1. TUTORIAL Dr. Shaikh Mujeeb 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. 1.RBC count, 2.hemoglobin concentration and 3.hematocrit.

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

8. 8 1. Define anemia.

9. 9 2. In iron deficiency anemia, how the RBCs look like on a blood film?

10. 10 3. What do the words microcytic and hypochromic means?

11. 11 4. Where is the iron absorbed?

12. 12 5. What is the daily requirement of iron?

13. 13 6. In this patient why was the stool colored black?

14. 14 7. Define erythropoiesis.

15. 15 8. What are the stages of erythropoiesis?

16. 16 9. What is erythropoietin? From where is it secreted?

17. 1 2 3 4 17 10. What substances are required for erythropoiesis?

18. 18 11. How Vitamin B12 is absorbed?