Hematological System

• Author: David A. Morton III
• Pages: 701-788

7-1

CHAPTER 7

Hematological System

Contents

Part I – Adults

§7.00 Hematological Disorders

§7.01 Category of Impairments, Hematological Disorders

§7.02-04 (Reserved)

§7.05 Hemolytic Anemias

§7.06-07 (Reserved)

§7.08 Disorders of Thrombosis and Hemostasis

§7.09 (Reserved)

§7.10 Disorders of Bone Marrow Failure

§7.11-16 (Reserved)

§7.17 Hematological Disorders Treated by Bone Marrow or Stem Cell Transplantation

§7.18 Repeated Complications of Hematological Disorders

Part II – Children

§107.00 Hematological Disorders

§107.01 Category of Impairments, Hematological Disorders

§107.02-04 (Reserved)

§107.05 (Hemolytic Anemias)

§107.06-07 (Reserved)

§107.08 Disorders of Thrombosis and Hemostasis

§107.09 (Reserved)

§107.10 Disorders of Bone Marrow Failure

§107.11 (Reserved)

§107.17 Hematological Disorders Treated by Bone Marrow or Stem Cell Transplantation

Part III – Forms

§7.02F Chronic Anemia

§7.05F Sickle Cell Anemia or Variants

§7.06F Chronic Thrombocytopenia

§7.07F Hereditary Telangiectasia

§7.08F Coagulation Defects

§7.09F Polycythemia Vera

 

§7.15F Granulocytopenia

§7.17F Aplastic Anemia With Bone Marrow or Stem Cell Transplant

HEMATOLOGICAL

SYSTEM

§7.00 MEDICAL ISSUES IN SOCIAL SECURITY DISABILITY 7-2

Form Reference:

See Forms 7.0x series to solicit treating source

medical information relevant to the above adult and

corresponding child listings.

Part I – Adults

§7.00 Hematological Disorders

A. What hematological disorders do we evaluate under

these listings?

1. We evaluate non-malignant (non-cancerous) hema

-

tological disorders, such as hemolytic anemias (7.05),

disorders of thrombosis and hemostasis (7.08), and dis-

orders of bone marrow failure (7.10). These disorders

disrupt the normal development and function of white

blood cells, red blood cells, platelets, and clotting-factor

proteins (factors).

2. We evaluate malignant (cancerous) hematological

disorders, such as lymphoma, leukemia, and multiple

myeloma, under the appropriate listings in 13.00, except

-

ciency virus (HIV) infection, under 13.11B, and primary



14.11C.

B. What evidence do we need to document that you have

a hematological disorder?

We need the following evidence to document that you

have a hematological disorder:



a hematological disorder, signed by a physician; or



a hematological disorder that is not signed by a physician

and a report from a physician that states you have the

disorder; or



test, a persuasive report from a physician that a diagnosis

-

priate laboratory analysis or other diagnostic method(s).

To be persuasive, this report must state that you had the

 -

nosing your disorder and provide the results, or explain

how your diagnosis was established by other diagnostic

method(s) consistent with the prevailing state of medical

knowledge and clinical practice.



results of appropriate laboratory testing you have had.

We will not purchase complex, costly, or invasive tests,

such as tests of clotting-factor proteins, and bone marrow

aspirations.

C. What are hemolytic anemias, and how do we evaluate

them under 7.05?

1. Hemolytic anemias, both congenital and acquired,

are disorders that result in premature destruction of red

blood cells (RBCs). Hemolytic disorders include abnor-

malities of hemoglobin structure (hemoglobinopathies),

abnormal RBC enzyme content and function, and RBC

membrane (envelope) defects that are congenital or

acquired. The diagnosis of hemolytic anemia is based

on hemoglobin electrophoresis or analysis of the con-

tents of the RBC (enzymes) and membrane. Examples

of congenital hemolytic anemias include sickle cell

disease, thalassemia and their variants, and hereditary

spherocytosis. Acquired hemolytic anemias may result

from autoimmune disease (for example, systemic lupus

erythematosus) or mechanical devices (for example, heart

valves, intravascular patches).

[The applicable Listing of Impairments introduces

each chapter and is typeset in Helvetica. Author com-

ments follow each Listing subsection and are typeset

in Times.]

SSA Listings of Impairments

1. The hospitalizations in 7.05B do not all have to be for

the same complication of the hemolytic anemia. They

  -

der. Examples of complications of hemolytic anemia

that may result in hospitalization include osteomyelitis,

painful (vaso-occlusive) crisis, pulmonary infections or

infarctions, acute chest syndrome, pulmonary hyperten-

sion, chronic heart failure, gallbladder disease, hepatic

(liver) failure, renal (kidney) failure, nephrotic syndrome,

aplastic crisis, and stroke. We will count the hours you

receive emergency treatment in a comprehensive sickle

cell disease center immediately before the hospitalization

if this treatment is comparable to the treatment provided

in a hospital emergency department.

HEMATOLOGICAL

SYSTEM

7-3 HEMATOLOGICAL SYSTEM §7.00

Figure 7.00 – 1: Process of Blood Formation1

1 Source: National Institute on Alcohol Abuse and Alcoholism (NIAAA), The Hematological Complications of Alcoholism, Ballard, Harold S.,

M.D., Alcohol Health & Research World, VOL. 21, NO. 1, 1997.

2. For 7.05C, we do not require hemoglobin to be mea-

sured during a period in which you are free of pain or

other symptoms of your disorder. We will accept hemo-

globin measurements made while you are experiencing

complications of your hemolytic anemia.

3. 7.05D refers to the most serious type of beta thalas-

semia major in which the bone marrow cannot produce



only available treatments for beta thalassemia major are

life-long RBC transfusions (sometimes called hypertrans-

fusion) or bone marrow transplantation. For purposes of

7.05D, we do not consider prophylactic RBC transfu-

sions to prevent strokes or other complications in sickle

  

to life-saving RBC transfusions for beta thalassemia

major. However, we will consider the functional limita-

tions associated with prophylactic RBC transfusions and





evaluate strokes and resulting complications under 11.00

and 12.00.

D. What are disorders of thrombosis and hemostasis, and

how do we evaluate them under 7.08?

1. Disorders of thrombosis and hemostasis include both

clotting and bleeding disorders, and may be congenital

or acquired. These disorders are characterized by abnor-

malities in blood clotting that result in hypercoagulation

(excessive blood clotting) or hypocoagulation (inade-

quate blood clotting). The diagnosis of a thrombosis or

hemostasis disorder is based on evaluation of plasma

clotting-factor proteins (factors) and platelets. Protein C

  -

ples of hypercoagulation disorders. Hemophilia, von

HEMATOLOGICAL

SYSTEM