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🩸 ANEMIA — PART 1/8 LONG CASE HISTORY ━━━━━━━━━━━━━━━━━━ 👨‍⚕️ Chief Complaints ✓ Severe weakness for … months. ✓ Occasional dizziness/light-headedness for … months. ✓ Tingling and numbness in both lower limbs for … months. ✓ Palpitation, anorexia and weight loss for … months. ━━━━━━━━━━━━━━━━━━ 👨‍⚕️ History of Present Illness The patient was apparently well until … months ago, when she developed severe weakness, which was gradually progressive and has become severe enough to interfere with her usual daily activities. For the last … months, she has also experienced occasional dizziness and light-headedness, associated with tingling and numbness in both feet and occasional cramps in the calf muscles. She also complains of palpitation, loss of appetite and weight loss for … months. There is no history of fever, dysphagia, bleeding from any site, menorrhagia, or bowel or bladder abnormalities. ━━━━━━━━━━━━━━━━━━ 👨‍⚕️ Important Questions in Anemia History 1️⃣ Dietary History Ask about: ✓ Poor dietary intake ✓ Vegetarian diet ✓ Iron-rich food ✓ Meat and animal products ✓ Folate-rich food 📌 Why? To detect nutritional deficiencies, especially iron, vitamin B12 and folate deficiency. ━━━━━━━━━━━━━━━━━━ 2️⃣ History of Blood Loss Ask about: ✓ Hematemesis ✓ Melena ✓ Hematochezia ✓ Epistaxis ✓ Gum bleeding ✓ Hematuria ✓ Menorrhagia ✓ Hemorrhoids 📌 Why? Chronic blood loss is an important cause of iron deficiency anemia. ━━━━━━━━━━━━━━━━━━ 3️⃣ Malabsorption Ask about: ✓ Chronic diarrhea ✓ Steatorrhea ✓ Weight loss ✓ Previous intestinal surgery ✓ Gastrectomy ✓ Ileal surgery 📌 Why? To detect impaired absorption of iron, vitamin B12 or folate. ━━━━━━━━━━━━━━━━━━ 4️⃣ Drug History Ask about: ✓ NSAIDs → GI bleeding ✓ Cytotoxic drugs → bone marrow suppression ✓ Chloramphenicol → aplastic anemia ✓ Antithyroid drugs ✓ Carbamazepine ✓ Methyldopa ✓ Sulfasalazine ━━━━━━━━━━━━━━━━━━ 5️⃣ Past History Ask about: ✓ Chronic kidney disease ✓ Chronic liver disease ✓ Rheumatoid arthritis/SLE ✓ Malignancy ✓ Tuberculosis ✓ Previous anemia ✓ Previous blood transfusion ━━━━━━━━━━━━━━━━━━ 6️⃣ Surgical History Ask specifically about: ✓ Gastrectomy ✓ Ileal resection ✓ Bariatric surgery 📌 Why? Especially important in vitamin B12 deficiency. ━━━━━━━━━━━━━━━━━━ 7️⃣ Family History Ask about: ✓ Similar illness ✓ Thalassemia ✓ Sickle cell disease ✓ Hereditary hemolytic anemia 📌 Why? To detect inherited hematological disorders. ━━━━━━━━━━━━━━━━━━ 8️⃣ Menstrual History Ask about: ✓ Cycle duration and regularity ✓ Amount of bleeding ✓ Passage of clots ✓ Menorrhagia 📌 Why? Menstrual blood loss is an important cause of iron deficiency anemia in premenopausal women. ━━━━━━━━━━━━━━━━━━ 9️⃣ Occupational & Social History Ask about: ✓ Diet ✓ Alcohol intake ✓ Radiation exposure ✓ Benzene/chemical exposure ━━━━━━━━━━━━━━━━━━ 🔟 Neurological History Ask about: ✓ Tingling ✓ Numbness ✓ Gait disturbance ✓ Loss of balance ✓ Weakness ✓ Cognitive changes 📌 Why? Neurological manifestations strongly suggest vitamin B12 deficiency. ━━━━━━━━━━━━━━━━━━ ⭐ EXAM PEARL Anemia + neurological manifestations → Think Vitamin B12 deficiency until proven otherwise. ━━━━━━━━━━━━━━━━━━ 🩸 ANEMIA — PART 1/8

🫁 𝐏𝐮𝐥𝐦𝐨𝐧𝐚𝐫𝐲 𝐄𝐦𝐛𝐨𝐥𝐢𝐬𝐦 (𝐏𝐄) 🫁 ​🏥 𝐀 𝐥𝐢𝐟𝐞-𝐭𝐡𝐫𝐞𝐚𝐭𝐞𝐧𝐢𝐧𝐠 𝐜𝐨𝐧𝐝𝐢𝐭𝐢𝐨𝐧 𝐢𝐧 𝐰𝐡𝐢𝐜𝐡 𝐚 𝐛𝐥𝐨𝐨𝐝 𝐜𝐥𝐨𝐭 (𝐮𝐬𝐮𝐚𝐥𝐥𝐲 𝐟𝐫𝐨𝐦 𝐚 𝐝𝐞𝐞𝐩 𝐯𝐞𝐢𝐧 𝐭𝐡𝐫𝐨𝐦𝐛𝐨𝐬𝐢𝐬 𝐢𝐧 𝐭𝐡𝐞 𝐥𝐞𝐠) 𝐭𝐫𝐚𝐯𝐞𝐥𝐬 𝐭𝐨 𝐭𝐡𝐞 𝐩𝐮𝐥𝐦𝐨𝐧𝐚𝐫𝐲 𝐚𝐫𝐭𝐞𝐫𝐢𝐞𝐬 𝐚𝐧𝐝 𝐛𝐥𝐨𝐜𝐤𝐬 𝐛𝐥𝐨𝐨𝐝 𝐟𝐥𝐨𝐰 𝐭𝐨 𝐭𝐡𝐞 𝐥𝐮𝐧𝐠𝐬. 📌 𝐂𝐥𝐚𝐬𝐬𝐢𝐜 𝐩𝐫𝐞𝐬𝐞𝐧𝐭𝐚𝐭𝐢𝐨𝐧: - ​𝐒𝐮𝐝𝐝𝐞𝐧 𝐨𝐧𝐬𝐞𝐭 𝐬𝐡𝐨𝐫𝐭𝐧𝐞𝐬𝐬 𝐨𝐟 𝐛𝐫𝐞𝐚𝐭𝐡 ➔ 𝐬𝐡𝐚𝐫𝐩 𝐩𝐥𝐞𝐮𝐫𝐢𝐭𝐢𝐜 𝐜𝐡𝐞𝐬𝐭 𝐩𝐚𝐢𝐧 (𝐰𝐨𝐫𝐬𝐞 𝐰𝐢𝐭𝐡 𝐛𝐫𝐞𝐚𝐭𝐡𝐢𝐧𝐠) ➔ 𝐦𝐚𝐲 𝐛𝐞 𝐚𝐬𝐬𝐨𝐜𝐢𝐚𝐭𝐞𝐝 𝐰𝐢𝐭𝐡 𝐫𝐚𝐩𝐢𝐝 𝐡𝐞𝐚𝐫𝐭 𝐫𝐚𝐭𝐞. 📌 𝐑𝐢𝐬𝐤 𝐟𝐚𝐜𝐭𝐨𝐫𝐬: - ​𝐑𝐞𝐜𝐞𝐧𝐭 𝐬𝐮𝐫𝐠𝐞𝐫𝐲 𝐨𝐫 𝐢𝐦𝐦𝐨𝐛𝐢𝐥𝐢𝐳𝐚𝐭𝐢𝐨𝐧 - ​𝐋𝐨𝐧𝐠 𝐭𝐫𝐚𝐯𝐞𝐥 - ​𝐏𝐫𝐞𝐯𝐢𝐨𝐮𝐬 𝐃𝐕𝐓/𝐏𝐄 - ​𝐂𝐚𝐧𝐜𝐞𝐫 - ​𝐏𝐫𝐞𝐠𝐧𝐚𝐧𝐜𝐲 📌 𝐓𝐡𝐢𝐧𝐤: o 𝐒𝐮𝐝𝐝𝐞𝐧 𝐝𝐲𝐬𝐩𝐧𝐞𝐚 + 𝐩𝐥𝐞𝐮𝐫𝐢𝐭𝐢𝐜 𝐜𝐡𝐞𝐬𝐭 𝐩𝐚𝐢𝐧 + 𝐫𝐢𝐬𝐤 𝐟𝐚𝐜𝐭𝐨𝐫𝐬 𝐟𝐨𝐫 𝐭𝐡𝐫𝐨𝐦𝐛𝐨𝐬𝐢𝐬 ➔ 𝐏𝐮𝐥𝐦𝐨𝐧𝐚𝐫𝐲 𝐄𝐦𝐛𝐨𝐥𝐢𝐬𝐦 (𝐏𝐄). 🫁 𐙚

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