42 Differential Diagnosis for PT: Hematological, Cardiovascular, Immune, and Digestive System Disorders: Summary
Leukocytic Disorders Leukocytosis Count of 10,000 WBCs/mm 3 • Bacterial infections • Inflammation/tissue necrosis
• Clients have a tendency to bleed or clot (impaired production of thromboplastin) Thrombocytopenia Decrease in count (less than 150,000/mm 3 ) resulting from defective platelet production or accelerated platelet destruction • Major concern is the prevention of excessive bleeding that occurs from trauma to mucous membranes • Causes: bone marrow infiltration disseminated intravascular coagulation (DIC): excessive bleeding and clotting (petechiae), hypersplenism • Symptoms: easy or excessive bruising (purpura), superficial bleeding into the skin that appears as a rash of pinpoint-sized reddish-purple spots (petechiae), prolonged bleeding from cuts, bleeding from gums or nose, blood in urine or stools Coagulation Disorders Hemophilia Hereditary blood-clotting disorder due to abnormal plasma proteins (factors VIII and IX), (malignancy), viral infections, prosthetic heart valves, nutritional deficiency (folic acid/vitamin B12), drugs, hemorrhage, 80% of hemophiliacs, transmitted by X-linked recessive trait, and manifested in men but carried by women Hemophilia B 30% of cases, no family history of the disorder, and the condition is the result of a spontaneous gene mutation • Both hemophilia A and B: Can be described as mild, moderate, or severe depending on amount of active clotting factor in blood • Signs and symptoms of blood disorders: vary depending on level of clotting factors ○ If deficiency is severe: Unexplained and excessive bleeding from cuts or injuries, or after surgery or dental work, Many large or deep bruises, Unusual bleeding after vaccinations, Pain, swelling, or tightness in joints, Blood in urine or stool, Nosebleeds without a known cause bleed longer, not faster Hemophilia A (classic)
• Metabolic • Neoplasms • Acute hemorrhage • Splenectomy • Acute appendicitis • Pneumonia • Chemical intoxication Leukopenia Reduction in number of leukocytes (<4,800/mm 3 ) • Bone marrow failure due to chemotherapy/ radiation therapy • Overwhelming infections • Dietary deficiencies • Autoimmune diseases
LEARNING TIP! Mild reduction in WBCs can be caused by viral infection.
• If client is immunosuppressed, physical therapist must know most recent WBC count prior to therapy session • Symptoms: Infections, fatigue, sleepiness, fever, and headache Nadir Lowest point in WBC count; occurs 7–14 days after chemo/radiation therapy • Client is extremely susceptible to opportunistic infections/complications; hand washing and hygiene extremely important in treating these clients Platelet Disorders Thrombocytosis Count of more than 1 million platelets per microliter • Usually temporary • Compensatory mechanism after severe bleeding, surgery, splenectomy, iron deficiency, or occult neoplasm
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