兒科學(xué)英文課件：IRON DEFICIENCY ANEMIA

NUTRITIONAL

IRONDEFICIENCYANEMIA

（缺鐵性貧血）NUTRITIONAL

IRONDEFICIENCYCasestudyBoy,9monthsPalefor9months,cough3daysPretermtwins,birthweight2.7kg;BreastfeedinguntilnowHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALdateWBCNLRBCHbMCVMCHMCHCPLTRet4.2424.280.750.254.055661.513.82257794.25260.530.423.955561132277350.0224.26160.240.714.31686315276240.022Hypochromicmicrocyticanemia

？CasestudyBoy,9monthsHEMATOCasestudyHypochromicmicrocyticanemiaHbF1.40,HbA21.80%,血紅蛋白電泳（-），SI6.15(11-30)umol/L,TIBC85(50-70)umol/L,TS7.2%.4.25CR:雙肺紋理增多、紊亂、模糊、中內(nèi)帶見(jiàn)片絮影，雙肺充氣過(guò)度，心影胸腺部分重疊。肺炎。

HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALWhatkindofAnemiaisthis?CasestudyHypochromicmicrocytClassification-Etiology

HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL造血減少所致貧血Reducedcapacitytoproduceredbloodcells--deficiencysyndrome溶血性貧血：Hemolysis失血性貧血：BloodLossClassification-EtiologyHEMATIronandHemoglobinIronandHemoglobinTheimpactofIDATheimpactofIDACONTENTSINDUCTIONIRONMETABOLISMETIOLOGY/PATHOGENESISMANIFESTATIONSLABORATORYFINDINGSDIAGNOSIS&DIFFERENTIALPREVENTION&TREATMENTCONTENTSINDUCTIONINTRODUCTIONDefinitionoftheirondeficiencyanemia(IDA)由于體內(nèi)鐵缺乏最終導(dǎo)致儲(chǔ)存鐵減少血紅蛋白合成減少所致的貧血N-IDA:Theanemiacausedbyinsufficientdietaryironuptake,inwhichtheironstorageandhemoglobinsynthesisdecreased.HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALINTRODUCTIONDefinitionoftheClinicalcharacteristics(臨床特征）鐵生化：

serumferritin(SF),serumiron(SI),transferrinsaturation(TS)貧血：hemoglobinconcentration,microcytichypochromicanemia,治療反應(yīng)：goodresponsetoirontherapy.年齡：6moto3yrs.Incidence

INTRODUCTIONHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALClinicalcharacteristics(臨床特征Theincidence:

InChina(2004)，aninvestigationfrom9118childrenin15provincesand26citiesreveledthattheincidenceis30.1%vs16.8%forthechildrenwith7～12mosand15.5%vs4.4%forthechildrenwith13～36mosIntheUSItisabout9%of1-2yr-oldsareirondeficient;3%haveanemia.Ofadolescentgirls,9%areirondeficientand2%haveanemia.INTRODUCTIONTheincidence:INTRODUCTIONIRONMETABOLISMCOMPARTMENTHemoglobin64%Storageiron30%Ferritin-SFhemosiderinMyloglobin3%Enzymeiron0.4%Serumiron0.4%HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALCONTENTSNewborn75mg/kgChildren35-70mg/kgAdultsM50mg/kgF35mg/kgIRONMETABOLISMCOMPARTMENTHEMAIronsourcesHemoglobinironDietaryironHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALIRONMETABOLISMIronsourcesHEMATOLOGY/ONCOLOGDietaryironHighinironRedmeat/liverkidney/oilyfishAverageironBeans/fortifiedcereals/darkgreenvegetables/driedfruit/nutsandseedsPoorinironMilk(1.5vs0.5mg/L)HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALIRONMETABOLISMDietaryironHEMATOLOGY/ONCOLOGIronabsorption

generalabsorption 1-20%Meat/fish/chicken 10-25%Cereals/vegetables 1%Breast/cow’smilk 50%/10%HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALIRONMETABOLISMIronabsorptionHEMATOLOGY/ONCO 動(dòng)物食品 非動(dòng)物食品 (血紅蛋白/肌紅蛋白)（膠狀氫氧化高鐵）

