Hematology History and Physical

single, various

Bleeding Details

-Bleeding isolated to a _____ organ or ______ body parts

• ONLY hematuria

• ONLY hematemesis

• ONLY recurrent epistaxis

• vs epistaxis AND prolonged menstruation

excessive, joint, bruising

Personal History of Bleeding

-Coag Questions:

• Ask about _________ bleeding with dental extractions, surgery, or childbirth

• Deep ____ bleeding

-Platelet Questions:

• Gingival bleeding, epistaxis, menorrhagia, hematuria, melena, or excessive bleeding

• Bruising at venipuncture sites or from minor cuts

• Petechia, spontaneous ________, or large bruises with minor trauma

primary, secondary

Goal of your medical history is to determine if the bleeding is _________ or ___________

family, hereditary, population, XI, sickle

Family History

-A ______ history is particularly important when __________ disorders are considered, extending back at least 2 generations

-___________ genetic information may be helpful to determine cause of symptoms.

• Ashkenazi Jews = factor __ deficiency

• African Americans = _____ cell

medication, aspirin, bleeding

Med History

-A __________ history is crucial, both prescription and non-prescription

-_______ and NSAIDs

-Ginkgo biloba and ginseng are the most commonly used herbals that can cause platelet dysfunction and induce _________

K, antibiotics, C, malabsorption

Nutritional History

-Assess the likelihood of:

• Vitamin _ deficiency, especially if the patient is taking broad spectrum ________

• Vitamin _ deficiency

• General malnutrition/___________

liver, cardiac

Metabolic History

-______, kidney, and ______ disease

heparin

Allergy History

-Ask about ________-induced thrombocytopenia or other heparin allergies

substance, alcohol

Social History

-________ use and abuse

-If the patient uses _______ or illicit drugs, identify the drugs and when they were last used

previous, bleeding, laboratory, transfusions

Objective Information

-________ hospital or physician visits for ________ symptoms

-Results of previous _________ evaluations

-Previous _________ of blood products for bleeding episodes

-History of anemia and/or previous treatment with iron

petechiae, splotchy

Physical Exam Findings

-_________ or ecchymoses

-Telangiectasias: spider telangiectasias found in patients with chronic liver disease have a more ________ and serpiginous appearance than those associated with hereditary hemorrhagic telangiectasia

-Purpura

-Hematomas, oozing at venipuncture/injection/catheter insertion sites

-Joint deformities and limited joint mobility