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
Anorexia
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 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

Further History

Recurrent Infections
Excessive Bleeding
During past surgeries
Past Transfusion Reactions
Autologous Stem Cell Transplant
Indication, mobilisation, complications
Allogeneic Stem Cell Transplant
Indication, conditioning, complications, post-transplant management

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

Read More...

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