胃酸胃蛋白酶 蛋白酶游離鹽酸

血紅素 三價(jià)鐵

血紅素分解酶

*VitC

腸： 二價(jià)鐵

十二指腸空腸上 三價(jià)鐵 腸黏膜細(xì)胞

轉(zhuǎn)運(yùn)鐵蛋白* 入血

脫落入腸道

肝脾儲(chǔ)存 骨髓造血

（圖1）Ironabsorptionandtransportation 動(dòng)物食品 非動(dòng)物食品（圖1）Ironabsorp

Ironstoresandutilizing食物鐵血紅素鐵SIliverspleenBonemarrowHb合成肌紅蛋白含鐵酶Ironstoresandutilizing食物鐵血IRONMETABOLISMRequirementandexcretion

demand

excretion

adults 1mg/d1mg/d 4mo-3yr 1mg//kg(15ug/kg/d) premature 2mg/kgHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALIRONMETABOLISMRequirementandHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL

ETIOLOGY&PATHOGENESISETIOLOGY病因PoorironstoresPoordietaryintakeofiron*

OverdevelopChronicbleedingAbsorptionproblemsHEMATOLOGY/ONCOLOGY,CHILDREN’PoorironstoresPrematurebirthMultiplebirth/LowweightbirthCordbloodMotherironreservePoordietaryintakeofiron*overdevelopBloodlossandirondepletionHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL

ETIOLOGY&PATHOGENESISPoorironstoresHEMATOLOGY/ONCPoorironstoresPoordietaryintakeofiron*MilkandcerealsFactorsinfluencingabsorptionOverdevelopBloodlossandirondepletionHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL

ETIOLOGY&PATHOGENESISPoorironstoresHEMATOLOGY/ONC

ETIOLOGY&PATHOGENESISPoorironstoresPoordietaryintakeofiron*Overdevelop3-5mo/1yrPrematurebirthPubertyChronicbleedingHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGY&PATHOGENESISPooriPoorironstoresPoordietaryintakeofiron*overdevelopChronicbleedingCow’smilkHookworminfectionMenstruatingOthers:idiopathicpulmonaryhemosiderosis(肺含鐵…）ulcer,gastritis(潰瘍、胃炎）hemangioma,meckeldiverticulum.

ETIOLOGY&PATHOGENESISHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALPoorironstoresETIOLOGY&PA

ETIOLOGY&PATHOGENESISPoorironstoresoverdevelopPoordietaryintakeofiron*ChronicbleedingAbsorptionproblemsDiarrhea/Infection

HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGY&PATHOGENESISPoori

ETIOLOGY&PATHOGENESISQA：Girl，llmoths,paleforonemonth,developmentisgood，noblackstool,nodiseasehistory，breast-fedonly.Birthweight3kg,now10kg.Motherisinhealth.DiagnosisisIDA.Thepossiblereason?A.poorironstore先天儲(chǔ)鐵不足B.poorironintake鐵攝入量不足C.overdevelopment生長(zhǎng)發(fā)育過(guò)快D.problemwithironabsorptionE.ironloose鐵丟失過(guò)多HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGY&PATHOGENESISQA：GirPathogenesisiron

