Hi and thanks for the query,

With a family history of hypertension and headaches, it’s vital that her blood pressure be controlled from the very start.

It’s important to get clear characteristics of the headaches like duration, age of onset, aggravating and relieving factors, associated signs and symptoms to know whether it’s a primary or a secondary headache. This difference is very important in the diagnostic and management process.

She shall require a detailed assessment and clinical evaluation.

A chest X XXXXXXX shall be very useful to ascertain the integrity of the lungs, the size of the heart and exclude a probable chest infection. Chest pain associated with bleeding abnormalities is a type of presentation seen in leukemia. A complete blood count shall be very important in determining the platelet count, which are very important in blood clotting, hemoglobin levels and white blood cell count, which if raised, could be suggestive of a bone marrow malignancy.

An abdominal ultrasound to exclude a predisposing factor that could lead to bleeding such as uterine fibroids is important. A clinical evaluation to exclude a cervical polyp or cervical malignancy, that could present itself as post coital (sex) bleeding shall be a key component in the assessment.

Joint pains require that a rheumatologic component be excluded. A basic rheumatologic work up including an erythrocyte sedimentation rate, C-reactive protein (CRP), Rheumatoid factor, Anti nuclear anti bodies could be sufficient.

Liver function tests might be necessary at some point in time. Liver disease could explain the bleeding, due to lack of vitamin K dependent clotting factors and the varicose veins.

My suggestion is you booking an appointment with an internist for a clinical evaluation and management. The laboratory and radiologic examinations shall actually be a function of the results of the physical examination and past medical history.

Thanks and hope this helps. Wishing you good health.
Dr Luchuo, MD.

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