I always feel tired

History Taking
1. onset, duration and progress
  1. trauma?
2. age and sex
  1. different Hb levels
3. associated symptoms
  1. pain
  2. bleeding
  3. ulcer
  4. cancer
4. family history
  1. thalassemia? sickle cell?
5. history of chronic illness
6. gynecological and gastrointestinal history
7. history of fever
  1. infection
  2. inflammation
8. changes in body weight/ bowel habit
9. diet
  1. vegan/ vegeterian?
10. drug ingestion
  1. NSAIDS?
Physical Examination
1. inspection
  1. hands
    1. tachycardia
    2. kolionychia
  2. arms
    1. scratch marks
    2. ecchymosis
  3. eyes
    1. pallor
    2. jaundice
  4. mouth
    1. angular stomatitis
    2. atrophic glossitis
2. Palpation
  1. of the lymph nodes
    1. cervical LNs
    2. axillary LNs
    3. epitrochlear LNs
    4. inguinal LNs
3. other examination
  1. neurological examination
  2. abdominal examination
  3. pelvic and rectal examination
  4. bone tenderness
Investigations
1. Complete Blood Count
  1. Peripheral Blood Film
    1. assessing
      1. RBC morphology and inclusions
      2. WBC morphology and differential count
      3. platelet morphology and count
      4. presence of any abnormal cells
  2. IRON studies
    1. 1)serum ferritin
      1. 2) serum iron
        3) TIBC
        4) % saturation
        amount of transferrin occupied by iron
        amount of iron available to be occupied by iron
        amount of iron present in plasma
      2. amount of iron in the stores
2. electrophoresis
  1. use of electric current to separate proteins and DNA
Erythropoiesis
1. erythropoietin stimulates PHSC to turn into Proerythroblasts
  1. reticulocytes have nuclear material in them, once they get rid of them in 1 or 2 days , they become erythrocytes
2. occurs in bone marrow
3. Hemoglobin Synthesis
  1. Heme synthesis
    1. Protoporphyrin
    2. iron
      1. iron metabolism
  2. Globin Synthesis
Anemia
1. decrease in RBC mass or hemoglobin concentration in blood
  1. decrease in oxygen carrying capacity
2. symptoms
3. Classifications
  1. RBC indices
    1. microcytic
      1. iron deficiency
        most common form of anaemia
      2. Anaemia of chronic disease
        due to Hepcidin release
        inhibits release of iron from stores
      3. sideroblastic anemia
        defect in heme synthesis, production of protoporphyrin
        Ringed sideroblasts
    2. macrocytic
      1. Megaloblastic anemia
        folate or Vitamin B12 deficiency
        DNA synthesis Impaired
        erythropoiesis insufficient
    3. normocytic
      1. hemolytic anemia
        thalassemia
        reduced or abolished globin chain synthesis
        hereditary spherocytosis
        genetic defect in genes coding for ankyrin and spectrum
        sickle cell anaemia
  2. Pathophysiological
    1. Blood loss
    2. hemolytic
    3. aregenerative

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I always feel tired

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	Created by Salma Mk about 7 years ago