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