Hematopoietic History-Taking
Obtain the Patients Biodata:
Name
Age
Sex
Address
Religion
Occupation
Marital status
Date of admission
Date of taking history
Source of taking history (from whom did you take this history)
Hospital (the hospital that the patient is admitted to now)
Chief Compliant and its Duration:
Ask about the main cause that brought the patient to the hospital.
Note: For us, the chief compliant must be either; Pallor, Bleeding or
Related abnormalities.
Note: The clinical presentation of anaemia varies according to age, for
example:
Child = Pallor
Adult = Weakness & Decreased Activity
Elderly = Depression
History of Presenting Illness (HPI):
Here we should elaborate on and explain the chief compliant by
mentioning their accompanying signs and symptoms, which are:
1. Fatigue (Anaemia).
2. Weakness (Anaemia).
Blood lose during defecation , hematuria
Conjuctiva
3. Palpitations (Anaemia).
4. Swollen Ankles (Lymphoedema).
5. Postural Dizziness (Anaemia).
6. Bleeding (Thrombocytopenia or Clot Disorder).
7. Bruising (Thrombocytopenia or Clot Disorder).
8. Fever (Cancer).
9. Night sweats (Cancer)
10. Weight loss (Cancer).
11. Jaundice (Haemolysis or Liver Dysfunction).
12. Lymph Node Enlargement (Cancer). If everything is ok
13. Lumps of any sort? (Cancer). we should ask for
endoscopy
14. Bone pain (Cancer).
15. Tingling and Loss of Sensation, B12 Deficit
(Anaemia).
16. Skin Rash (Lupus, Bacteriaemia, Cancer, or
Autoimmune Haemolytic Anaemia).
Familt history , colon cancer history , drug history , spleenectomy history
Iliac resection ——> gastrictomy ——> megaloblastic anemia
Note: The bold points are the important things that we must know
based on the lectures that we have studied.
Note: The best site to examine for the pallor, found in anaemia, are the
conjunctiva. But pallor can also be examined by looking at the tongue,
soft palate, and palms.
Note: Causes of Pallor are:
Anxiety.
Anaemia.
Hypotension.
Vasoconstriction.
Ferrous sulphate ————> iron supplement
Hypoadrenalism.
Hypopituitarism.
Hypothyroidism.
Indications of i.v ———> venofeir(iron sucrose) , ferric carboxylmaltose
Malabsorption
Iron intolerance
For Pallor, we should ask:
Ask about the duration and site of pallor (i.e., Whether it is
generalized or localized?).
Ask whether the pallor starts spontaneously or after a period of
bleeding.
Ask whether the pallor is continuous or intermittent? (Because
intermittent pallor happens due to exposure to a cold environment).
For Bleeding, ask the following questions:
Ask about the site and duration of bleeding?
Determine the severity of bleeding (i.e., Whether it s mild or
severe).
Know the type of bleeding. Whether it is Haematemesis (ask
about vomiting), Epistaxis, Haematoma, Ecchymosis, Gum
Bleeding, GI Bleeding, Menorrhea, and/or etc
Past Medical History (PMH):
Ask about chronic diseases, such as; Hypertension, Diabetes
Mellitus and etc
Ask about blood transfusion?
Ask about any Hospitalization (What was the cause of admission
and how was it managed).
Ask about splenectomy or spleen problems (because about 1/3 of
platelets are in the spleen).
And depending on whether the problem was bleeding or pallor we
must ask other questions about the following:
1. Pregnancy.
2. Menstrual History.
3. Frequent Infections.
4. Diarrhoea.
5. Tarry Stools.
6. Blood in Stools.
7. Recent Trauma with Bleeding.
8. Radiotherapy.
9. Previous Cancers.
10. GIT Surgery.
11. Transplants.
Past Surgical History (PSH):
Has the patient had any surgeries before?
o And, if yes, did they have any bleeding at that time?
Drug History:
Ask about the use of drugs like:
o Chemotherapy.
o NSAIDs.
o Anticoagulants.
o Thrombolytic.
o Steroids.
o Vitamin Supplements (Iron?)
Ask about whether they have any known drug allergies?
Family History:
Any family members with the same complaints as the patient (for
possible hereditary diseases that affect clotting).
Ethnic origin? (Mediterranean, south-east Asian or others?)
Social History:
Smoking?
Alcohol?
Diet? (Vegetarianism, those who are liable for
Pancytopenia).
Sexual lifestyle, if AIDS is suspected.
IV drug usage.
Occupation (exposure to Radiation, Benzene or etc ).
Hematopoietic Physical Examination
Since blood is not localized to any single location in the body, we
overestimate the general examination over the local examination of
some systems that have an effect on the Haematopoietic System.
