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Medical Significance And Clinical Aspects Of Hematological Disorders
A Pale Hand
In the majority of cases, the symptoms are generalized. But some clinical manifestations to note are: Pallor, Jaundice, Hepatospenomegaly, Fever, Bleeding etc.
Pallor: Pallor of the mucous membranes and skin occurs when hemoglobin level is below 10g/dL. Skin color depends also on other factors such as state of peripheral circulation and pigmentation. Mucous membrane over the soft palate is the most suitable area to assess pallor since this is least likely to be influenced by other factors. Though, there is general agreement between pallor and the severity of anaemia, these show wide disparity in many cases.
Jaundiced Skin And Sclera
Jaundice is an important finding in hemolytic anaemia. The severity of jaundice depends on the level of bilirubin in the blood and this corresponds to the severity of hemolysis. In the majority of cases, jaundice is only mild to moderate, but severe jaundice may occur in hemolytic crises. In hemolytic jaundice, the serum contains unconjugated bilirubin and the urine is loaded with urobilinogen, but bile pigments are absent. Ins evere cases methem-albumin may be present in the serum and urine may contain hemoglobin. In fulminant cases, renal failure may occur.
Many hematological disorders are associated with hepatospenomegaly. Mild or moderate hepatosplenomegaly occurs in 10-20% of cases of nutritional anaemias, 60-80% of acute leukemias, 90% of hemolytic anaemias, 80% of infectious mononucleosis and rarely in immune thrombocytopenia. Gross splenomegaly exceeding 15 cm is seen in thalassemias, hemoglobinopathies, chronic granulocytic leukemia, lymphomas, and myelofibrosis. The liver also shows variable degrees of enlargement in these cases.
Moderate enlargement of lymph nodes occurs in acute leukemias and infectious mononucleosis. Lymphomas, chronic lymphatic leukemia and blastic transformation of chronic granulocytic leukemia are characterized by gross lymphadenopathy.
Fever is a common nonspecific accompaniment of many hematological disorders. In anaemia, when the hemoglobin level goes below 7g/dL, fever is common. The temperature reverts to normal on correcting the anaemia. Hectic rise to temperature may accompany hemolytic crises. In all forms of leukemia, fever may occur. Often this is due to infection, but rarely it may be due to the malignant process itself. Presence of fever in lymphomas is of diagnostic and prognostic importance.
A Bleeding Finger
Hemorrhagic manifestations may be the primary symptoms in disorders like immune thrombocytopenic purpura and hemophilia. In acute leukemia and aplastic anaemia, secondary thrombocytopenia may occur resulting in bleeding. Purpuric hemorrhage into the skin, mucous membranes or tissues is commonly seen if the abnormality affects the platelets or blood vessels. Bleeding from cuts and wounds tends to be prolonged markedly.
© 2014 Funom Theophilus Makama