NJSC KAZAKH NATIONAL MEDICAL UNIVERSITY NAMED AFTER S.D.

ASFENDIYAROVA "

Departments of Biochemistry, Physiology, Anatomy, Histology, Medical Ecology

Why Dolores suffocate?

Dolores Wellborn, a 28-year-old lawyer, lives in Portland, Oregon.

Dolores is in the second trimester of her first child, and although her pregnancy
was proceeding normally, she recently noticed that she gets tired very quickly
and suffocates from even the slightest exertion. She also had periods of
dizziness, but not to the point of fainting. Other changes she noticed were leg
cramps, ice crunching, and tongue pain. She doubts that all of these symptoms
are related to each other, but she is concerned and makes an appointment with
the doctor.
When Dolores is examined, her doctor discovers that she has tachycardia, pale
gums and nail beds, and a swollen tongue. Based on her medical history and the
results of her physical examination, the doctor suspects that Dolores has anemia
and orders blood tests.

The results are shown in the Table

Bloodtestresults
Redbloodcellcount 3,5 mln / mm3
Hemoglobin (Hb) 7 g / dl
Hematocrit (Hct) 30%
Serumiron low
Medium Corpuscular Low Volume (MCV) low
Medium low corpuscular hemoglobin low
concentration (MCHC)
Total blood iron binding capacity (TIBC) promoted
 Biochemicalbloodtestresults
Component Results Norm
Serumiron 4.3μmol / l 5,83-34,5 μmol / L
Ferritin 11 μg / l 22-180mkg / l inwomen
Totalironbindingcapacity 86 μmol / l 45,3-77,1 μmol / L
% 10% 15-50%
transferrinsaturationwithiron 50% in the third trimester of
pregnancy

Anemia due to iron deficiency is diagnosed and oral iron supplements are
given. Dolores's symptoms disappear within a couple of weeks and the remainder
of her pregnancy goes smoothly.

Questions of biochemistry:
1. Which substances enhance the absorption of iron, and what substances inhibit?
2. Which vitamins and microelements are deficient in iron deficiency?
3. Which of the above symptoms can be associated with a violation of biochemical processes?
4. Which advice doctors give pregnant women for the prevention of iron deficiency in the body?
5. Explain what the test measures mean: serum iron, total iron binding capacity,% iron
transferrin saturation.

Test questions on normal physiology:

1. Assess the indicators of the hemogram

Bloodtestresults Doloresindicator Norm Physiological

value of the
indicator
erythrocytecount(RBC) 3,5 3 ×1012 / l In men:
For women:
Newborn children:
Children 1 yearold:
hemoglobin (Hb) 70 g / l In men:
For women:
Newborn children:
Children 1 yearold:
Hematocrit (Hct) 30% In men:
For women:
Newborn children:
Children 1 yearold:
Iron serum low

MediumCorpuscularLowVolum low
e (MCV)
Average low concentration of low
corpuscular hemoglobin
(MCHC)
General high ability to bind iron promoted
in blood (TIBC)

2. Calculate and evaluate the following indicators

 Indicator Indicatorrate Doloresindicator Physiological value of the
indicator / Indicator shift
terms
CIB (color index of blood)
Average hemoglobin content in
erythrocyte or erythrocyte index
(HCE or MCH, HbE)
The average concentration of
hemoglobin in an erythrocyte
(KGE or MCHC, HbKE) is an
indicator of the saturation of
erythrocytes with hemoglobin.
Average erythrocyte volume -
EV (MCV, DVЕ)
Bloodoxygencapacity (BOC)

Conclusion on indicators: _____________________________________________________

3. What is the function of blood iron?

4. What changes in physiological functions can you note?

Questions on anatomy:
1. Where is iron absorbed? Give anatomical justification
2. Why do pregnant women often have anemia from the second trimester? What changes are
possible on the part of organs and systems?
3. Name the organs and systems involved in the production of red blood cells, as well as the
process of hematopoiesis and destruction of red blood cells

Questions on histology
1. Describe the structure and features of the microenvironment of the erythroid islets red bone
marrow.
2. The mechanism of iron supply to the cells of the erythroid islets.

Medical ecology questions:

1. What environmental factors that shape health do you know? When assessing health, which 4
levels are distinguished?

2. How can adverse environmental factors influence iron deficiency in the body?

3. What environmental pollutants interfere with the absorption of iron in the body?