+protoporphyrin

IDAheme+globinshemoglobinHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGY&PATHOGENESISHEMATOLOGY/ONCOLOGY,CHILDREN’ID.Irondeficiency（鐵減少期）decreasedironstore-SFIDE.Irondeficiencyerythropoiesis（紅細(xì)胞生成鐵減少期）decreasedironstore-SFIncreaseFEPIDA.Irondeficiencyanemia（缺鐵性貧血期）decreasedironstore-SFIncreasedFEPSI,TIBC,TSHypochromic/microcyticanemiaETIOLOGY&PATHOGENESISID.Irondeficiency（鐵減少期）ETIPathogenesisHypochromic/microcyticanemiaID.IrondeficiencyIDE.IrondeficiencyerythropoiesisIDA.IrondeficiencyanemiaEnzymesImmunefunctionSkin/mucosalHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGY&PATHOGENESISPathogenesisHEMATOLOGY/ONCOLOGFeatures特點(diǎn)Age:6mo~3yrsTheonsetoftheIDAThedegreeofanemiaHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALCLINICALMANIFESTATIONSFeatures特點(diǎn)HEMATOLOGY/ONCOLOGYPallor蒼白Extramedullaryhematopoiesis髓外造血Theslightsplenomegalyisfoundin10-15%ofthecasesHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALCLINICALMANIFESTATIONSPallor蒼白HEMATOLOGY/ONCOLOGY,Moderate/SevereconditionDigestivesystem食欲減低、惡心嘔吐、腹瀉、舌炎、胃炎Cardiacfunctiontachycardia,cardiacdilatationandsystolicmurmursareoftenpresentNeurology/intellectual神萎或煩躁、頭暈、耳鳴、注意力不集中、反應(yīng)遲鈍、學(xué)習(xí)能力和智力ImmunefunctionHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALCLINICALMANIFESTATIONSModerate/SevereconditionHHemoglobin:belowtheacceptablelevelforageRedcellindices:MCV<80fl,MCH<26ug,MCHC<0.31,highRDWBloodsmear:HypochromicsandmicrocyticwithanisocytosisandpoikilocytosisHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALLABORATORYFINDINGSHemoglobin:HEMATOLOGY/ONCOLO兒科學(xué)英文課件：IRONDEFICIENCYANEMIA兒科學(xué)英文課件：IRONDEFICIENCYANEMIAReticulocytecount:isusuallynormalbutinsevereIDAassociatedwithbleeding,areticulocytecountof3-4%mayoccurPlateletcountItvariesfromthrombocytopeniatothrombocytosis.ThrombocytopeniaismorecommoninsevereIDA;thrombocytosisispresentwhenthereisassociatedbleedingfromthegut.FreeerythrocyteprotoporphyrinFEPelevationoccursassonasthebodystresofironaredepleted,beforemicrocyticanemiadevelops.AnelevatedFEPlevelisthereforeanincicationforirontherapyevenwhenanemiaandmicrocytosishavenotyetdeveloped.HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALLABORATORYFINDINGSReticulocytecount:HEMATOLOGYSerumferritinItreflectsthelevelofbodyironstores;itisquantitative,reproducible,specificandsensitive.Aconcentrationoflessthan12ng/mlisconsidereddiagnosisofirondeficiency.SerumironandironsaturationpercentageSI：<9-10.7umol/L(12.8-31.3umol/L) or<50-60ug/dl(75-175ug/dl）TIBC：>62.7umol/L(>350ug/dl)TS：<15%（30-50%）HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALLABORATORYFINDINGSSerumferritinHEMATOLOGY/ONCOLSerumtransferrinreceptorlevels(STfR)ItssensitiveandcorrelateswithHbandotherLabparametersofironstatus.ItisincreasedininstancesofhyperplasiaoferythroidprecursorssuchasIDAandthalassemiaItisunaffectedbyinfectionandinflammationBonemarrow:Erythroidhyperplasia;StainableironHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALLABORATORYFINDINGSSerumtransferrinreceptorlevHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL

