Haematological Examination
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Transcript of 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).• Colours: pale (anaemia), jaundice (haemolytic
anaemia), bruising (thrombocytopoenia)• Dyspnoea (anaemia, enlarged hylar lymph nodes)
Nails
• Nicotine stains.• Koilonychia (iron deficiency).• Pale nails (anemia).• Splinter haemorrages (haemotological
neoplasm)
Hands
• Pallor of palmar creases (anemia 2° to blood loss).
• Tophi (Gout 2° to myeloproliferative dz).• Pulse: rate (anaemia has tachycardia), rhythm,
character.
Arms
• Blood pressure.• Scratch marks (lymphatic CA,
myeloproliferative dz).
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)
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)
Examine Waldeyer’s Ring
Looking for enlargement and possible NH lymphoma
• Pharyngeal tonsil• Tubal tonsil• Palatine tonsils• Lingual tonsils
Cervical and supraclavicular nodes
Particularly interested in the supraclavicular nodes
• Dx is Virchow's node, usually L one:• Classically, stomach CA• GI CA• Pelvic CA• Other CAs
Chest
• Trachea for deviation from nodes• Assess bone pain (bone CA):
• Compress sternum with hands.• Compress clavicle with hands.• Tap spine with fist.
Abdomen
• Palpate along the abdominal aorta for grossly enlarged para-aortic nodes
Inguinal Nodes
• Palpate:• Superficial inguinal and femoral nodes• Deep inguinal
• Inguinal Node Examination
Popliteal Nodes
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