English Language Patient Consultations

BLOOD & LYMPHATIC MODULE Anemia

BLOOD & LYMPHATIC MODULE : Anemia

History & Symptoms

Hi! Im Dr. Hampton. How can I help you?

Well, basically, over the last couple of weeksI play football on Sundaysand a bit more than a couple of weeks ago, I was getting a bit more tired than I used to be. Like Id get out of breath in the game. Id get puffed out. But more recently, its been little things, like walking up and down stairs, and stuff like that. Thats got me a bit tired as well. So I was just wondering whats whats up with me, really,

OK. When did you first start feeling poorly? Can you remember?

Thats the thing: I had a cold, you see. Well, I thought it was a cold: I had a sore throat. And I was quite under the weather for that. But Ive never really recovered since then.

And how long ago was that?

Thatd be about a couple of months ago now

A couple of months? Did we see you with that?

No. So I

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BLOOD & LYMPHATIC MODULE Anemia

No, I didnt see you on the computer. So, you just basically managed that yourself, and ah

Yes. I thought it was getting better, but its never really I suppose thats never really gone away entirely. So maybe it was something more than a cold. I dont know.

OK. What symptoms were you getting with that cold at the time?

Um Bad sore throat. My glands were felt quite big, as well. So, um. I was just really tired, really, really, you know. No energy.

Were you short of breath at that time during that cold?..

Yes, but not as much as now. Thats why Ive come in now, because

its got worse

.yeah, . its got a bit more noticeable

Have those cold symptoms gone away now?

Yes. Pretty much. I still get a bit of a sore throat every now and again.

Pretty much Right, OK. When you are at rest, do you get short of breath?

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No.

No. Okay. Have you noticed any noisy breathing?

No No, not really.

Never had asthma, or any sort of chest problems, as far as you know?

No, nothing like that. Thats why Ive come in: because its strange to me.

Yes? OK. And what about your appetite and weight? How are you with eating and drinking?

Fine, yes. Been OK.

And do you have a particular diet?Do youare you a vegetarian, or anything?

No, Im not a vegetarian. I eat quite a lot of meat, actually.

You do?

Yes.

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Red meat?

Yes, yes.

What about green, leafy vegetablessort of?

Whenever I can, yes.

OK. UmHave you noticed any problems with abdominal pain, or indigestion

No, no. Nothing severe, no.

Nothing severehave you had some from time to time?

No, not really. Ive had mild discomfort, but that could be just indigestion, I suppose. I dont know.

Yes, OK. Is that something youve had on and off for many years? Or, new with this

Its nothing new, no.

Its nothing newOK. UmAny nausea or vomiting with this?

No.

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What about your bowels? Have they been working normally?

Yes. Been fine.

. Been fine? Not passed any diarrhea or

No, no, no.

In particular, not passed any black, or very dark motions?

No.

No? OK. You mentioned getting out of puff In yourself, just day-to-day, how are you feeling at the moment?

Just generally, a bit worn down, to be honest with you. Feel a bit under the weather, I suppose youd say.

Just not right, sort of

Yes. Somethings wrong I can feel somethings wrong, because Im a bitjust a bit dozy, almost. Just a bit you know.

Are you suffering from any fevers, or sweats, or anything like that?

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BLOOD & LYMPHATIC MODULE Anemia

Mm. Not really, no.

And, um, what about family history? Is there a family history of people getting anemic, for example, for any reason, as far as you are aware?

No, not that I can think of,,,

No-ones had any, sort of, umblood disorders, or anything? Nothing like that, as far as youre aware. Parents both healthy?

Yes, yes.

And brothers and sisters?

Yes, theyre fine.

Right. Fine. And did you have an idea in your own mind, what this might be?

I thought it maybe could have been related to the cold I had, because one of my friends did have glandular fever around like a few months ago. Because my glands were up, I thought it could be related to that.

Yes, OK. But you think the glands have gone down now?

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BLOOD & LYMPHATIC MODULE Anemia

Yes, theyve gone down now, but, you knowit could be, like, an after-effect of that.

Physical Examination
OK, so you just lie, flat on your back, and just relax all your muscles. Im going to be feeling round the abdomen, and I just want you to tell me if you feel any tenderness first of all.

Nothing there, no

No, OK. Right. If I do hit tenderness, let me know. No tenderness there?