NormalIDIDEIDAMarrowiron+++0SF(ug%)1006010-20FEP

SITIBCTS

HbMCVMCH

HEMATOLOGY/ONCOLOGY,CHILDREN’DiagnosisImpression6月-24月/36月生產(chǎn)史、喂養(yǎng)史小細(xì)胞低色素性貧血Diagnosis：biochemicalchangeSF減低；FEP升高；SI減低，TIBC升高，TS降低ProvenbytherapyHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALDIAGNOSIS&DIFFERENTIALTypicalpictureDiagnosisHEMATOLOGY/ONCOLOGY,HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALTable3-8DiagnosticTestsforIron-deficiencyAnemiaBloodsmearHypochromicmicrocyticredcells,confirmedbyRBCincices:MCVlessthannromalrangeofageMCHlessthan27.0pgMCHClessthan30%RDWgreaterthan14.5%Freeerythrocyteprotoporphyrin:elevatedSerumferritin:decreasedSerumironandironbingdingcapacityDecreasedserumironIncreasedironbindingcapacityDecreasedironsaturation(16%orless)Serumtransferrinreceptorlevel：elevatedBonemarrowDealyedcytoplasmicmaturationDecreasedorabsentstainalbeironTherpeuticresponsestooralironReticulocytosiswithpeak5-10daysafterinstitutionoftherapyFollowingpeakreticulocytosisHblevelrisesonanverageby0.25-0.4g/dl/dyorhematocritrises1%/dayHEMATOLOGY/ONCOLOGY,CHILDREN’Differential地中海貧血alassemia慢性Chronic&inflammatorydiseases肺含鐵血黃素沉著癥Pulmonaryhemosiderosis鐵粒幼細(xì)胞貧血SiderblasticanemiaHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALDIAGNOSIS&DIFFERENTIALDifferentialHEMATOLOGY/ONCOLOGDifferential—Thalassemia是血紅蛋白珠蛋白肽鏈合成障礙引起的一組遺傳性溶血性貧血。地區(qū)性明顯，有家族史；輕型臨床上難以區(qū)別，重型常有特殊面容，肝脾腫大明顯；外周血涂片可見(jiàn)靶形紅細(xì)胞和有核紅細(xì)胞血紅蛋白檢查顯示胎兒血紅蛋白水平異常增高或血紅蛋白電泳出現(xiàn)異常成分區(qū)帶；血清鐵增高，骨髓鐵粒幼細(xì)胞增多HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALDIAGNOSIS&DIFFERENTIALDifferential—ThalassemiaHEMAT

TREATMENTGeneralcareEradicatethecauses*Ironsupplementation*TransfusionHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL原則去除病因補(bǔ)充鐵劑TREATMENTGeneralcareHEMATOLO

治療

(Treatment)QA哪些因素或病因是可以預(yù)防的？哪些因素或病因是可以去除的？治療(Treatment)QA

治療

(Treatment)NutritionalCounselingMaintainbreastfeedingforatleast6moUseaniron–fortifiedinfantformulauntil1yearageUseiron–fortifiedcerealfrom6mo-1yearProvidesupplementalironforlowbirthweightinfants:Infants1.5-2.0kg:2mg/kg/dsupplementalironInfants1.0-1.5kg:3mg/kg/dsupplementalironInfants<1.0kg:4mg/kg/dsupplementalironFacilitatorsofironabsorptionsuchasVC-richfoods,meat,fishandpoutryshouldbeincludedinthedietandinhibitorsofironabsorptionsuchtea,phosphateandphytatescommoninvegetariandietsshouldelinminated治療(Treatment)NutritionalCoIronsupplementation（補(bǔ)鐵）Elementaliron：4-6mg/kg/dOralironmedicationTypes-ferrousformAdministrationBetweenmealsVitaminCCourse:6-8weeksafterHbnormalization

HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL

TREATMENTIronsupplementation（補(bǔ)鐵）HEMATFerrousSalts4mg/kg/dFerroussulfate（20%）(硫酸亞鐵）20mg/kg/dferrousfumarate

(30%）（富馬酸亞鐵）13mg/kg/dFerrousgluconate（11%）（葡萄糖酸亞鐵）40mg/kg/dHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALTable:FerroussaltsanttheironcontentsFerrousSalts4mg/kg/dFerrouIronsupplementation（補(bǔ)鐵）Parenteraliron（胃腸外注射鐵）

Indication:intoleranttooralironorabsorptionproblemtypes：HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL

TREATMENTIronsupplementation（補(bǔ)鐵）HEMAT

IRONTHERAPYRESPONSE（fromNelson）timeresponse12-24hrReplacementofironenzymes,subjectiveimprovement36-48hrInitialmarrowresponse:erythroidhyperplasia48-72hrReticulocytespeaking5-7d4-30daysHemoglobinlevel1-3moReplenishofstoresHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALIRONTHERAPYRESPONSE（fromNTREATMENTTransfusion（輸血）IndicationsSevereanemiaInfectionPre-operationComponent：redbloodcellsVolume：Hb<30g/L,3-5ml/kg Hb30-60g/L,5-10ml/kgAttentionsHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALTREATMENTTransfusion（輸血）HEMATOPREVENTION預(yù)防EducationForpregnantwomenFortermBreastmilk/cow’smilkIronrichsupplementaryfoodIron-fortifiedfoodForprematureinfantHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALPREVENTION預(yù)防EducationHEMATOLOMegaloblasticAnemia

