Neither quantitative nor qualitative disorders necessarily imply impairment. Rather, impairment depends on the severity of the defect and the mode of clinical expression.
Within this section, general reference is made to symptomatology and to limitations of the patient’s daily activities. The physician should determine whether these fit into one of the following categories:
a. NONE there are no complaints or evidence of disease, and the usual activities of daily living can be performed;
b. MINIMAL some signs or symptoms of disease are present, and there is some difficulty in performing the usual activities of daily living;
c. MODERATE signs and symptoms of disease are present, and difficulty is experienced in performing the usual activities of daily living that now require varying amount of assistance from others; or
d. MARKED signs and symptoms of disease are present, and assistance is needed in performing most to all activities of daily living.
ANEMIA
Persistent refractory anemia may cause impairment, regardless of etiology; the degree of impairment is related to the severity of the anemia and the need for transfusions.
Under the best of circumstances, with normal survival of the transfused red cells, the beneficial effects of transfusions last 6—8 weeks. In patients with hemolytic anemias due to serum factors, and in some patients who have been transfused many times, the survival of transfused cells becomes shortened and transfusions must be repeated at shorter intervals of 1—5 weeks. As hemolysis becomes more severe, impairment increases.
(Mild anemia with a hemoglobin level of about l0gm/100ml is associated with little impairment in a patient who has a normal cardiovascular system)
WHITE BLOOD CELL DISEASES OR ABNORMALITIES
Class 1—Impairment of the Whole Person, 1—10%
A patient belongs in Class 1 when (a) there are symptoms or signs of leukocyte abnormality; and (b) no or infrequent treatment is needed; and (c) all or most of the activities of daily living can be performed.
Class 2—Impairment of the Whole Person, 11—25%
A patient belongs in Class 2 when (a) there are symptoms and signs of leukocyte abnormality; and (b) although continuous treatment is required, most of the activities of daily living can be performed.
Class 3—Impairment of the Whole Person, 26—50%
A patient belongs in Class 3 when (a) there are symptoms and signs of a leukocyte abnormality; and (b) continuous treatment is required; and (c) there is interference with the performance of daily activities that require occasional assistance from others.
Class 4—Impairment of the Whole Person, 51—90%
A patient belongs in Class 4 when (a) there are symptoms and signs of a leukocyte abnormality and (b) continuous treatment is required; and (c) difficulty is experienced in the performance of the activities of daily living that requires continuous care from others.
PLATELET AND/OR BLEEDING DISORDERS
Class 1—Impairment of the Whole Person, 1—10%
A person belongs in Class 1 when (a) there are symptoms or signs of a platelet and/or bleeding abnormality; and (b) no or infrequent treatment is needed; and (c) all or most of the activities of daily living can be performed.
Class 2—Impairment of the Whole Person, 11—25%
A patient belongs in Class 2 when (a) there are symptoms and signs of a platelet and/or bleeding abnormality; and (b) although continuous treatment is required, most of the activities of daily living can be performed.
Class 3—Impairment of the Whole Person, 26—50%
A patient belongs in Class 3 when (a) there are symptoms and signs of a platelet and/or bleeding abnormality; and (b) continuous treatment is required: and (c) there is interference with the performance of daily activities that requires occasional assistance from others.
Class 4—Impairment of the Whole Person, 51—90%:
A patient belongs in Class 4 when (a) there are symptoms and signs of a platelet and/or bleeding abnormality and (b) continuous treatment is required; and (c) difficulty is experienced in the performance of the activities of daily living that requires continuous care from others.