oozing, hematoma:
suggest coagulation disorders
History as a part of the clinical evaluation
of a bleeding patient
B- Duration of bleeding
• Lifelong:
– indicates hereditary defect, of usually a single factor;
– confirm with family history of bleeding or presence of
consanguinity for suspected recessive traits
• Recent onset:
– indicates an acquired disorder, usually defects of
multiple factors;
– confirm by history of no bleeding with past trauma,
surgery, teeth extractions, menses
History as a part of the clinical evaluation
of a bleeding patient

C- Systemic illnesses associated

with bleeding
• liver disease
• renal failure
• malignant disease