I always feel tired

I always feel tired

1. Differential diagnosis of dyspnea

   • Acute coronary syndrome Congestive heart failure Chronic obstructive pulmonary disease Asthma Pneumothorax Pneumonia Pulmonary embolism

2. History Taking

   • Onset, duration and progress (trauma?) Age & sex (different Hb levels) Associated symptoms (pain? bleeding? ulcer? cancer?) Occupation Family history (thalassemia?) History of chronic illness Gynecological history History of fever ( infection ? Inflammation ?)
   • Previous CBC history of gastrointestinal (Abdominal pain , consumption ) Changes in body weight Changes in bowel habits Abnormal urine color (renal and hepatic disease ) Diet (Iron,B2,Folate) Drug ingestion (NSAID)

3. Red Blood Cells

   • classification of RBC
     • Assessing red cell size
       • Microcytosis Macrocytosis
     • Assessing red cell shape
       • Poikilocytosis :more than the normal degree of variation
     • Assessing red cell colour
       • Cells that have an area of central pallor more than a third of the diameter of the cell are said to be hypochromic and the film is said to show hypochromia. Cells that lack central pallor are said to be hyperchromic.
   • Erythropoiesis

4. Iron metabolism

   • Iron Distribution in Healthy Young Adults (mg)
   • Iron homeostasis

5. Anemia

   • Investigations
     • blood
     • iron
       • Serum iron
         • Measures amount of iron bound to transferrin.
           • Male (87-150µg/dL) Female(72-130 µg/dL)
         • Total iron-binding capacity
         • Ferritin
           • Males( 30-400 ug/L) Females(13-150 ug/L)
             • Reflects body iron stores
     • Gel Electrophoresis
       • Electrophoresis is the movement of molecules by an electric current.
     • Stool Analysis
   • types according to the problem
   • classification according to size
   • iron deficiency anaemia
     • signs
       • pica
     • Treatments--> Iron supplements
       • side effects when taking iron supplements including
         • nausea sickness abdominal pain heartburn constipation
       • , some foods and medicines can make it harder for your body to absorb iron
     • Complications
       • Heart problems. Problems during pregnancy. Growth problems
   • signs +symptoms