Presenting symptoms and their duration

A full medical history needs to be taken to which is added direct questioning on relevant features associated with presenting symptoms:

• Non-specific symptoms such as fatigue, fevers, weight loss.

• Symptoms relating to anaemia e.g. reduced exercise capacity, recent onset of breathlessness and nature of its onset, or worsening of angina, presence of ankle oedema.

• Symptoms relating to neutropenia e.g. recurrent oral ulceration, skin infections, oral sepsis.

• Evidence of compromised immunity e.g. recurrent oropharyngeal infection.

• Details of potential haemostatic problems e.g. easy bruising, bleeding episodes, rashes.

• Anatomical symptoms, e.g. abdominal discomfort (splenic enlargement or pressure from enlarged lymph nodes), CNS symptoms (from spinal compression).

• Past medical history, i.e. detail on past illnesses, information on previous surgical procedures which may suggest previous haematological problems (e.g. may suggest an underlying bleeding diathesis) or be associated with haematological or other sequelae e.g. splenectomy.

• Drug history: ask about prescribed and non-prescribed medications.

• Allergies: since some haematological disorders may relate to chemicals or other environmental hazards specific questions should be asked about occupational factors and hobbies.

• Transfusion history: ask about whether the patient has been a blood donor and how much he/she has donated. May occasionally be a factor in iron deficiency anaemia. History of previous transfusion(s) and their timing is also critical in some cases e.g. post-transfusion purpura.

• Tobacco and alcohol consumption is essential; both may produce significant haematological morbidity.

• Travel: clearly important in the case of suspected malaria but also relevant in considering other causes of haematological abnormality, including HIV infection.

• Family history also important, especially in the context of inherited haematological disorders.

A complete history for a patient with a haematological disorder should provide all the relevant medical information to aid diagnosis and clinical assessment, as well as helping the haematologist to have a working assessment of the patient's social situation. A well taken history also provides a basis for good communication which will often prove very important once it comes to discussion of the diagnosis.

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