Heme

• Heme disorder risk factors

  • Prolonged NSAID use → reduces platelets
  • Prolonged steroid use
  • Difficulty with blood clotting
  • Post-surgical → reduces RBCs
  • Chemotherapy or radiation → kills good cells too
• Heme disorder signs and symptoms

  • Difficulty with physical effort → low RBCs or RBCs not carrying enough O2
  • Dyspnea
  • Chest pain
  • Palpitations
  • Severe weakness
  • Fatigue
  • Frequent infection → low WBCs
  • Pallor → low RBCs
  • Cyanosis → low O2 delivery
  • Bruising → low platelets
  • Headache
  • Dizziness or syncope
• Immune disorder risk factors

  • Often unknown
  • Family history of systemic inflammatory disease
• Immune disorder signs and symptoms

  • Prolonged morning stiffness → RA
  • Single joint swelling → OA
  • Generalized weakness
  • Nail bed changes
  • Lymph node changes
• Heme physician referral

  • Blood in stool or emesis
  • Excessive menses
  • Family history of anemia with new onset of symptoms
  • Drug ingestion/alcohol abuse with new onset of symptoms
  • Family history of sickle cell disease with new onset of symptoms
  • Suspected finding of thrombocytopenia → immediate referral
  • Painful muscles or joints in patients with hemophilia
  • Blood and lymph cancer immediate physician referral
  • New/changing lump or nodule
  • Idiopathic muscle weakness with decreased DTR
  • Unexplained bleeding
  • Male with pelvic, groin, SI, or LBP with sciatica and PMH of prostate cancer
• Immune immediate physician referral

  • Signs/symptoms of anaphylactic shock
  • New onset of joint pain with recent history of surgery
  • Dusky blue discoloration or erythema with exquisite tenderness is sign of septic joint
• Concerning symptoms requiring further investigation

  • Constant pain
  • Night pain (7/10 or higher)
  • No change in symptoms with repositioning or treatment
  • New onset joint pain within 6 weeks of surgery
  • Symmetric swelling and pain in peripheral joints
  • Development of progressive neurologic symptoms 1-3 weeks after infection or vaccine
  • Spinal cord compression with history of RA
  • Bowel/bladder changes
  • Positive ptosis tests for MG
• Complications of prolonged DMARD use (drug toxicity)

  • Rash
  • Petechiae
  • Ecchymosis
  • Photosensitivity
  • Dyspnea
  • Edema
  • Nausea/vomiting
• Complications of prolonged NSAID use

  • Confusion
  • GI or renal complications
  • Delayed wound healing
  • Increased MSK symptoms
  • Increased MI and CVA risk
  • Elevated BP