I always feel tired

I always feel tired

1. diagnosed with

   • Fe deficiency anemia
     • anemia
       • Normocytic
         • increased destruction (hemolytic anemia)
           • Hereditary spehrocytosis
         • Sickle cell anemia
         • Glucose-6-phosphate dehydrogenase (G6PD) deficiency
         • Paroxysmal Nocturnal Hemoglobeinuria
       • MCV: >100um3
         • Macrocytic
           • Megaloblastic anemia
             • VB 12 deficiency
               • symptoms of VB12 DEF
                 • Nerve damage.
                 • Neurological problems
                 • Nausea and vomiting
                 • enlarged liver
                 • smooth, beefy red tongue
               • CAUSES
                 • vegan
                 • Impaired absorption
                   • Intrinsic factor deficiency (prenicious anemia- gastrectomy
                   • Malabsorption diseases (pancreatic insufficiency)
                   • Diffuse intestinal disease (lymphoma-Crohn’s
                   • Competitive parasitic uptake (tape worm infestation)
             • folate deficiency
               • Increased homocysteine level
               • Normal mehylmalonic acid
               • CAUSES
                 • Dietary deficiency (alcohol-elderly)
                 • Increased demand pregnancy- cancer patients
             • Impaired DNA synthesis
               • Ineffective erythropoiesis
           • Non-megaloblastic anemia
             • Alcoholism
             • Drugs (Ex- 5 FU)
             • Liver disease
       • SYMPTOMPS OF ANEMIA
       • MCV: <80
         • Microcytic
           • Anemia of chronic disease
             • TB
             • Rheumatoid arthritis
             • Malignancy
             • Chronic alcoholism
             • Iron is trapped in BM macrophages
               • HEPCIDIN prevents the release of iron from BM
                 • decrese EPO production
                   • Increase in BM iron stores
           • Sideroblastic
             • Chronic alcoholism
             • VB6 deficiency
             • Lead poisoning
             • INH therapy
             • Hereditary types (x- linked)
             • Free iron accumulates inside the mitochondria (Iron loaded mitochondria in the bone marrow erythroblasts)
               • RING SIDEROBLASTS
       • Risk factors
         • Women
         • Infants and children
         • Vegetarians
         • Frequent blood donors
       • Complications
         • Heart problems
         • Problems during pregnancy
         • Growth problems
       • Treatment
         • Oral or parenteral iron preparations
         • pyridoxine
         • Hydroxyurea
         • Pentoxifylline
       • RBC
         • HB
           • Transport of O2 from lungs to tissues &CO2 and H+ from tissues to the lungs for excretion
             • HEME
               • porphyrin ring with central iron
                 • . Iron is the site of attachment with O2.
                   • 4 heme groups
                     • 4 O2 molecules
                   • Iron
                     • immune system healthy
                     • produce the connective tissue
                     • STORED
                       • Ferritin
                         • TRASPORTED
                           • Transferrin
             • GLOBIN
     • Microcytic hypochromic
       • C/P
         • General features of anemia
         • Epithelial atrophy- Plummer Vinson syndrome
         • Koilonichia
         • Pica
     • causes
       • increased loss
       • dietary deficiency

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