缺鐵性貧血課件1

1、Etiology病因Clinical manifestations臨床表現(xiàn)Differential diagnosis鑒別診斷Treatment治療Iron-Deficiency Anemia1 Iron helps red blood cells carry oxygen to the body and plays a key role in brain and muscle function. A lack of iron in the blood can lead to iron-deficiency anemia, a common nutritional deficiency . E

2、very red blood cell in the body contains iron in its hemoglobin, the protein that carries oxygen to the bodys tissues from the lungs. Iron gives hemoglobin the strength to carry (bind to) oxygen in the blood, so that oxygen gets to where it needs to go. People who become iron deficient means that th

3、e body cant make hemoglobin, so it makes fewer red blood cells. This is a condition called anemia. Iron is essential to hemoglobin production.2EtiologyBlood LossGastrointestinal Tract胃腸道Menstrual Blood Loss月經(jīng)失血Urinary Blood Loss (Rare)尿失血(罕見)Blood in Sputum (Rarer)血痰(罕見)Increased Iron Utilization利用率

4、,生長發(fā)育快PregnancyInfancy出生后3-5月Adolescence青春期Polycythemia Vera紅細(xì)胞增多Malabsorption吸收不良Tropical Sprue熱帶口炎性腹瀉Gastrectomy胃切除術(shù)Chronic atrophic gastritis慢性萎縮性胃炎insufficient iron in the diet.鐵攝入不足 乳類/谷類食物含鐵低3Clinical manifestationsGeneralHemopoietic systemRespiratory& Cardiovascular systemGastrointestinal sys

5、temCNS system4Groups of people at higher risk Girls and women their bodies cant store as much iron and lose blood during menstruation. Infants and children affected by mothers, drink excessive amounts of milk Athletes exercise often tend to lose more ironVegetarians iron from plant sources is more d

6、ifficult absorbedGeneral5GeneralAny age; commonly found in age 6 mths 2 yrsPallor 蒼白: esp. lips, buccal mucosa口腔黏膜Koilonychia 凹甲(spoon-shaped nailsTinnitus耳鳴Fainting or feeling faintfatigue and weaknessSleepiness Hemopoietic system造血系統(tǒng) Enlargement of liver and spleen肝脾6Respiratory & cardiovascular s

7、ystemPalpitation 心悸Dyspnea 呼吸困難Tachypnea呼吸急促Tachycardia心跳過速Enlargement of heartEven heart failure心力衰竭Gastrointestinal system消化系統(tǒng)Angular stomatitis口角炎Glossitis 舌炎(inflammation or infection of the tongue)Angular cheilitis 傳染性口角炎(inflammatory lesions at the mouths corners)Pagophagia or pica 食冰癖,異食癖Unus

8、ual obsessive food cravingsIce chewing7CNS manifestations: central nervous systemIrritability易怒decreasing learning ability of infantLoss of concentrationreduced myelination 髓鞘形成of the spinal cord8 symptomslack energy or the skin may be pale more tiredphysically weakunable to concentratehave headache

9、smore prone to infections heart pain or angina 心絞痛be irritable easily9鑒別診斷 （Differential diagnosis)診斷：初步： age年齡,deit,growth, hemogram血象確診： Iron metabolism and biochemical 鐵代謝生化證實： 治療10DiagnosisUseful tests include the following:Complete blood count全血球計數(shù)Serum iron血清鐵, total iron-binding capacity 總鐵結(jié)合

10、力(TIBC), and serum ferritin血清鐵蛋白Evaluation for hemosiderinuria含鐵血黃素尿 , hemoglobinuria血紅蛋白尿, pulmonary hemosiderosis肺含鐵血黃素沉積 11Further investigations for differential diagnosisPeripheral blood smear末梢血像 Blood is smeared on a glass slide for microscopic examination of RBCs, which can sometimes indicat

11、e the cause of the anemia.Reticulocyte count網(wǎng)織紅細(xì)胞計數(shù) A measure of young RBCs, this helps to determine if RBC production is at normal levels.Bone marrow aspiration骨髓穿刺This test can help determine whether cell production is happening normally in the bone marrow.Hemoglobin Electrophoresis血紅素電泳分析 and fet

12、al hemoglobin 胎血紅蛋白 Used to identify various abnormal hemoglobins in the blood and to diagnose sickle cell anemia, the thalassemias, and other inherited forms of anemia.Enzymes level 12Treatment Iron-rich dietEtiological treatment去病因治療Iron therapy (replacement therapy補(bǔ)充療法，鐵劑治療)Blood transfusion ther

13、apy輸血治療13Iron-rich dietMeats - beef, pork, lamb, liver, and other organ meatsPoultry - chicken, duck, turkey, liver Fish - shellfish, including clams蛤蚌, mussels蚌類 , and oysters, sardines沙丁魚Leafy greens of the cabbage family甘藍(lán)類 , such as broccoli西蘭花, turnip greens蘿卜葉, and collards羽衣甘藍(lán)Legumes豆類, such

14、as lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas豇豆(Egg yolks蛋黃Iron-enriched white bread, pasta, rice, and cereals谷類1415Etiological treatmentCorrect bad habit (picky eater 挑食)Lead poisoning Parasite infection寄生蟲感染blood loss ( hookworm十二指腸蟲)Congenital abnormality

15、of gastrointestinal tract胃腸道的先天性異常Body changes - An increased iron requirement and increased red blood cell production is required when the body is going through changes such as growth spurts in children and adolescents. 16Iron therapy (replacement therapy)In the meanwhile addition supply of Vit C will increase iron absorption. 4-6 mg/kg/day (Ferrous sulfate硫酸亞鐵) Iron therapy should produced an increase in the reticulocyte 網(wǎng)織紅細(xì)胞count within few days, reaching a maximum at 7 to 12 days. Patients should be continue iron therapy for two months after Hb levels is normal to reestalbis