Haematology History-Taking

Presenting Complaints

Constitutional Symptoms
Fatigue, lethargy, malaise
Symptoms of Anaemia
Fatigue, shortness of breath, reduced exercise tolerance, lightheadedness, worsening angina, ankle swelling
Symptoms of Neutropaenia
Mouth ulcers, skin infections
Symptoms of Bleeding Diathesis
Easy bruising, epistaxis, gum bleeding, joint pain / swelling
Epistaxis
Bruising
Gingival bleeding
Suggestive of Iron Deficiency Anaemia
Malaena, haematemesis, haematochezia, PV bleeding
Symptoms of Lymphoma
Enlarged / painful lymph nodes, fevers, weight loss, drenching night sweats
Enlarged / Painful Lymph Nodes
Location, onset
Fevers
Associated infective symptoms
Night Sweats
Drenching / need to change clothes
Symptoms of Hyperviscosity
Neuropathy, epistaxis, blurred vision, headache
Symptoms of DVT
Limb pain, swelling
Symptoms of PE
Chest pain, shortness of breath, palpitations
Abdominal Pain
Due to splenomegaly or lymphadenopathy

Past Medical History

Haematologic Disease
Diagnosis, symptoms, severity, functional impact, management
Haematologic malignancy
AML, ALL, CML, CLL, myeloma, lymphoma
Myeloproliferative neoplasms
Polycythaemia vera, essential thrombocytosis
Myelodysplastic syndromes
Anaemias
Aplastic anaemia, iron deficiency Anaemia, anaemia of chronic disease, haemolytic anaemia, thalassaemias, sickle cell anaemia
Bleeding disorders
Haemophilias, Von Willebrand disease
Thrombotic disorders
DVT / PE, antiphospholipid syndrome
Platelet disorders
ITP, DIC, TTP, HUS, HELLP, HITS
Haemochromatosis
Amyloidosis
Recurrent infections
Excessive bleeding during past surgeries
Past transfusion reactions

Medications

Haematologic Medications
Click for a summary
Drugs Associated with Bleeding
NSAIDs, antiplatelets, anticoagulants, SSRIs, certain herbal medications
Drugs Associated with Thrombosis
OCP, HRT, COX-2 inhibitors, EPO, warfarin (initially)
Drugs Associated with Anaemia
Due to haemolytic, megaloblastic, sideroblastic or aplastic anaemia
Drugs Associated with Immune Haemolysis
Methyldopa, quinine, IVIg, penicillins, cephalosporins, diclofenac
Drugs Associated with Thrombotic Microangiopathy
Chemotherapy, interferons, cyclosporine, tacrolimus, clopidogrel, quinine, cocaine
Drugs that can Trigger Haemolysis in G6PD Deficiency
Dapsone, methylene blue, naphthalene, nitrofurantoin, primaquine, sulfamethoxazole
Drugs Associated with Megaloblastic Anaemia
Methotrexate, trimethoprim, chemotherapy, anticonvulsants, NRTIs, colchicine, PPIs
Drugs Associated with Sideroblastic Anaemia
Isoniazid, pyrazinamide, ethanol
Drugs Associated with Aplastic Anaemia
NSAIDs, sulfasalazine, antithyroid drugs, anticonvulsants, chloramphenicol
Drugs Associated with Pure Red Cell Aplasia
rhEPO, linazolid, isoniazid, dapsone, antivirals, anticonvulsants, azathioprine, mycophenolate
Drugs Associated with Erythrocytosis
Anabolic steroids, EPO
Drugs Associated with Thrombocytopaenia
Drug-induced ITP, TMA or HIT
Drugs Associated with Immune Thrombocytopaenia
GPIIb/IIIa inhibitors, heparins, anticonvulsants, quinine, NSAIDs, paracetamol, HCT
Drugs Associated with Thrombotic Microangiopathy
Chemotherapy, interferons, cyclosporine, tacrolimus, clopidogrel, quinine, cocaine
Drugs Associated with Heparin-Induced Thrombocytopaenia
Between 5 and 10 days prior to onset of thrombocytopaenia

Heparin sodium, low molecular weight heparins
Drugs Associated with Neutropaenia
NSAIDs, antipsychotics, anticonvulsants, antithyroid drugs, antibiotics, chemotherapy
Drugs Associated with Neutrophilia
Corticosteroids, adrenaline, lithium, G-CSF
Drugs Associated with Eosinophilia
Penicillins, cephalosporins, phenytoin, carbamazepine, H2 blockers, PPIs

Family History

Haematologic Malignancy
AML, ALL, CML, CLL, myeloma, lymphoma
Haemochromatosis
Haemophilia
Von Willebrand's Disease
Thalassaemia

