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

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

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

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

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

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

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

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

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

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

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

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