Pallor of skin or nail beds can be indicative of what?
Low hemoglobin levels which means low oxygen. Low hemoglobin is a type of anemia.
Flushing
Too much hemoglobin due to polycythemia, and congestion of capillaries. Flushing of the palms of the hands or soles of the feet are a possible indication of anemia.
Jaundice
This is an accumulation of bile pigment caused by rapid or excessive hemolysis or liver damage.
Cyanosis
Reduce hemoglobin, excessive concentration of deoxyhemoglobin in the blood
Excoriation
scratching from intense pruritus
Pruritus
Hodgkins lymphoma, cutaneous lymphomas, inflitrative leukemias, increased bilirubin
Leg ulcers
Sickle cell disease
Angioma
Benign tumor consisting of blood or lymph vessels. Most are congenital, some may disappear spontaneously.
Telangiectasia
Small angioma with tendency to bleed. Focal red lesions, course or fine red lines. This can be due to dilation of small vessels.
Spider nevus
Type of telangiectasia. It has a round red central portion and branching radiations resembling a spider. Usually on face, neck, or chest. Elevated estrogen levels as in pregnancy or liver disease.
Purpura
Conditions like petechiae, ecchymosis (bruise) or other small hemorrhages in the skin and mucous membrane. This can be due to low platelets or clotting factors resulting in hemorrhage into the skin. Vascular abnormalities, break in blood vessel walls resulting in trauma
Chloroma
A tumor arising from myeloid tissue and containing a pale green pigment. Can be caused by acute myelogenous leukemia that has infiltrated the skin.
Plasmacytoma
Tumor arising from abnormal plasma cells. Can be caused by multiple myeloma that has infiltrated the tissue.
Jaundiced sclera
Due to accumulation of bile pigment resulting from rapid or excessive hemolysis or liver disease or infiltration.
Conjuctival pallor
Due to low hemoglobin levels
Blurred vision, diplopia, visual field cuts
Can be caused by anemia, extreme leukocytosis, polycythemia may cause visual abnormalities. Thrombocytopenia may cause intraoccular hemorrhage with visual abnromalities. Excessive clotting may cause thromboses in the circulation to the brain that cause visual field cuts
Smooth tongue
Tongue surface is smooth and shiny, mucosa is thin and red from decreased papillae. This can be due to pernicious anemia or iron-deficiency anemia.
Bone pain in pelvis, ribs, spine, or sternum
Can be due to multiple myeloma related to enlarged tumors that stretch periosteum, bone invasion by leukemia cells. Bone demineralization resulting from various malignancies. Sickle cell disease.
Joint swelling
this can occur due to hemophilia and sickle cell anemia as bleeding occurs into the joint causing inflammation.
Lymphadenopathy
Enlarged lymph nodes that may be tender to the touch. This can be due to infection, foreign infiltration. systemic disease such as leukemia, lymphoma, Hodgkin's lymphoma, and metastatic cancer.
Tachycardia
compensatory mechanism in anemia to increase cardiac output.
palpitations
feeling the heartbeat, flutter, or pound in the chest. This can be due to anemia, fluid volume overload, hypotension with impending syncope, hypertension, or dysrhythmias.
orthostasis
This is when heart rate goes up about 20 beat per minute or when blood pressure goes down 20 from baseline when moving from a lying position to either sitting or standing. This is a common manifestation in anemia, especially if also accompanied by low blood volume.
Hypotension
Hypotension is a systolic blood pressure below 90 or a drop of 40 from baseline. This may indicate an infectious process, blood loss, or compromised cardiovascular compensatory mechanism.
Hypertension
Hypertension is a blood pressure greater than 140/90. This usually occurs as a compensatory mechanism for anemia.
Sternal tenderness
Leukemia resulting from increased bone marrow cellularity can cause an increase in pressure and bone erosion.
Low oxygen saturation
This can be decreased due to severe cases of anemia
Hepatomegaly
Leukemia, cirrhosis, or fibrosis secondary to iron overload from sickle cell disease or thalassmeia can cause this.
