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I always Feel Tired

Causes of generalized dyspnea
1. Acute coronary syndrome
2. Congestive heart failure
3. Chronic obstructive pulmonary disease
4. Asthma
5. Pneumothorax
6. Pneumonia
7. Pulmonary embolism
8. History Taking
  1. Onset, duration and progress
    1. Trauma?
  2. Age & sex
    1. (different Hb levels)
  3. Associated symptoms
    1. (pain? bleeding? ulcer? cancer?)
  4. Occupation
  5. Family history
    1. (thalassemia?)
  6. History of chronic illness
  7. What to ask a patient when he complains of tiredness and dyspnea
  8. Previous CBC
  9. history of gastrointestinal
    1. (Abdominal pain , consumption )
  10. Changes in body weight
  11. Changes in bowel habits
  12. any complains of Abnormal urine color
    1. (renal and hepatic disease )
  13. Diet
    1. deficiency of (Iron,B2,Folate)
  14. Drug ingestion
    1. NSAIDS
9. Investigations done
  1. Blood Investigations
    1. CBC
      1. Hb
        A hemoglobin test measures the amount of hemoglobin in blood
      2. Hematocrit
        The ratio of the volume of red blood cells to the total volume of blood.
      3. RBC count
        measure the number of red blood cells (RBCs) in the blood
      4. RBC indices
        MCV
        Mean corpuscular volume (MCV) is the average volume of red cells.
        MCH
        mean corpuscular hemoglobin (MCH) is the average mass of hemoglobin per red blood cell in a sample of blood.
        MCHC
        Mean corpuscular hemoglobin concentration, a measure of the concentration of haemoglobin in a given volume of packed red blood cells
      5. WBC count
        measure the number of white blood cells (WBCs) in the blood.
      6. Platelet count
        a lab test to measure how many platelets are in blood
      7. Peripheral blood film
        Assessing red cell size
        Microcytosis
        If red cells are smaller than normal
        MCV 62 fl.
        Macrocytosis
        If red cells are bigger than normal
        MCV 105 fl
        Normocytosis
        Normal RBC size
        Anisocytosis
        If red cells show greater variation in size than normal the blood film is said to show
        Severe anisocytosis; the MCV was 133 fl but the macrocytosis is not uniform
        Assessing red cell shape
        Poikilocytosis
        If red cells show more than the normal degree of variation in red cell shape there is said to be poikilocytosis .
        Severe poikilocytosis; cells vary considerably in shape but no single shape dominates.
        Individual cells of a particular shape have names that identify them.Diagrammatic representation of different types of poikilocyte
        Assessing red cell colour
        Hypochromia
        Cells that have an area of central pallor more than a third of the diameter of the cell are said to be hypochromic
        Hyperchromia
        more highly colored than normal
        normochromic
        Normal red cells are reddish-brown with approximately the central third to quarter of the cell being paler.
        Anisochromasia
        Cells which show a greater than normal variation in the degree of haemoglobinization are said to show anisochromasia
        Polychromasia
        Red cells that have a blue or lilac tinge are said to show polychromasia (‘many colours’) are young cells, newly released from the bone marrow
    2. Iron studies
      1. Serum iron
        Measures amount of iron bound to transferrin.
        HIGH/NORMAL
        Liver disease, sideroblastic anemia, iron overload, hemochromatosis, Thalassemia, Vit B12 deficiency
        LOW
        Iron-deficiency, Anemia of chronic disease
        Male (87-150µg/dL) Female(72-130 µg/dL)
      2. Total iron-binding capacity
        (240-450 ug/dL) Transferrin(2-4g/L)
        High
        Fe deficiency
        low
        Thalassemia, hemolytic anemia, sideroplastic , anemia of chronic infections
        TIBC measures how well transferrin transports iron.
      3. Ferritin
        major iron storage protein
        Reflects body iron stores
        high/ normal
        Hemochromatosis(Fe overload) Chronic disease
        Males( 30-400 ug/L) Females(13-150 ug/L)
  2. Gel Electrophoresis
    1. is the movement of molecules by an electric current.
      1. Equipments
        α-Thalassemia trait
        Beta thalassemia major
        both genes are beta-0
        absence of hemoglobin A
        about 5 to 10% Hb A2
        and over 90% Hb F
        Co-inheritance of genetic factors :increasing g-chain production γ-chains will combine with excess chains resulting in high HbF.
        Beta-thalassemia Minor
        Hb A: 83.6% Hb A2: 6.2% Hb F: 1.1%
      2. Gel electrophoresis is a laboratory method used to separate mixtures of DNA, RNA, or proteins according to molecular size.
  3. Stool Analysis
    1. Guaiac – Based ( hemoccult) test
      1. Guaiac is a colorless compound that turns blue on exposure to hemoglobin
