I. Characteristics of blood diseases
Blood is not a definite organ, it circulates constantly in the body in a liquid state, perfusing the microcirculation of each organ. The special anatomical and physiological relationship between blood and various tissues of the human body, which are interdependent and mutually influencing, determines that when pathological changes occur in blood or hematopoietic organs, symptoms and signs of diseases of various tissues and organs may occur; and diseases of various tissues and organs may also produce abnormal manifestations of blood and hematopoietic organs. Therefore, the characteristics of blood determine the characteristics of hematological diseases.
The symptoms and signs of blood diseases are often non-specific. The symptoms and signs of common blood diseases, such as anemia, bleeding, lymph nodes and liver and spleen enlargement, can also be seen in many other diseases, requiring clinicians to be familiar with and master the nuances, characteristics and concomitant phenomena of various blood diseases.
Many systemic diseases can cause changes in the blood picture, such as various infections, liver, kidney, endocrine diseases and tumors can appear anemia, bleeding and other symptoms.
3.Laboratory examination is very important to confirm the diagnosis of hematological diseases. Many hematological diseases need laboratory examination to confirm the diagnosis, such as the patient’s pale face is not necessarily anemia, swollen lymph nodes are not necessarily lymphoma. The results of laboratory tests are also indispensable for the observation of the therapeutic effect in the treatment process.
Common symptoms and signs
1.Anemia Anemia is the most common symptom of blood disease. There are many causes of anemia, but the clinical manifestations are similar because of the common pathological basis that the oxygen-carrying capacity of blood is reduced, resulting in hypoxic changes in various tissues and systems. Generally, the skin and mucous membranes are pale, especially the face is the most common pale. Clinical observation of the finger (toe) nails, mucous membrane of the mouth and lips, and conjunctiva of the lids is more reliable. The severity of anemia and the speed of its development, as well as the cause of anemia, determine the severity of its clinical manifestations, from no sensation in mild cases to cardiovascular and respiratory system dysfunction in severe cases, such as panic, shortness of breath, etc., which are aggravated during labor; in severe cases, anemic heart disease or heart failure may even occur. In addition, patients often have headache, dizziness, dizziness, tinnitus, lack of concentration, memory loss and weakness of limbs, mental lethargy, etc. In severe cases, there may be hypothermia (due to increased basal metabolism), loss of appetite, nausea, abdominal distension, constipation, diarrhea and other manifestations (related to lack of gastric acid, gastric mucosa atrophy).
2, bleeding tendency The characteristics of bleeding in hematological diseases are mostly circumscribed, rather than localized. Another characteristic is that the degree of bleeding and the trauma causing bleeding may be extremely disproportionate, and there may even be no history of trauma. Spontaneous purpura of the skin and mucous membranes is a characteristic feature of capillary hemorrhage, while deep tissue hemorrhage and hematoma formation after trauma, and non-invasive joint hemorrhage or persistent bleeding from the skin and mucous membranes are characteristics of abnormal coagulation mechanisms. Any spontaneous extensive or localized bleeding from skin, mucous membrane, joints and muscles, or continuous bleeding after trauma or surgery, or a family member with a history of bleeding, all suggest the possibility of abnormal hemostasis mechanism.
3.Fever Fever in hematological diseases is mostly infectious. Clinically, fever is often seen in leukemia, lymphoma, aplastic anemia, myelodysplastic syndrome, etc. Due to the abnormal quantity and quality of white blood cells, it is easy to combine with infection. Non-infectious fever is due to the growth and rapid destruction of immature leukocytes, increased proteolysis, increased basal metabolic rate, and absorption of necrotic material. Periodic hyperthermia is one of the typical symptoms of Hodgkin’s disease. In addition, blood diseases such as direct invasion of the thermoregulatory center can cause dysfunction of the center, as seen in leukemia infiltration and intracranial hemorrhage.
4, jaundice From the point of view of hematologic disease is mainly hemolytic jaundice. Jaundice caused by hemolysis is generally less serious, serum bilirubin is indirect, usually not more than 85.5µmol/L (<5mg/dl), more than this value, to consider liver malfunction or biliary obstruction. Acute hemolysis, due to the destruction of a large number of red blood cells clinical often appear severe hemolytic reaction, manifested as chills, high fever, muscle pain, headache, vomiting, etc., often soy sauce-colored hemoglobinuria, serious cases can be complicated by acute renal insufficiency. Signs can be seen in the sclera, mucous membrane, skin are yellow stained, anemic appearance. In chronic hemolysis, the clinical course is mild, often with mild or fluctuating jaundice, anemia, and large liver and spleen.
