History and examination
Symptoms often develop late in the course of disorders of the blood and lymphoid system. In their early stages, anaemias, chronic leukaemias and other myeloproliferative disorders may be completely asymptomatic, or they may be associated with only vague symptoms, many of which are common in the general population, including fatigue, headaches, faintness, shortness of breath, palpitations, angina pectoris, intermittent claudication and recurrent minor infections.
Patients with acute leukaemia commonly present with a short history of more definite symptoms, which may include - in addition to the symptoms of anaemia - mouth ulceration, sore throat and other signs of infection, enlarged lymph nodes, bruising and bleeding, bone pain and symptoms caused by tissue infiltration. Those with thrombocytopenias present with characteristic skin changes; other major bleeding disorders also produce obvious symptoms, but more minor degrees of bleeding disorder may be subclinical and thus asymptomatic.
Thrombotic disorders usually have symptoms and signs related to arterial or venous thrombosis; however, disseminated intra-vascular coagulation (DIC) may cause haemostatic failure and is usually seen in severely ill patients, who are likely to have multiple symptomatology from the underlying cause of the condition.
Patients with lymphomas often present with lym-phadenopathy, fever or symptoms resulting from tissue infiltration or compression by the lymphomatous process, with failure of the immune system, or with a haemorrhagic or haemolytic disorder; nevertheless, some patients remain asymptomatic and are diagnosed largely by chance.
Because of the absence of specific diagnostic symptoms in many disorders of the blood, clinical examination of the patient is of great importance. Clinical signs in haematology may result from abnormalities of red cells, white cells, platelets, plasma globulins or coagulation factors.