Social History

Recent Travel
Risk of DVT, tropical infections

Long haul flights, travel to developing countries
Smoking
Pack-years, years since quitting
Alcohol
Risk of myelosuppression

Average per day / week, CAGE

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Al-Nouri ZL, Reese JA, Terrell DR, Vesely SK, George JN. Drug-induced thrombotic microangiopathy: a systematic review of published reports. Blood. 2014 Jan 1:blood-2014. Link

Arndt PA, Garratty G. The changing spectrum of drug-induced immune hemolytic anemia. InSeminars in hematology 2005 Jul 1 (Vol. 42, No. 3, pp. 137-144). WB Saunders. Link

Aster RH, Bougie DW. Drug-induced immune thrombocytopenia. New England Journal of Medicine. 2007 Aug 9;357(6):580-7. Pubmed

Aster RH, Curtis BR, McFarland JG, Bougie DW. Drug‐induced immune thrombocytopenia: pathogenesis, diagnosis, and management. Journal of Thrombosis and Haemostasis. 2009 Jun;7(6):911-8. Pubmed

Beutler E. G6PD deficiency. Blood. 1994 Dec 1;84(11):3613-36. Pubmed

Bhatt V, Saleem A. Drug-induced neutropenia–pathophysiology, clinical features, and management. Annals of Clinical & Laboratory Science. 2004 Apr 1;34(2):131-7. Pubmed

Bing RJ, Lomnicka M. Why do cyclo-oxygenase-2 inhibitors cause cardiovascular events?. Link

Bubp J, Jen M, Matuszewski K. Caring for glucose-6-phosphate dehydrogenase (G6PD)–deficient patients: Implications for pharmacy. Pharmacy and Therapeutics. 2015 Sep;40(9):572. Pubmed

Chan FC, Lau KK, Chan AK, Chan HH. Tranexamic acid is a weak provoking factor for thromboembolic events: A systematic review of the literature. Link

Davis JM, Albert JD, Tracy KJ, Calvano SE, Lowry SF, Shires GT, Yurt RW. Increased neutrophil mobilization and decreased chemotaxis during cortisol and epinephrine infusions. The Journal of trauma. 1991 Jun;31(6):725-31. Pubmed

Dlott JS, Danielson CF, Blue‐Hnidy DE, J McCarthy L. Drug‐induced thrombotic thrombocytopenic purpura/hemolytic uremic syndrome: a concise review. Therapeutic Apheresis and Dialysis. 2004 Apr;8(2):102-11. Pubmed

Frank JE. Diagnosis and management of G6PD deficiency. American family physician. 2005 Oct;72(7):1277-82. Pubmed

Garbe E, Andersohn F, Bronder E, Salama A, Klimpel A, Thomae M, Schrezenmeier H, Hildebrandt M, Späth-Schwalbe E, Grüneisen A, Meyer O. Drug-induced immune thrombocytopaenia: results from the Berlin Case–Control Surveillance Study. European journal of clinical pharmacology. 2012 May 1;68(5):821-32. Pubmed

Hesdorffer CS, Longo DL. Drug-induced megaloblastic anemia. New England Journal of Medicine. 2015 Oct 22;373(17):1649-58. Pubmed

Kaferle J, Strzoda CE. Evaluation of macrocytosis. American family physician. 2009 Feb 1;79(3). Pubmed

Kast RE. How lithium treatment generates neutrophilia by enhancing phosphorylation of GSK-3, increasing HIF-1 levels and how this path is important during engraftment. Bone marrow transplantation. 2008 Jan;41(1):23. Pubmed

Kaufman DW, Kelly JP, Jurgelon JM, Anderson T, Issaragrisil S, Wiholm BE, Young NS, Leaverton P, Levy M, Shapiro S. Drugs in the aetiology of agranulocytosis and aplastic anaemia. European Journal of Haematology. 1996 Dec;57(S60):23-30. Pubmed

Kim Y, Bang OY. Paradoxical procoagulant effect of early doses of warfarin: possible role of non-vitamin K oral anticoagulant in patients with atrial fibrillation-related stroke. Journal of stroke. 2015 May;17(2):216. Pubmed

Lacy P. Mechanisms of degranulation in neutrophils. Allergy, Asthma & Clinical Immunology. 2006 Sep;2(3):98. Pubmed

Low MS, Vilcassim S, Fedele P, Grigoriadis G. Anabolic androgenic steroids, an easily forgotten cause of polycythaemia and cerebral infarction. Internal medicine journal. 2016 Apr;46(4):497-9. Pubmed

