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TUTORIAL - 1

TUTORIAL - 1. HMIM BLOCK 224. Dr. Shaikh Mujeeb Ahmed Assistant Professor AlMaarefa College. Case History.

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TUTORIAL - 1

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  1. TUTORIAL - 1 HMIM BLOCK 224 Dr. ShaikhMujeeb Ahmed Assistant Professor AlMaarefa College

  2. Case History • A 35 year old, businessman consults his physician complaining of passing black stools for the last 2 weeks. He had a history of abdominal pain (epigastric region) for the last one year. He had been relieving this pain by taking tablets off and on. In the past week the patient noticed that he became breathless (dyspneic) on exertion.

  3. DISCUSSION

  4. Case History cont… • Upon examination the patient looked pale. The pallor is most obvious in the conjunctivae and the nail beds. His heart rate was 105 beats/ minutes at rest (slightly raised) and there is tenderness on palpation of the epigastrium. Stool examined by naked eye looked black (malena). Laboratory test was positive for blood.

  5. DISCUSSION

  6. Case summary • A patient looks pale, with history of dyspnea on exertion, slightly increased heart rate and the presence of blood in the stool, the following blood test were ordered. • RBC count, • hemoglobin concentration and • hematocrit.

  7. Write the expected results • RBC count • Hemoglobin concentration • Hematocrit

  8. 1. Define anemia. • Decrease in RBC count, decreased in Hb, and decrease in hematocrit,. Ultimately decreased in oxygen carrying capacity of blood.

  9. 2. In iron deficiency anemia, how the RBCs look like on a blood film? • Small cells – microcytic, and decreased hemoglobin- hypochromic

  10. 3. What do the words microcytic and hypochromic means? • Small cells – microcytic, and decreased hemoglobin- hypochromic

  11. 4. Where is the iron absorbed? • Small intestine - Duodenum

  12. 5. What is the daily requirement of iron? • 15 – 20 mg per day. Man absorbs about 0.5 – 1 mg / day where as woman absorb about 1 – 1.5 mg/day.

  13. 6. In this patient why was the stool colored black? • Upper gastrointestinal bleeding – formation of acid hematin when Hb combines with HCl in the stomach.

  14. 7. Define erythropoiesis. • Formation and maturation of erthrocytes is defined as erythropoiesis.

  15. 8. What are the stages of erythropoiesis? • Pluripotent hemopoeitic stem cell – myeloid stem cells- erythroblast – reticulocytes – erythrocytes.

  16. 9. What is erythropoietin? From where is it secreted? • Erythropoietin is a hormone released by the kidney into the blood, which in turn stimulates erythropoiesis by the bone marrow

  17. 10. What substances are required for erythropoiesis? • Protein, • Iron, • Hormones, • vitamins

  18. 11. How Vitamin B12 is absorbed? • Vitamin B12 can be absorbed from the intestinal tract only when this nutrient is bound to intrinsic factor.

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