Palpitation: It is feeling the heart beat. It may arise from fever and anemia in malignant hematological diseases leading to anemia.
Fatigue and tiredness: Anemia is seen in diseases progressing with abnormal proliferation of blood and lymph node cells progressing with spleen enlargement (myeloproliferative and lymphoproliferative diseases)
Dyspnea: Observed as a result of cardiac failure due to anemia and pressure of lymph nodes on lung and air duct.
Jaundice: Jaundice is observed in skin and mucosa with bilirubin increase due to pressure of lymph nodes enlarging in the stomach on liver and bile tracts and hemolytic anemia. Moreover, jaundice resulting in lemon yellow appearance can be observed in B12 and folic acid deficiency anemia (megaloblastic). Jaundice is seen in anemia in young people due to splenomegaly and gall bladder stone.
Paleness: Anemia in the form of skin and mucosa paleness is seen in diseases due to insufficient or defective blood cell forming in the bone marrow (cancer of blood, leukemia, especially acute ones, myelodysplastic disease table).
Nail disorders: Especially spoon nail is noted in iron deficiency anemia. Lines due to chemotherapy, and nail renewal is observed in patients having stem cell transplantation. Darkening and dark lines in skin and nails are observed in patients having chemotherapy due to medications especially using hydroxyurea.
Weight loss: Losing weight is seen in diabetes and toxic goiter patients in spite of appetite is normal even increased. Weight loss is noted in especially lymph node cancers (lymphoma) and malignant blood diseases with loss of appetite. Excessive losing weight (cachexia) is seen in patients being resistant and relapsing due to side effects of medicines and disease. Patients having chemotherapy lose weight due to side effects of medicines such as nausea, vomiting and suppressing appetite.
Fever: Fever may be observed in many hematological diseases. It is generally above 38 centigrade in malignant blood diseases. In infections, hypotension, palpitation and shivering may accompany high fever. The patient of lymph node and cancer of blood (lymphoma, acute and chronic leukemia), vitamin B12 deficiency anemia and low leukocyte (neutropenic) may have fever due to infection.
Ankle ulcers: Patients with sickle cell, Mediterranean anemia, using the medicine called hydroxyurea for a long time may have ankle ulcers.
Skin bleeding: Bleeding may be observed in skin and mucosa in the size of pinhead or bigger. It occurs in the numerical scarcity of cells serving in coagulation in our blood (thrombocyte) later or congenitally (thrombocytopenia). It may arise from deficiency of subsequent or congenital coagulation factors.
Intra-articular hemorrhage (Hemarthrosis): It is the intra-articular hemorrhage due to coagulation factors deficiency or hereditary deficiency. The most frequent reason is hemophilia A. It is seen in knee joint most frequently.
Lymph node enlargement (Lymphadenopathy): It means abnormal of one or more than one lymph node in terms of diameter, number and consistency. Lymph node
bigger than 1 cm is considered as abnormal. Moving, rubber consistent and general lymph node enlargement bigger than 2 cm without pain is seen in lymphoma and some chronic leukemia.
Spleen enlargement (Splenomegaly): The size of spleen in adults is about 11-12 cm. Palpating the spleen in physical examination means that the spleen is three times bigger than normal. Infections (Brucella, malaria), rheumatismal diseases (rheumatoid arthritis, systemic lupus erythematous), cirrhois, cardiac failure and many blood disease may lead to splenomegaly. Diseases resulting in splenomegaly include Mediterranean anemia (Thalassemia) hereditary erythrocyte diseases (hereditary spherocytosis), chronic and acute leukemia, chronic lymphocytic leukemia, chronic myelocytic leukemia, lymph node cancers (lymphoma), diseases progressing with excessive increase of blood cells (myelofibrosis, polycythenia Vera), hairy cell leukemia and congenital storage disease.
Hepatosplenomega (Hepatomegaly): Hepatomegaly is the enlargement of liver. Hepatomegaly may result in a number of diseases. Cardiac failure, cirrhosis, clot in liver vein, infectious diseases (thyroid, jaundice, brucella, malaria, kala-azar), storage diseases caused by congenital enzyme deficiency, cancers (lymphoma, leukemia, primary tumors of liver, metastatic cancers, myelofibrosis, polycythenia vera) are the diseases leading to enlargement.
Gall bladder stones: Gall bladder Stones may be observed in young in case of anemia due to congenital hemolysis (hemolytic anemia, hereditary spherocytosis,
Thalassemia, sickle-cell anemia). If a young patient has anemia, splenomegaly and gall bladder stone, the reason of it is the anemia due to congenital hemolysis unless otherwise proven.
Hematuria: One red blood cell is observed in urine of men under a microscope and four red blood cells are observed in urine of women. The most frequent reason of hematuria is the urinary tract infections. It may arise from number (thrombocytopenia) and dysfunction of cells (thrombocyte) for coagulation in blood diseases.
Acute gout attack: It can be seen due to increased uric acid in the blood in diseases that cell lysis and formation increases in blood diseases (myeloproliferative diseases, lymphoproliferative diseases, acute and chronic leukemia and post-chemotherapy). The patient has toe swelling pain in the form of burn and redness.
Redness and pain of fingers (Erythromelalgia): The reason is the ischemia due to capillary vessel occlusion. It is the case that hands and feet are red and have pain in the form of burn. It is more frequently seen in diseases progressing with abnormal increase of red blood cells (polycythemia vera), abnormal increase of blood cells (Acute leukemia and essential thrombocystosis).
Gingiva swelling: Gingiva swelling is noted. It can be seen in acute leukemia (myelomonocytic and monoblastic leukemia), persons using lithium, cyclosporine, diphenylhydantoin, pregnant and in case of dental diseases. In acute leukemia, it depends on involvement of leukemia cells in gingiva (monoblast).
Flattening of surface of tongue: There is papilla on tongue enabling us to taste on the tongue. It occurs in cells covering digestive system surface where cell and tissue formation fast and lysis occurs due to vitamin B12 and folic acid deficiency. Surface of tongue is red and flat. It is observed in especially megaloblastic anemia and iron defiency anemia patients.
Artery and vein coagulation: life-threatening coagulation may be observed in especially vein due to vein wall disorder or deterioration of structure or slow blood flow in blood diseases. It is frequently seen in the below diseases:
• Polycythemia Vera disease characterized with abnormal increase of red blood cells
• Diseases progressing with abnormal protein increase in blood (Paraproteinemia; multiple myeloma, waldenström macroglobulinemia, crio globulinemia)
• Sickle-cell anemia
• Disease progressing with abnormal increase of cells for coagulation (Primary thrombocytosis)
• Diseases inclined to coagulation congenitally (Factor V leiden mutation, prothrombine gene mutation, Protein C and S deficiency, antithrombine deficiency, hyperhomocystinemia)