Splenomegaly
Can be caused due to anemia, thrombocytopenia, leukemia, lymphomas, leukopenia, mononucleoisis, malaria, cirrohosis, trauma, portal hypertension.
Distended abdomen
Lymphoma may manifest as abdominal adenopathy, masses or bowel obstruction.
Parasthesias of feet and hands; ataxia
This can be due to a colbamin deficiency or folate deficiency
Weakness
Low hemoglobin levels, anemia
headache, nuchal rigidity
this is a pain in the cranium, potentially invovling one area or extending form the frontal area to the back of the neck. Headaches can be due to mild to moderate anemia. Severe headaches with or without visual disturbances may signal intracranial hemorrhage due to thrombocytopenia.
Normal hemoglobin levels
This is to help us measure the gas-carrying capacity of RBC. In females, 12-16, in males, 14-18.
Normal hematocrit levels
This is to measure the packed cell volume of RBCs expressed as a percentage of the total blood volume. In females, 36-46, in males, 42-52.
Normal WBC
This is the measurement of total leukocytes. 5,000-10,000
Normal platelets
This is the number of total platelets available, and it tells us what the person's clotting ability looks like. 150,000-400,000
Normal RBC
This is total circulating RBCs. In females, 4.2 to 5.4. In males, 4.7 - 6.1.
Normal aPTT
This is activated partial thromboplastin time. This is an assessment of intrinsic coagulation by measuring clotting factors specific to intrinsic pathway. It is longer in patients using heparin. 25-35 seconds by book standard.
Normal PT
Prothrombin time. This is an assessment of extrinsic coagulation by measurement of clotting factors specific to extrinsic pathway. 11-12.5 seconds on chart, but 11-16 per book.
thromboplastin
Enzyme released by damaged cells that convert prothrombin to thrombin.
Prothrombin
Enzyme that coverts fibrinogen to fibrin after it is converted to thrombin.
D-dimer
Measures breakdown of fibrin products. This is used as an adjunctive measure in diagnosis of hypercoagulable conditions like DIC or pulmonary embolism. Usually used to rule out DVT, but not used to diagnose. < 250/L is normal
INR Internationalized ratio
This is a standardized system of reporting PT based on a reference calibration model and calculated by comparing the patient's PT with a control value. reference level is 2-3
= desired effects with warfarin.
Bilirubin
measures the degree of RBC hemolysis or liver's inability to excrete normal quantities of bilirubin. three forms to look at. Total: 0.2-1.2, Direct: 0.1-0.3. Indirect: 0.1-1.0
Coombs test
This helps to differentiate among the types of hemolytic anemias. Detection of immune antibodies and RH factor. Normal value would be negative.
ESR is erythrocyte sedimentation rate
This is a measurement of sedimentaion or settling of RBCs in 1 hour. This helps us know if a patient is experiencing inflammation. During inflammation, alteration of plasma proteins can resulti in aggregation of RBCs and making them heavier. The faster the sedimentation rate, the higher the ESR. Less than 30 mm/hr.
Colbamin
Colbamin needed to produce RBCs, normal amount is 200-835
Ferritin
Amount of stored circulating iron. normal is 10-250
Folic acid
Folic acid is needed for RBC production. Normal is 3-16
Serum iron
Amount of total iron used and stored. 50-175
Total iron-binding capacity (TIBC)
This is a measurement of all proteins available for binding iron. Transferring represents the largest quantity of these proteins. 250-425
Reticulocyte count
Measurement of immature RBCs which is a reflection of bone marrow activity. 0.5%-1.5% of RBC count.
Transferrin
This is the largest of proteins that bind to iron. It is increased in most people with iron deficiency anemia. 190-380 mL
Transferrin saturation
Decreased in iron-deficiency anemia and increased in hemolytic and megaloblastic anemia. 15%-50%.
Normal WBC
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