        Sensitive for detecting hemoglobin in stool
    2. Positive for occult blood
      1. Peptic ulcer disease (gastric ulcers)
        group of medications known as NSAIDs Ulcers that bleed slowly doesn’t show symptoms and by time the person be anemic.
        infection with Helicobacter pylori
      2. Angiodysplaslia(colon)
        Its related to aging and breakdown of blood vessels And the most common is vascular abnormality. the bleeding occurs in the right colon usually.
      3. Esophageal varices
        abnormal, enlarged veins in the esophgus
      4. colorectal cancer
        Tumor enlarge, ulceration and hemorrhage
      5. Crohn’s disease
        inflammation of any part of the GI Tract usually the proixmal part. The cause is unknown.
      6. Diverticular Disease
        occurs when pouches (diverticula ) that have developed in the wall of the large intestine (colon) bleed. This condition is called:diverticulosis.
      7. Iron Deficiency anemia
        One of its symptoms: Dark, tar-colored stools or blood in the stool.
        Symptoms
        Angular cheilitis
        Pika
        Glossitis
        Treatment
        Pharmacological
        ferrous sulphate, taken orally two or three times a day.
        side effects
        nausea /sickness abdominal pain heartburn constipation diarrhoea / black stools
        check-up two to four weeks after the patient has started taking iron supplements to assess how well he has responded to the treatment.
        Nonpharmacological
        Dietary advice
        Eat
        watercress and curly kale
        iron-fortified cereals
        wholegrain
        beans
        meat
        nuts
        Apricots
        prunes
        raisins
        Avoid
        Tea and coffee
        Calcium, found in dietary products
        antacids
        Proton pump inhibitors
        Whole grain cereals
        Complications
        Heart problems.
        Problems during pregnancy.
        Growth problems
      8. Divecular bleeding
        Large amount of blood appears in stool.
Anemia
1. An RBC consists of
  1. Hemoglobin
    1. Heme
      1. Iron
        any problem causes
        Iron deficiency anemia
      2. Porphyrin
        any problem causes
        Sideroblastic anemia
    2. Globin
      1. Any problem with it leads to
        Thalassemia
        Sickle cell anemia
  2. Other problems relating to RBCS
    1. Maturation
      1. Megaloblastic anemia
    2. Structure
      1. Hereditary spherocytosis
    3. Anemia of chronic disease
    4. Hemolytic anemia
      1. Number
      2. Immune hemolytic anemia
      3. RBC trauma:
        Mechanical heart valves breaking RBC’s
        MICROANGIOPATHIES: Hemolytic Uremic Syndrome
      4. Hemolytic anemia due to G6PD deficiency
      5. Parasitic hemolysis.
  3. According to the MCV of the rbc, anemia can be classified to
    1. Microcytic
      1. MCV<80 fl
        Iron deficiency
        Anemia of chronic disease (some cases)
        Sideroblastic anemia
    2. Normocytic
      1. MCV 80-100 fl
      2. Many haemolytic anaemias
      3. Anemia of chronic disease (some cases)
      4. After acute blood loss
      5. Renal disease
      6. BM failure, post chemotherapy, infiltration by CA
    3. Macrocytic
      1. MCV>100 fl
      2. Megaloblastic:Vitamin B12, or Folate deficiency
      3. Non-megaloblastic: alcohol, liver disease, aplastic anaemia
2. Anemia symptoms
3. a condition in which there is a deficiency of red cells or of haemoglobin in the blood, resulting in pallor and weariness.
  1. Insufficient oxygen transport
    1. Tissue hypoxia
      1. Brain
        somnolence and fatigue
      2. Heart
        Chest pain
        Angina
        heart attack
      3. Lung
        Dyspnea and low respiratory reserve
      4. Skeletal muscles
        Weakness and fatigue
Life Span of Red Blood Cells
1. Erythropoiesis in the bone marrow(after birth)
  1. Bone marrow is the flexible tissue found in the hollow interior of bones
    1. produces the cellular elements of the blood, including platelets, red blood cells and white blood cells.
      1. yellow marrow (consisting mainly of fat cells).
      2. red marrow (consisting mainly of hematopoietic tissue)
        Myeloid stem cells
        give rise to erythrocytes, eosinophils, baso, neutrophils, monocytes and megakaryocytes
        lymphoid stem cells
        develop in the bone marrow
  2. Differentiation of stem cells to mature cells is associated with:
    1. Decreasing cell size
    2. Hemoglobin production
    3. Gradual decrease and loss of all cell organelles
    4. Changing cytoplasmic staining
    5. Condensation and eventual extrusion of the nucleus
2. after RBCs' degradation
  1. Iron metabolism

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I always Feel Tired

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	Created by Fatma Shwaylia almost 7 years ago