History taking and anamnesis
Complaints in blood disorders are often non-specific: patients note general weakness, headaches, fever, shortness of breath, or abdominal pain. Since hematological shifts are frequently secondary (anamnesis morbi), the physician must carefully study the history of symptom development.
Pharmacological history is critically important. It is necessary to find out which drugs the patient is currently taking or has taken previously, clarifying their dosages and course duration. Special attention should be paid to self-medication, such as the uncontrolled use of analgesics, which can cause severe toxic reactions: agranulocytosis and leukopenia.
Family history helps to identify hereditary pathologies:
- Hereditary hemolysis (cases of anemia and jaundice in relatives).
- Hemostasis disorders (increased bleeding tendency, early mortality of siblings).
- Hemophilia (involvement of male relatives across different generations).
Examination of the skin and its appendages
Skin changes are caused by the state of the capillary bed or pigment deposition. During the examination, attention is paid to the following signs:
- Pallor. Indicates anemia. It is important to assess the color not only of the skin but also of the mucous membranes (conjunctiva, oral cavity) and nail beds, as skin pallor can be constitutional.
- Hyperemia. A crimson or cherry-red hue, especially on the face, is characteristic of polycythemia vera. The influence of alcohol or temperature factors must be excluded.
- Jaundice. Indicates hemolysis (destruction of red blood cells).
- Hemorrhagic syndrome. The appearance of petechiae, purpura, or ecchymoses indicates a hemostatic disorder.
- Specific changes. Skin nodules (leukemids) may appear in acute myeloid leukemia. Pronounced skin itching with excoriations is suspicious for Hodgkin's lymphoma.
- Nail changes. Deformation, thickening, striation, or spoon-shaped indentations (koilonychia) indicate sideropenia (iron deficiency).
Examination of the oral cavity
The oral mucosa is an important "mirror" of hematological disorders. Examination of the tongue is particularly informative:
- Atrophic glossitis (smoothing or disappearance of papillae) is a classic sign of iron deficiency anemia.
- Gunther's glossitis (bright red, "lacquered", "raspberry" tongue) is a marker of vitamin B12- and folate-deficiency anemias.
In addition, the condition of the gums and the corners of the mouth is evaluated:
- Ulcerative-necrotic gum lesions are characteristic of agranulocytosis.
- Hypertrophy (infiltration), hyperemia, and bleeding of the gums are frequently found in leukemias.
- Cracks in the corners of the mouth (cheilitis, angular stomatitis) accompany iron deficiency and pernicious anemias.
Lymphatic and hepatolienal systems
Generalized lymphadenopathy is characteristic of leukemias (especially chronic lymphocytic leukemia) and Hodgkin's lymphoma. The physician performs palpation with circular movements of the fingertips, moving from the occipital nodes down to the inguinal ones. The size, consistency, and tenderness of the nodes are evaluated. It is important to exclude regional enlargement (e.g., in tonsillitis).
Enlargement of the liver and spleen (hepatosplenomegaly) is an important diagnostic criterion. Hepatomegaly is detected by palpation and percussion, and often accompanies leukemias and hemolytic syndrome. The spleen is palpated in the supine position and on the right side (normally it is not palpable). With marked splenomegaly, the lower edge of the organ can descend into the lesser pelvis.
Also, during the examination, attention is paid to the skeletal system: percussion of flat bones can reveal ossalgia, characteristic of leukemias and multiple myeloma. Among neurological manifestations, subacute combined degeneration of the spinal cord (funicular myelosis) in vitamin B12 deficiency should be kept in mind.
Briefly: answers to topical questions
What neurological symptoms manifest in funicular myelosis in B12-deficiency anemia?
Funicular myelosis in B12-deficiency anemia presents with a complex of sensory, motor, and neuropsychiatric disorders.
The main symptoms include:
- Sensory disturbances — symmetrical paresthesias of the feet and fingers, impaired deep sensation (vibration and proprioception).
- Motor disturbances — progressive spastic ataxia, unsteady gait, weakened reflex reactions, and the appearance of pathological reflexes.
- Neuropsychiatric changes — irritability, drowsiness, sensory impairments (vision, smell, taste), and in severe cases, mental disorders develop.
Which specific groups of lymph nodes must be palpated when a blood system disorder is suspected?
When a blood system disorder is suspected, palpation of peripheral lymph nodes is performed in a strict sequence from top to bottom.
The following groups must be examined:
- Head — occipital and parotid.
- Maxillofacial region — submandibular and submental.
- Neck — superficial cervical.
- Shoulder girdle and chest — supraclavicular, infraclavicular, and pectoral.
- Upper extremities — axillary and epitrochlear.
- Lower part of the trunk — inguinal.
Which specific groups of drugs are most often capable of causing drug-induced agranulocytosis?
Drug-induced agranulocytosis can be an adverse effect of medications; when taking the history, it is important to clarify the intake of drugs, especially analgesics.
The cited sources explicitly name:
- Metamizole sodium preparations and products containing it — the risk of developing agranulocytosis is indicated.
- Intestinal anti-inflammatory drugs — aminosalicylic acid and similar medications; agranulocytosis is listed as an adverse drug reaction.
Class and exam questions
Why is skin pallor an unreliable sign of anemia?
Skin pallor can be an individual (constitutional) feature of a person. To confirm anemia, it is necessary to assess the color of the oral mucosa, conjunctiva, and nail beds.
What is the difference between atrophic glossitis and Hunter's glossitis?
Atrophic glossitis manifests as the disappearance of papillae and is characteristic of iron deficiency. Gunther's glossitis appears as a bright red "lacquered" tongue and is observed in vitamin B12 or folic acid deficiency.
How to properly palpate the spleen?
Palpation of the spleen is the most reliable method (unlike percussion). It is performed with the patient in the supine position and then on the right side.
What else to study on this topic
- Complete Blood Count (CBC) as a screening method
- Sternal puncture and bone marrow examination
- Differential diagnosis of hemorrhagic syndrome
- Instrumental methods (ultrasound, CT, radiography) in hematology
Master the entire topic in the "Propaedeutics" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on the topic «History Taking and Examination of Patients with Diseases of the Hematopoietic System» and 3,152 more pages for the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 113 video lessons on the subject
Other topics in the "Blood System" section
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.