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History in Hematologic

Disorders

Dr. ZAFER BALAR

Division of HematologyDepartment of Internal Medicine

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OUTLINE OF HISTORY TAKING

IN HEMATO

LO

GY

A - PERSONAL HISTORY

B - FAMILY HISTORY

C - GENERAL SYMPTOMS

D - SPECIFIC SYMPTOMS

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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)

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A - PERSONAL HISTORY (cont.)

Social history:

occupation, marital status, sexual life,hobbies, pets, recent travels, blooddonation

Drug history:

prescribed, OTC, vitamins, illicit /

recreational; alcohol consumption;exposure to chemicals

Dietary habits:

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B - FAMILY HISTORY

Any relative with similar symptoms / signs

Relation of the affected relative(s)

(mode of inheritance)

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C - GENERAL SYMPTOMS

Weight loss

Fever - chills - night sweats

Fatigue - malaise - lassitude

Weakness

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D - SPECIFIC SYMPTOMS

Nervous system:

Headache

Paresthesias

Confusion

Impairment of consciousness

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D - SPECIFIC SYMPTOMS (cont.)

Eye:

Abnormalities of vision

Diplopia - disturbances of ocular movement

Blindness

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D - SPECIFIC SYMPTOMS (cont.)

Ears:

Vertigo - tinnitus - roaring in the ears

Neck:

Painless/painful swelling

Diffuse swelling

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D - SPECIFIC SYMPTOMS (cont.)

Nasopharynx and mouth:

Epistaxis

Anosmia - olfactory hallucinations Sore tongue

Macroglossia

Bleeding gums - hypertrophied gums Oral ulcers

Dryness of the mouth

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D - SPECIFIC SYMPTOMS (cont.)

Chest and heart:

Dyspnea - palpitation

Angina pectoris

Cough

Chest pain

Tenderness of the sternum

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D - SPECIFIC SYMPTOMS (cont.)

Gastrointestinal system:

Dysphagia

Indigestion - abdominal fullness - belching -

discomfort

Abdominal pain

Vomiting

Diarrhea Gastrointestinal bleeding

Constipation

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D - SPECIFIC SYMPTOMS (cont.)

Genitourinary system:

Impotence

Bladder dysfunction

Hematuria - red urine

Amenorrhea

Menorrhagia

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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

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D - SPECIFIC SYMPTOMS (cont.)

Skin:

Texture changes

Jaundice

Pallor

Erythroderma

Hyperpigmentation

Cyanosis

Itching Easy bruising - petechiae - ecchymoses

Infiltrative lesions

Necrotic lesions

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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;

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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

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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

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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

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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

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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 andintervals, miscarriages,anemia?

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History as a part of the diagnostic

approach to anemia

I - Past history

previous anemia diagnosis, treatment, response

surgery ( esp. gastric, gall bladder)

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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 )

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History as a part of the clinical evaluation

of a bleeding patient

C- Systemic illnesses associated

with bleeding

liver disease

renal failure

malignant disease