General Examination:
How the patient looks (look at the body texture).
Consciousness of Patient.
Pallor (Anaemia).
Jaundice (Haemolytic Anaemia).
Bruising (Clot Disorder).
Scratch Marks (Lymphoid Cancer).
Plethoric Red Face (Polycythaemia).
Cachexic, Muscle Wasting (Cancer).
Splinter Haemorrhage (Infective Endocarditis).
Examine the Vital Signs:
o Blood Pressure.
o Respiratory Rate.
o Pulse Rate.
o Temperature, with a thermometer.
Note: Know the patient s race and gender because some diseases are
more common in certain groups, for example:
Mediterranean = Thalassaemia
African = Sickle Cell Anaemia
Examination of the Upper Limbs
NAILS
Splinter Haemorrhage.
Capillary Refill Time (CRT). Within 2 seconds is normal.
Nicotine Staining.
Koilonychia.
Finger Clubbing.
Vasculitis of the Nail Bed (Bacteriaemia).
Flapping Tremor (Respiratory Failure or Liver Failure).
HANDS
Palmar Creases (in the case of Anaemia, the colour of the creases
and the rest of the palm are the same indicating Pallor).
ARMS
Temperature, for bilateral comparison, NOT fever (Fever is
checked with a thermometer in Vital Signs).
Pulse Rate.
Blood Pressure.
Scratch Marks.
Palpable Purpura (Vasculitis or Septicaemia).
Epitrochlear Nodes (Lymph Nodes).
AXILLA
Examine the lymph nodes at the Axilla, which are:
o Central LN.
o Lateral LN.
o Pectoral LN.
o Infraclavicular LN.
o Subscapular LN.
Examination of the Face
Cheeks
Telangiectasia.
EYES
Jaundice.
Look at the conjunctiva.
Injected Sclera.
MOUTH
Cheilosis (a defect in the lips).
Hypertrophied Gums (Acute Leukemia).
Bleeding (Chemotherapy or Lymphoma).
Scurvy (a Gum Defect due to Vitamin D deficiency).
Angular Stomatitis.
Patients Teeth Status and Oral Hygiene.
TONGUE
Look at the Frenulum (very sensitive).
Glossitis (Iron Deficiency Anaemia).
Ulcerated.
Tonsillar/Adenoid Enlargement.
Examination of the Neck
Dull Neck?
Auscultate Carotid Artery for any Bruits.
Lymph Node Examinaition:
o Submental LN.
o Submandibular LN.
o Preauricular LN.
o Postauricular LN.
o Occipital LN.
o Jugular Chain LN.
o Supraclavicular LN.
o Paratracheal LN.
Position the Trachea, by feeling it in the
suprasternal notch.
Examination of the Chest
Bone Pain.
Find Apex Beat.
Examination of the Legs
Inguinal Nodes.
Bruising.
Ecchymosis.
Petechiae.
Popliteal Nodes.
Oedema (Swollen Legs). Is it unilateral or bilateral?
Purpura.
Toe Clubbing.
Nail changes, same as in fingers?
Local Examination
Local examination is to investigate the underlying cause of any
Haematological problems.
1. Check Abdomen
Examine the Spleen and Liver.
2. Check Respiratory System
Feel for any Mediastinal Mass.
Percussion, hear a dull sound in Lung Collapse.
3. Check Cardiovascular System
1) Listen for Flow Murmur (due to Anaemia).
4. Check Neurological Symptoms
1st Skill Lab Hematology
Venepuncture
• Consult the 1st Skill Lab for CVS “Blood Sample Collection”, as the way the doctor
taught us the procedure is completely identical.
2nd skill lab
Hemato
Blood grouping
• Rh and ABO are two different blood grouping
systems and no relation between them.
• In this procedure by using antibody & blood
determination of different groups occur.
• By using three different types of antibody (antibody
A blue in color- antibody B yellow in color- antibody
D colorless one).
• Agglutination is present in case of having reaction
between antibody and antigen in same type. For
example if you added antibody A with a drop of
blood and there is agglutination, means on RBCs
there is antigen A and blood group of this person
can be A or AB.
• But for Rh, when you added antibody if antigen is
present, means antigen + there must be
agglutination. And if there is no agglutination means
Rh-.
Procedure
1. Put three drop of blood 50mL on a slide.
2. Add single drop of each antibodies near each drop of
blood.
3. Use different small pieces of wood for mix each drop
of blood with one of the antibodies.
Video
https://www.youtube.com/watch?v=- jKzLLHjRfs
Haematopoietic Skill Lab - Cannulation
For cannulation we should do the following steps:
1) Greet the patient and introduce yourself.
2) Wash your hands.