Marsh JC, Ball SE, Cavenagh J, Darbyshire P, Dokal I, Gordon‐Smith EC, Keidan J, Laurie A, Martin A, Mercieca J, Killick SB. Guidelines for the diagnosis and management of aplastic anaemia. British journal of haematology. 2009 Oct;147(1):43-70. Pubmed

Means RT. Pure red cell aplasia. Blood. 2016 Jan 1:blood-2016. Link

Mintzer DM, Billet SN, Chmielewski L. Drug-induced hematologic syndromes. Advances in hematology. 2009;2009. Pubmed

Noris M, Remuzzi G. Atypical hemolytic–uremic syndrome. New England Journal of Medicine. 2009 Oct 22;361(17):1676-87. Pubmed

Patel JN, Jiang C, Hertz DL, Mulkey FA, Owzar K, Halabi S, Ratain MJ, Friedman PN, Small EJ, Carducci MA, Mahoney JF. Bevacizumab and the risk of arterial and venous thromboembolism in patients with metastatic, castration‐resistant prostate cancer treated on Cancer and Leukemia Group B (CALGB) 90401 (Alliance). Cancer. 2015 Apr 1;121(7):1025-31. Pubmed

Pintova S, Bhardwaj AS, Aledort LM. IVIG—a hemolytic culprit. New England Journal of Medicine. 2012 Sep 6;367(10):974-6. Pubmed

Ramot Y, Nyska A, Spectre G. Drug-induced thrombosis: an update. Drug safety. 2013 Aug 1;36(8):585-603. Pubmed

Rauscher C, Freeman A. Drug-induced eosinophilia. InAllergy & Asthma Proceedings 2018 May 1 (Vol. 39, No. 3). Link

Reese JA, Li X, Hauben M, Aster RH, Bougie DW, Curtis BR, George JN, Vesely SK. Identifying drugs that cause acute thrombocytopenia: an analysis using three distinct methods. Blood. 2010 Jan 1:blood-2010. Link

Salama A. Drug-induced immune hemolytic anemia. Expert opinion on drug safety. 2009 Jan 1;8(1):73-9. Pubmed

Saste VV, Terrell DR, Vesely SK, George JN. Drug-Associated Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome (TTP-HUS): Frequency, Presenting Features, and Clinical Outcomes. Link

Serebruany VL. Selective serotonin reuptake inhibitors and increased bleeding risk: are we missing something?. The American journal of medicine. 2006 Feb 1;119(2):113-6. Pubmed

Soloway HB. Drug-induced bleeding. American journal of clinical pathology. 1974 May 1;61(5):622-7. Pubmed

Stroncek DF. Drug-induced immune neutropenia. Transfusion medicine reviews. 1993 Oct;7(4):268-74. Pubmed

Sundström A, Seaman H, Kieler H, Alfredsson L. The risk of venous thromboembolism associated with the use of tranexamic acid and other drugs used to treat menorrhagia: a case–control study using the General Practice Research Database. BJOG: An International Journal of Obstetrics & Gynaecology. 2009 Jan 1;116(1):91-7. Pubmed

Tenner S, Rollhauser C, Butt F, Gonzalez P. Sideroblastic anemia: A diagnosis to consider in alcoholic patients. Postgraduate medicine. 1992 Nov 15;92(7):147-50. Pubmed

Tesfa D, Keisu M, Palmblad J. Idiosyncratic drug‐induced agranulocytosis: possible mechanisms and management. American journal of hematology. 2009 Jul;84(7):428-34. Pubmed

Tobu M, Iqbal O, Fareed D, Chatha M, Hoppensteadt D, Bansal V, Fareed J. Erythropoietin-induced thrombosis as a result of increased inflammation and thrombin activatable fibrinolytic inhibitor. Clinical and applied thrombosis/hemostasis. 2004 Jul;10(3):225-32. Pubmed

Visentin GP, Liu CY. Drug-induced thrombocytopenia. Hematology/oncology clinics of North America. 2007 Aug 1;21(4):685-96. Pubmed

Wickramasinghe SN. Diagnosis of megaloblastic anaemias. Blood reviews. 2006 Nov 1;20(6):299-318. Pubmed

Williams C. Drug-induced eosinophilia. Lung cancer. 2018 Jun 12;15:05. Pubmed

Yang Y, Li Z, Nan P, Zhang X. Drug-induced glucose-6-phosphate dehydrogenase deficiency-related hemolysis risk assessment. Computational biology and chemistry. 2011 Jun 1;35(3):189-92. Pubmed

Haematology History-Taking

Presenting Complaints

Past Medical History

Medications

Family History

Social History

Related Pages

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