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8730051
I always Feel Tired
Description
Mind Map on I always Feel Tired, created by Fatma Shwaylia on 30/04/2017.
Mind Map by
Fatma Shwaylia
, updated more than 1 year ago
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Created by
Fatma Shwaylia
over 7 years ago
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Resource summary
I always Feel Tired
Causes of generalized dyspnea
Acute coronary syndrome
Congestive heart failure
Chronic obstructive pulmonary disease
Asthma
Pneumothorax
Pneumonia
Pulmonary embolism
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
What to ask a patient when he complains of tiredness and dyspnea
Previous CBC
history of gastrointestinal
(Abdominal pain , consumption )
Changes in body weight
Changes in bowel habits
any complains of Abnormal urine color
(renal and hepatic disease )
Diet
deficiency of (Iron,B2,Folate)
Drug ingestion
NSAIDS
Investigations done
Blood Investigations
CBC
Hb
A hemoglobin test measures the amount of hemoglobin in blood
Hematocrit
The ratio of the volume of red blood cells to the total volume of blood.
RBC count
measure the number of red blood cells (RBCs) in the blood
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
WBC count
measure the number of white blood cells (WBCs) in the blood.
Platelet count
a lab test to measure how many platelets are in blood
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
Iron studies
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)
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.
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)
Gel Electrophoresis
is the movement of molecules by an electric current.
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%
Gel electrophoresis is a laboratory method used to separate mixtures of DNA, RNA, or proteins according to molecular size.
Stool Analysis
Guaiac – Based ( hemoccult) test
Guaiac is a colorless compound that turns blue on exposure to hemoglobin
Sensitive for detecting hemoglobin in stool
Positive for occult blood
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
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.
Esophageal varices
abnormal, enlarged veins in the esophgus
colorectal cancer
Tumor enlarge, ulceration and hemorrhage
Crohn’s disease
inflammation of any part of the GI Tract usually the proixmal part. The cause is unknown.
Diverticular Disease
occurs when pouches (diverticula ) that have developed in the wall of the large intestine (colon) bleed. This condition is called:diverticulosis.
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
Divecular bleeding
Large amount of blood appears in stool.
Anemia
An RBC consists of
Hemoglobin
Heme
Iron
any problem causes
Iron deficiency anemia
Porphyrin
any problem causes
Sideroblastic anemia
Globin
Any problem with it leads to
Thalassemia
Sickle cell anemia
Other problems relating to RBCS
Maturation
Megaloblastic anemia
Structure
Hereditary spherocytosis
Anemia of chronic disease
Hemolytic anemia
Number
Immune hemolytic anemia
RBC trauma:
Mechanical heart valves breaking RBC’s
MICROANGIOPATHIES: Hemolytic Uremic Syndrome
Hemolytic anemia due to G6PD deficiency
Parasitic hemolysis.
According to the MCV of the rbc, anemia can be classified to
Microcytic
MCV<80 fl
Iron deficiency
Anemia of chronic disease (some cases)
Sideroblastic anemia
Normocytic
MCV 80-100 fl
Many haemolytic anaemias
Anemia of chronic disease (some cases)
After acute blood loss
Renal disease
BM failure, post chemotherapy, infiltration by CA
Macrocytic
MCV>100 fl
Megaloblastic:Vitamin B12, or Folate deficiency
Non-megaloblastic: alcohol, liver disease, aplastic anaemia
Anemia symptoms
a condition in which there is a deficiency of red cells or of haemoglobin in the blood, resulting in pallor and weariness.
Insufficient oxygen transport
Tissue hypoxia
Brain
somnolence and fatigue
Heart
Chest pain
Angina
heart attack
Lung
Dyspnea and low respiratory reserve
Skeletal muscles
Weakness and fatigue
Life Span of Red Blood Cells
Erythropoiesis in the bone marrow(after birth)
Bone marrow is the flexible tissue found in the hollow interior of bones
produces the cellular elements of the blood, including platelets, red blood cells and white blood cells.
yellow marrow (consisting mainly of fat cells).
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
Differentiation of stem cells to mature cells is associated with:
Decreasing cell size
Hemoglobin production
Gradual decrease and loss of all cell organelles
Changing cytoplasmic staining
Condensation and eventual extrusion of the nucleus
after RBCs' degradation
Iron metabolism
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