3) Gather the equipment:
a) Tourniquet.
b) Cannula.
c) Cannula Dressing.
d) Etc
4) Explain the procedure to the patient and gain their permission.
5) Position the patient so that they are sitting comfortably and the
position is comfortable for you, then adequately expose the patients
arms for the procedure.
6) Prepare the equipment, then apply the tourniquet proximal to the
planned cannulation site.
7) Choose the vein, tapping the vein and asking the patient to repeatedly
clench their fist can make the vein easier to visualize and palpate, and
avoid areas near the elbow and wrist joint.
8) Sterilise the planned cannulation site with the alcohol.
9) Wear a clean pair of gloves, remove the cannula sheath, open the
cannula wings and hold the cannula with your dominant hand and use
your non-dominant hand to fix the cannulation site (the p
forearm or hand).
10) Insert the cannula at an angle of 20°.
11) Observe the backflow of blood into the cannula chamber, which
confirms that the needle has punctured the vein.
12) When you have observed the backflow of blood into the cannula
chamber, release the tourniquet.
13) Then partially withdraw the introducer needle.
14) Carefully introduce the rest of the cannula further into the vein as
you simultaneously withdraw the introducer needle. Do this until the
cannula is fully inserted and the needle is almost removed.
Simultaneously, apply pressure to the proximal vein, close to the tip
of the cannula, to reduce bleeding and then connect a Luer lock cap or
primed extension set to the cannula hub.
15) Immediately dispose of the introducer needle into a sharp
container.
16) Apply adhesive strips to secure the cannula wings to the skin.
17) Flush the cannula by injecting normal saline into the cannula (this
prevents thrombosis within the cannula).
18) Dispose of the clinical wastes into an appropriate clinical waste
bin.
19) Take off your gloves and dispose of them into the appropriate bin.
20) Thank the patient for their time.
Haematopoietic Skill Labs -
Blood Transfusion
2) For determining blood groups, we have two general techniques which
are; Forward Technique (wherein we add blood from the person to
the laboratory antibodies, this is the commonly used technique), and
Reverse Technique (wherein we add the serum of p blood to
the laboratory blood).
The steps for the determining blood groups are:
1) Greet the patient and then introduce yourself.
2) Explain the procedure and get permission.
3) Puncture the tip of their finger to get blood (if you hadn t previously
taken blood from the person).
4) Put three drops of blood on the slide, separately (make sure that they
.
5) Add a single drop of each antibody (different types of antibodies like;
Antibody-A (Blue in color), Antibody-B (Yellow in color), Antibody-
D (Colorless), these colors are universal).
6) Then use different small pieces of wood for mixing each drop of
blood with one of the antibodies.
7) Agglutination will be present in the case of a reaction between
antibody and antigen of the same type, for example if you added
antibody B with a drop of blood and there is agglutination, means on
RBCs there is antigen B and blood group of the person can be B or
AB, but for Rh when you added antibody, if agglutination is present,
this means it s Rh positive and if there is no agglutination, it means
it s Rh negative.
the Person t Lab antibody
blood from
.
forward technique →
's blood -1 Lab blood
serum of Patient
technique
.
→
reverse
5th skill lab
Hematology module
Cross Matching
• Compatibility test is a short test done to know whether a unit of blood is
compatible for a patient or not. It is routine before every blood transfusion.
• Blood grouping is done first.
• When we found out the blood grouping, then we determine the compatible
type
• Always we try to use the most common type to transfer. But...But.. But we
can use O- blood if we don’t have time to determine any of the above
tests.
Procedure:
1. Wear gloves
2. We need (slide- pippette- tip of pippette- RBC of recipient- plasma of
donor).
3. 30 micro litter of RBC and put them on a slide
4. Add 30 micro litter of plasma of the donor
5. Mix them
6. Wait 2-3 minutes to see if there is agglutination or not, if no agglutination
means these bloods are compatible
There is agglutination
Video:
https://www.youtube.com/watch? time_continue=8&v=ZTLB3Trr3bM
Cross Matching
Alternative Procedure:
1) Wear gloves and take a venous blood sample from the recipient and
put in an EDTA tube, then centrifuge it for 5 minutes.
2) Use the bottom layer (the RBC) to identify the recipients blood group
(if the recipients blood group is unknown).
3) Select the matched blood units (ABO & Rh systems).
4) Put drops of plasma (the upper portion of the tube) on the
slide and put one drop of blood from the blood unit, then mix them
with the wooden stick.
5) After that, look for macroscopic and microscopic (under microscope)
agglutination. If no agglutination is seen, then the blood unit is fit for
the recipients blood, but if agglutination is seen, so that means the
blood unit is not fit for the recipients blood and as a result, other
blood units should be selected and tested again.