(營(yíng)養(yǎng)性巨幼細(xì)胞貧血)MegaloblasticAnemia

(營(yíng)養(yǎng)性巨幼細(xì)胞貧INTRODUCTIONDefinition:AkindofanemiawithlargerRBC,causedbythedeficiencyoffolicacidand/orvitaminB12Clinicalfeatures:macrocyticanemia,neuropsychiatricchanges,megaloblasticRBCinthebonemarrow,responsetovitaminB12andfolicacidwell.Theincidence:changingfromcommontorare

HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALINTRODUCTIONDefinition:AkinETIOLOGY

Inadequateintake

DecreasedabsorptionDruginducedabnormalitiesCongenitalabnormalitiesHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGYInadequateintakeHEMAETIOLOGYInadequateintake

AllweneedofB12andfolateisfromfood;Therequirement:forB12:1ug/d;forfolate:60-100ug/d(WHO)Underclinicalconditionswherethereareincreasedvitaminrequirements(pregnancy,growthininfancy,chronichemolysis).HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGYInadequateintakeHEMATETIOLOGYInadequateintakeFolatesabundantinmanyfoodsincludinggreenvegetables,fruits,andanimalorgans(liver,kidney).Humanbreastmilk,pasteurizedcow'smilk.andinfantformulasprovideadequateamountsoffolicacid.Goat'smilkisdeficient;folicacidsupplementationmustbegivenwhenitisthemainfood.Unlesssupplemented,powderedmilkmayalsobeapoorsourceoffolicacid.HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGYInadequateintakeHEMATETIOLOGYInadequateintakeVitaminB12VitaminB12(cobalamin)ispresentinmanyfoods,mostlyinanimalfoods,VitaminB12deficiencymayoccurinthecasesofextremedietaryrestriction(strictvegetariansorvegans)

occursinbreast-fedinfantswhosemothersarevegansorthemselveshaveperniciousanemiaHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGYInadequateintakeHEMATETIOLOGYDecreasedabsorptionChronicdiarrheaInflammatorydiseasesNeonatalnecrotizingenterocolitisSurgeryininterestine/terminalileumHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGYDecreasedabsorptionHEETIOLOGYDruginducedabnormalitiesCertainanticonvulsantdrugs(e.g.,phenytoin,primidone,phenobarbital)canimpairabsorptionoffolicacid

Anumberofdrugshaveanti–folicacidactivity:MethotrexateHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGYDruginducedabnormaliETIOLOGYCongenitalabnormalitiesCcongenitaldihydrofolatereductasedeficiencyLackofintrinsicfactor-CongenitalperniciousanemiaTranscobalaminII(TC-II)deficiency

HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGYCongenitalabnormalitiPATHOGENESIS

HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALVitamin12↓Folicacid↓FolicacidreductaseDNASynthesis↓

TetrahydrofolicacidNucleotidePATHOGENESISHEMATOLOGY/ONCOLOPATHOGENESISInfluenceonhematopoiesis(造血）MegaloblasticRBCDecreasedDNAsynthesisdelaysthematurationofthenucleusoferythrocytesNeutrophilandMegakaryocytehypersegmentedneutrophils(manyneutrophilswithmorethanfourtofivelobes).Ineffectiveerythropoiesis（無(wú)效造血）thatdescribesactiveerythropoiesiswithprematuredeathofcells,adecreasedoutputofRBCfromthemarrow,and,consequently,anemia.HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALPATHOGENESISInfluenceonhematPATHOGENESISInfluenceonneurological

systemVitaminB12playsimportantroleinkeepingtheintactofthenervefiberscontainingmyelinsheathThedeficientresultinneuropsychiatricchangesHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALPATHOGENESISInfluenceonneuroCLINICALMANIFESTATION

General一般情況6～18moWeakness,fatigue,orirritability,failuretothrive,glossitis,vomiting,diarrheaHair:lessandyellowish.Anemia血液系統(tǒng):Paleandpuffyicterus;PetechiaHepatomegaly/splenomeaglyHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALCLINICALMANIFESTATIONGeneralCLINICALMANIFESTATION

Neurologicalinvolvement（神經(jīng)系統(tǒng)）developmentaldelay,developmentalregressionTrembles,seizuresparesthesias,sensorydeficits,hypotonianeuropsychiatricchanges.

HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALNeurologicproblemsfromvitaminB12deficiencycanoccurintheabsenceofanyhematologicabnormalitiesCLINICALMANIFESTATIONNeuroloLABFINDINGS

MacrocyticnormochromicanemiaNeutrophilsmaybelargeandhypersegmented,Neutropeniawith/thrombocytopeniaMarrowfilm:megaloblasticformsofnucleatedRBCSerumVitB12and/orfolicacidHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALLABFINDINGSMacrocyticnormoc兒科學(xué)英文課件：IRONDEFICIENCYANEMIA兒科學(xué)英文課件：IRONDEFICIENCYANEMIADIAGNOSIS

Clinicalmanifestation:anemiaPeripheralbloodmacrocyticanemia,fragmentedneutrophils,BonemarrowmegaloblasticformsofnucletedRBCSerumB12levelandFolicacidconcentration

HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALDIAGNOSISClinicalmanifestatiDIAGNOSIS

HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALAnemiawithLargeMCV/MCHBM:MegaloblasticformsofnucleatedRBChistoryTremblesSerumB12FolicacidVitaminB12deficiencyFolicaciddeficiencyMADIAGNOSISHEMATOLOGY/ONCOLOGY,TREATMENTGeneralcareDrugtherapyVitaminB1225-100ug/次，2-3times/w，weeksortoHbnormal；Onehighdose：500ug

imFolicacid：5mg,tid,2-3w，

Otherdrug：VitaminC；B6；ironinrecovery

TransfusionHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALTREATMENTGeneralcareHEMATOLOGPREVENTIONGoodnutritionformotherAvoidstrictdietrestrictionProvidesolidfoodforinfantsTreattheGIdisordersthedruginducedMA

HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALPREVENTIONGoodnutritionformCASESTUDY男孩，11月，流涕、輕咳2天，發(fā)熱1天就診。體溫38度，咽充血，R40次/分，肺音清，HR120次/分，有力，律齊；肝肋下2cm,脾未捫及血常規(guī)RBC300X1012/L,MCV72fl,MCH21pg,MCHC29,Hb81g/LWBC8.0X109/L,N0.28,L0.70,PLT230X109/L外周血紅細(xì)胞大小不均，蒼白區(qū)擴(kuò)大。CASESTUDY男孩，11月，流涕、輕咳2天，發(fā)熱1天就CASESTUDYQ1:進(jìn)一步詢問(wèn)病史？A1：生產(chǎn)史：產(chǎn)重2.8kg，出生時(shí)無(wú)明顯大失血情況；喂養(yǎng)史：?jiǎn)渭兡溉槲桂B(yǎng)，6月加稀飯，偶爾雞蛋、肉食過(guò)去史：1月前腹瀉5-6天Q2：進(jìn)一步檢驗(yàn)？A2：血清鐵：4.3umol/L鐵結(jié)合力:70umol/L轉(zhuǎn)鐵蛋白飽和度：6%Q3A3：診斷：營(yíng)養(yǎng)性缺鐵性貧血CASESTUDYQ1:進(jìn)一步詢問(wèn)病史？HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALReviewthesecontentsafterclass,trytomakethesummaryon:TheetiologyofIDAandpersonalhistoryLaboratoryfindingsaccordingtothestagesDiagnosisandDifferentials:espwiththalassemiaImportanttreatment:oralironrelatedMAdiagnosisCasestudyHEMATOLOGY/ONCOLOGY,CHILDREN’

