o General symptoms - fatigue, dizziness, shortness of breath in effort, weakness, chest paim, fainting, urinary incontinence
o Habits - alcohol, diet (vegetarian), smoking (peptic ulcer), NSAID's intake
o Questions related to peptic ulcers, stomach aches, heartburn, black stools, vomiting, change in exit habits.
o Change in appetite, weight loss
o Medication - use of Omeprazole
o Changes related to deficiency B12 - headaches, palpitations, burning tongue, diarrhea
o Tumors - pain in the bones, back pain
o Women - pregnancy, severe menstrual vaginal bleeding
o Background diseases - blood transfusions, known cirrhosis, tumors, bowel disease (Crohn's, UC), past bowel surgeries
o o Family history - G6PD def., Thalasemia, sickle cell anemia
o Vital signs - BP, pulse, breathing, fever
o General - Paleness of the skin (including the palm of the hand)
Signs of liver disease - palmar erythema, clubbing, spider angiomatas, gynecomastia.
o Subcutaneous hemorrhage due to hematologic malignancy.
o Angular Cheilitis and / or iron deficiency Koilonychia (fingernails bending)
o Enlarged lymph nodes –signs of lymphoma or other infections/malignancies.
o Abdominal - upper abdominal tenderness, liver and / or spleen enlargement - sign of hematological disease.
o Rectal examination - hemorrhoids, polyps, blood, prostate
Neurological examination - mainly on suspicion of B12 deficiency !!! Numbness, weakness, ataxia, absence of reflexes or increased reflexes, pathological reflexes, impairment of sensation and vibration, mental disorders.
Treatment for iron deficiency anemia - PO iron treatment, in a more difficult condition Iron IV. We prefer to avoid blood transfusions, especially in a young woman due to gynecological bleeding. Depending, of course, on severity.