No. How about here?

No

OK thats fine. And here. I want you to just try and keep all your muscles relaxed but breathe deeply in, just. (breath) and out. Just keep on breathing in and out now. ..Just keep on going. And out. OK thats good. Same thing on this side now. No pain or anything around there?

No

OK . And again. And out, OK thats fine. I want to feel this side more closely for a minute. I want you to just turn so youre facing slightly towards me, about there. Thats perfect. Are you comfortable there just for a minute? If you could just pop your arm down so youre relaxed, as best you can.

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Do you want me to breathe?

Just carry on breathing in and out please yes. OK. Just want to do that again. And again, OK thats fine. You can get dressed again

Diagnosis & Explanation

Right. The main thing I find when Im examining you is you are, you have all the signs anyway of being anemic. Do you know what anemia is?

. Something to do with the blood?

Thats right. It means that basically youve not got enough of the blood cells that carry the oxygen around the body.

OK

And when thats the case in your case when youre not doing anything it's fine but if youre trying to then exert yourself ; play football or run up the stairs

Oh I see

your body takes a bit of time to catch up which is why youre getting a bit short of breath

What could be causing it?

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BLOOD & LYMPHATIC MODULE Anemia

Well this is the next question for me really. Theres no obvious cause. I mean, by and large, the main causes are that your diets not sufficient and you need to build up on the elements to give you the supplies to make the blood cells. Sometimes that theres a slow bleed going on somewhere but theres certainly no evidence of that whatsoever. Or that there for some reason youre just not producing the right blood cells that you need for whatever reason. Now at this stage Im afraid Im not in a position to answer those questions. I think the first thing is that I need to just establish that my suspicion you are anemic is in fact correct so I need to do a blood test is what Im saying

Oh OK

And Id like to get it within a short-ish timescale. Ill be doing a few other blood tests that might also then give some more information about why youre anemic, if youre anemic and what type of anemia it is. Because theres all sorts of different reasons why it might be. It could be because you havent got enough of certain vitamins or not enough iron. So in other words we need to look into this and I need to see you again

Treatment & Advice

At this stage I dont think I want to give you any treatment, I really want to know what were dealing with before we take it any further. So I would be grateful, in fact Ill give the receptionist a ring, if we could squeeze you in this morning to get a blood test done and well get that done today and I'll see you in 4 days time. So if you just let the receptionist know and shell sort out all the dates with you. So Ill get those results back and well talk it through The glandular fever, or sorry the infection, could well be, could be relevant

It could have been glandular fever?

Well it could have been. When I examined you, the only thing apart from anemia I could find was your spleen, (its an organ in the body that deals with red blood cells), is slightly enlarged. But not very much, and it certainly wasnt bothering you. So, you know, Im not sure of the relevance of that at this stage. Given that youre a slim chap maybe I can

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just feel a normal spleen. But with you being anemic, Im not quite sure what to make of that at this stage but I think that theres enough reasons for me to say look we need to look into this to get things right for you

OK right

. and I cant really answer too many questions at this stage because I havent got the foundations to answer them. So you know at this stage not quite sure whats going on, need to find out more, Ill find that out within a short-ish time scale, and see you again in 4 days time when we have all the blood tests back

and take it from there.

and take it from there. Now I realize theres a lot of uncertainties with this. Any particular concerns you have on your mind at the moment?

Just that if it is anemia, or I am anemic what can I do to fix it?

I think again it depends on why youre getting it, if its just purely that youre low on iron, well (1) weve got to find out why youre not absorbing iron because your diet seems good enough, or if its a vitamin deficiency of another type, we just replace that and thats the end of that. Again being fair haired, blue eyes theres a chance you might have a certain type of vitamin deficiency which is quite common in people of Nordic descent, interestingly. But there are other reasons as well so I suppose I cant really answer your questions right now.

OK, its too early. OK, well wait until we get the tests back.

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Any other questions?

No

No, OK, thats fine. So make the arrangements with the receptionist, theyll squeeze you in for a blood test today. If theres any problem with that, tell them to give me a ring and Ill sort it all out. Ill see you in 4 days and at that point will have a lot more certainty on which to base some more advice

.OK ,so its a waiting game

It is indeed. So Ill see you in a few days

OK

OK

. Thanks, bye

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