NUTRITIONAL

IRONDEFICIENCYANEMIA

（缺鐵性貧血）NUTRITIONAL

IRONDEFICIENCYCasestudyBoy,9monthsPalefor9months,cough3daysPretermtwins,birthweight2.7kg;BreastfeedinguntilnowHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALdateWBCNLRBCHbMCVMCHMCHCPLTRet4.2424.280.750.254.055661.513.82257794.25260.530.423.955561132277350.0224.26160.240.714.31686315276240.022Hypochromicmicrocyticanemia

？CasestudyBoy,9monthsHEMATOCasestudyHypochromicmicrocyticanemiaHbF1.40,HbA21.80%,血紅蛋白電泳（-），SI6.15(11-30)umol/L,TIBC85(50-70)umol/L,TS7.2%.4.25CR:雙肺紋理增多、紊亂、模糊、中內(nèi)帶見(jiàn)片絮影，雙肺充氣過(guò)度，心影胸腺部分重疊。肺炎。

HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALWhatkindofAnemiaisthis?CasestudyHypochromicmicrocytClassification-Etiology

HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL造血減少所致貧血Reducedcapacitytoproduceredbloodcells--deficiencysyndrome溶血性貧血：Hemolysis失血性貧血：BloodLossClassification-EtiologyHEMATIronandHemoglobinIronandHemoglobinTheimpactofIDATheimpactofIDACONTENTSINDUCTIONIRONMETABOLISMETIOLOGY/PATHOGENESISMANIFESTATIONSLABORATORYFINDINGSDIAGNOSIS&DIFFERENTIALPREVENTION&TREATMENTCONTENTSINDUCTIONINTRODUCTIONDefinitionoftheirondeficiencyanemia(IDA)由于體內(nèi)鐵缺乏最終導(dǎo)致儲(chǔ)存鐵減少血紅蛋白合成減少所致的貧血N-IDA:Theanemiacausedbyinsufficientdietaryironuptake,inwhichtheironstorageandhemoglobinsynthesisdecreased.HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALINTRODUCTIONDefinitionoftheClinicalcharacteristics(臨床特征）鐵生化：

serumferritin(SF),serumiron(SI),transferrinsaturation(TS)貧血：hemoglobinconcentration,microcytichypochromicanemia,治療反應(yīng)：goodresponsetoirontherapy.年齡：6moto3yrs.Incidence

INTRODUCTIONHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALClinicalcharacteristics(臨床特征Theincidence:

InChina(2004)，aninvestigationfrom9118childrenin15provincesand26citiesreveledthattheincidenceis30.1%vs16.8%forthechildrenwith7～12mosand15.5%vs4.4%forthechildrenwith13～36mosIntheUSItisabout9%of1-2yr-oldsareirondeficient;3%haveanemia.Ofadolescentgirls,9%areirondeficientand2%haveanemia.INTRODUCTIONTheincidence:INTRODUCTIONIRONMETABOLISMCOMPARTMENTHemoglobin64%Storageiron30%Ferritin-SFhemosiderinMyloglobin3%Enzymeiron0.4%Serumiron0.4%HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALCONTENTSNewborn75mg/kgChildren35-70mg/kgAdultsM50mg/kgF35mg/kgIRONMETABOLISMCOMPARTMENTHEMAIronsourcesHemoglobinironDietaryironHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALIRONMETABOLISMIronsourcesHEMATOLOGY/ONCOLOGDietaryironHighinironRedmeat/liverkidney/oilyfishAverageironBeans/fortifiedcereals/darkgreenvegetables/driedfruit/nutsandseedsPoorinironMilk(1.5vs0.5mg/L)HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALIRONMETABOLISMDietaryironHEMATOLOGY/ONCOLOGIronabsorption

generalabsorption 1-20%Meat/fish/chicken 10-25%Cereals/vegetables 1%Breast/cow’smilk 50%/10%HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALIRONMETABOLISMIronabsorptionHEMATOLOGY/ONCO 動(dòng)物食品 非動(dòng)物食品 (血紅蛋白/肌紅蛋白)（膠狀氫氧化高鐵）