Bone pain Bone marrow is the hematopoietic tissue of human body, so we pay more attention to bone pain from the perspective of hematology. In particular, pain in the sternum, spine, pelvis and limb bones is often associated with hematological diseases. Especially in children, the bone pain is prominent and acute due to the small reserve force of the bone cavity. In acute leukemia, for example, the bone marrow cavity is filled with leukemia cells, which increases the pressure in the cavity and causes bone pain. Sternal pressure pain is a typical symptom of leukemia and has a high diagnostic value. Acute granulocytic leukemia lesions may invade the skull and eye sockets, forming green tumors (chloroma), showing symptoms such as protruding eyes, diplopia, and cerebral nerve palsy. It may also invade the sternum, ribs and spine, and when the bone cortex is involved, it may bulge outward and form nodules. In patients with myeloma, abnormal plasma cells infiltrate the bones and affect the blood supply to the bone cortex, resulting in diffuse osteoporosis or limited bone destruction, and skeletal pain is often the main symptom at the earliest stage, mostly in the thoracic and lumbar spine, followed by the thorax. Pathological fractures are more frequent in the long bones of the lower limbs, and myeloma nodules of various sizes can be palpated on flat bones.
6. Splenomegaly in hematologic diseases is commonly caused by
(1) Infiltration and malignant proliferation of abnormal cells: In various acute and chronic leukemias caused by the infiltration and abnormal proliferation of immature leukocytes, especially in chronic granulocytic leukemia, the spleen can be heavily or even extremely enlarged to the pelvis. In addition, patients with lymphoma and malignant histiocytosis may have varying degrees of splenomegaly.
(2) Extramedullary metaplasia: This is commonly seen in myelofibrosis, where the spleen is enlarged due to extramedullary hematopoiesis.
(3) Splenomegaly: This is a common clinical condition that is characterized by a decrease in one or more blood cells and a corresponding increase in bone marrow hematopoietic cells.
(4) Lipid storage disease: Due to impaired lipid metabolism, the spleen is enlarged due to accumulation of various lipids, such as Gaucher disease, Niemann-Pick disease, and Letterer-Siwe disease.
In addition, hemolytic anemia and idiopathic thrombocytopenic purpura may also have mild splenomegaly.
Enlarged lymph nodes are one of the common signs of hematologic diseases, especially malignant tumors of the hematopoietic system, such as leukemia and lymphoma. The swollen lymph nodes should be carefully examined, noting first the location, whether the superficial lymph nodes are enlarged to varying degrees throughout the body, or whether they are confined to one or certain areas; the number, size, hardness, surface temperature, and relationship with adjacent tissues of the enlarged lymph nodes should also be examined. The time of their appearance, the rate of enlargement, and whether they are accompanied by redness, swelling, pain, and other systemic symptoms should be clarified during the consultation. Lymphadenitis caused by acute and chronic infections, lymph node tuberculosis, and metastatic cancer of lymph nodes should be considered in the differential diagnosis.
The enlarged lymph nodes caused by malignant tumors of the hematopoietic system may be localized in the early stage, but as the disease progresses, the tumor gradually spreads to lymph nodes and other organs in other areas of the body. This is the main basis for clinical staging of lymphoma. In lymphoma, the lymph nodes can be mildly to significantly enlarged, hard like rubber, and usually move in the early stage, but in the late stage, they can adhere to the adjacent tissues and become more fixed. There is usually no obvious tenderness, unless it grows too fast or secondary infection occurs. Leukemia, especially chronic lymphocytic leukemia can have varying degrees of lymph node enlargement.
8. Skin manifestations Itchy skin is common in Hodgkin’s disease. The skin surface is infiltrated by lymphocytes and may produce desquamative erythroderma, which may be combined with edema and hyperkeratosis, as seen in Sézary’s syndrome. In acute monocytic leukemia, skin infiltrates and nodules may be present. Methemoglobinemia and certain hemoglobinopathies should be thought of in cyanosis; brick-red changes in the skin may suggest true erythrocytosis.