胃酸胃蛋白酶 蛋白酶游離鹽酸

血紅素 三價(jià)鐵

血紅素分解酶

*VitC

腸： 二價(jià)鐵

十二指腸空腸上 三價(jià)鐵 腸黏膜細(xì)胞

轉(zhuǎn)運(yùn)鐵蛋白* 入血

脫落入腸道

肝脾儲(chǔ)存 骨髓造血

（圖1）Ironabsorptionandtransportation 動(dòng)物食品 非動(dòng)物食品（圖1）Ironabsorp

Ironstoresandutilizing食物鐵血紅素鐵SIliverspleenBonemarrowHb合成肌紅蛋白含鐵酶Ironstoresandutilizing食物鐵血IRONMETABOLISMRequirementandexcretion

demand

excretion

adults 1mg/d1mg/d 4mo-3yr 1mg//kg(15ug/kg/d) premature 2mg/kgHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALIRONMETABOLISMRequirementandHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL

ETIOLOGY&PATHOGENESISETIOLOGY病因PoorironstoresPoordietaryintakeofiron*

OverdevelopChronicbleedingAbsorptionproblemsHEMATOLOGY/ONCOLOGY,CHILDREN’PoorironstoresPrematurebirthMultiplebirth/LowweightbirthCordbloodMotherironreservePoordietaryintakeofiron*overdevelopBloodlossandirondepletionHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL

ETIOLOGY&PATHOGENESISPoorironstoresHEMATOLOGY/ONCPoorironstoresPoordietaryintakeofiron*MilkandcerealsFactorsinfluencingabsorptionOverdevelopBloodlossandirondepletionHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL

ETIOLOGY&PATHOGENESISPoorironstoresHEMATOLOGY/ONC

ETIOLOGY&PATHOGENESISPoorironstoresPoordietaryintakeofiron*Overdevelop3-5mo/1yrPrematurebirthPubertyChronicbleedingHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGY&PATHOGENESISPooriPoorironstoresPoordietaryintakeofiron*overdevelopChronicbleedingCow’smilkHookworminfectionMenstruatingOthers:idiopathicpulmonaryhemosiderosis(肺含鐵…）ulcer,gastritis(潰瘍、胃炎）hemangioma,meckeldiverticulum.

ETIOLOGY&PATHOGENESISHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALPoorironstoresETIOLOGY&PA

ETIOLOGY&PATHOGENESISPoorironstoresoverdevelopPoordietaryintakeofiron*ChronicbleedingAbsorptionproblemsDiarrhea/Infection

HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGY&PATHOGENESISPoori

ETIOLOGY&PATHOGENESISQA：Girl，llmoths,paleforonemonth,developmentisgood，noblackstool,nodiseasehistory，breast-fedonly.Birthweight3kg,now10kg.Motherisinhealth.DiagnosisisIDA.Thepossiblereason?A.poorironstore先天儲(chǔ)鐵不足B.poorironintake鐵攝入量不足C.overdevelopment生長(zhǎng)發(fā)育過(guò)快D.problemwithironabsorptionE.ironloose鐵丟失過(guò)多HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGY&PATHOGENESISQA：GirPathogenesisiron

+protoporphyrin

IDAheme+globinshemoglobinHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGY&PATHOGENESISHEMATOLOGY/ONCOLOGY,CHILDREN’ID.Irondeficiency（鐵減少期）decreasedironstore-SFIDE.Irondeficiencyerythropoiesis（紅細(xì)胞生成鐵減少期）decreasedironstore-SFIncreaseFEPIDA.Irondeficiencyanemia（缺鐵性貧血期）decreasedironstore-SFIncreasedFEPSI,TIBC,TSHypochromic/microcyticanemiaETIOLOGY&PATHOGENESISID.Irondeficiency（鐵減少期）ETIPathogenesisHypochromic/microcyticanemiaID.IrondeficiencyIDE.IrondeficiencyerythropoiesisIDA.IrondeficiencyanemiaEnzymesImmunefunctionSkin/mucosalHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGY&PATHOGENESISPathogenesisHEMATOLOGY/ONCOLOGFeatures特點(diǎn)Age:6mo~3yrsTheonsetoftheIDAThedegreeofanemiaHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALCLINICALMANIFESTATIONSFeatures特點(diǎn)HEMATOLOGY/ONCOLOGY