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1、Iron Deficiency AnemiaIron Deficiency Anemia (IDA)(IDA)Dr.Liu ChonghaiIron-deficiency anemia affected about 1.48 billion people in 2015.A lack of dietary iron is estimated to cause approximately half of all anemia cases globally.Women and young children are most commonly affected.In 2015 anemia due
2、to iron deficiency resulted in about 54,000 deaths down from 213,000 deaths in 1990.Disability-adjusted life year for iron-deficiency anemia per 100,000 inhabitants in 2004.Metabolism of Iron Metabolism of Iron A.Iron distribution in the body A.Iron distribution in the A.Iron distribution in the bod
3、ybodyB.The source of B.The source of ironironEndogenous old RBC(2/3)Exogenous through food(1/10mg/d)Animal foods with high iron content and high heme iron,the absorption rate of 10-25%Iron of vegetable food is non-heme iron,the absorption rate of 1.7-7.9%C.Physiological requirement of ironC.Physiolo
4、gical requirement of iron:1mg 1.5mg/kg/d (15yr)Premature 2mg/kg/dIndex Index of iron nutritionof iron nutritionTIBC TIBC and iron saturation in IDAand iron saturation in IDAEtiology Etiology of iron deficiencyof iron deficiency1.Insufficient iron store:premature,severe maternal iron deficiency,intra
5、-uterus transfusion etc.2.Insufficient intake:food with insufficient iron,e.g.fed with milk,flour or rice flour only etc.3.Absorptive problems:chronic diarrhea,steatorrhea4.Growth demand:young infants,premature baby,adolescent children,girls after menarche etc.5.Blood loss:chronic gastrointestinal b
6、leeding caused by peptic ulcer,hook worm,multiple polyps,angioma,diverticuloritis or inflammative enteropathy,or acute blood loss with injury or epitaxisetc.3 stagesIron depletion,ID:Iron deficient erythropoiesis,IDEIron deficiency anemia,IDAImpact on body health by Impact on body health by IDID1.He
7、matopoieticsystem:gradual anemiaStages Ferritin Serum iron,SI Hb ID Low N NIDE L L NIDA L L L Impact on body health by ID(continued)Impact on body health by ID(continued)2.GI system:absorptive disorders;3.Circulative system:cardiac contractivity decrease,heart enlargement,murmur and heart failure;4.
8、Neuroschycological system:insomnia,attention absent(aprosexia),apathy;5.Immune system:compromised immunity,susceptible to infection;6.Skin and hair system:dryness of skin,sparse and brittle hairs,loss of polish,fragile nails,koilonychia;Clinical ManifestationClinical ManifestationAge:6 months 3yrsGe
9、neral:anemic pale,positional hypotension;GI system:diarrhea,dyspepsia,nausea,vomitingHematopoietic System:hepatosplenomegaly(extramedullary hematopoiesis)Circulatory system:tachycardia,murmurs and heart enlargement;Immune system:infection;Neuropsycological system:pica,apathy;Lab Lab teststests-Blood
10、 smear:Blood smear:Microcytic and hypochromic RBCMicrocytic and hypochromic RBCBM smearBM smear：Cellularity:hypercellularity;Iron stain:compromised both intercellular and intracellular iron stains.Developing nucleated erythrocytes:delayed cytoplasmicdevelopment;Indices of iron Indices of iron nutrit
11、ionnutritionSI(serum iron)Fn(Ferritin)TIBC(total iron binding capacity)FEP(free erythrocyticprotopophrin)1、IDA:is a gradual process which can be divided into 3 stages,ie,ID stage,IDE stage and IDA stage.2、Ferritin is the most sensitive marker for IDA;3、Once Hbhas been recovered to normal level,iron
12、agents should be used continuesllyfor another 2 months.Diagnosis Diagnosis and differential diagnosisand differential diagnosisDiagnosis:History clinical manifestation lab testsDifferential diagnosis:(Hypochromic and microcytic anemias)thalassemia,lead poisoning,chronic infection etc.TreatmentTreatm
13、ent1.Looking for etiology and modify feeding formula;2.Medications:iron agents for Oral:ferrous gluconate,ferrous sulfate;for Inj:Ferrous dextran;dosage:3-6mg elemental iron/kg/day,3 divided doses Responses:reticulocyte 2-3d ,5-7d to peak,2-3wks to normal.Hb 1-2wks ,3-4wks correction anemia.Caution:
14、continue to give iron for 4-6 months(India)6-8 wks(China)after Hb becomes normal.Blood TransfusionBlood Transfusionwhen it is necessary.1.severe anemia with congestive cardiac failure 2.with severe infection 3.need surgeryHb 60g/L,NO.PreventionPrevention1.Health propaganda and councilling;2.Adequate
15、 diet for pregnant mothers;3.Correct feeding for baby;4.Treatment of diseases:GI disorders,parasitesetc.Megaloblastic AnemiaMegaloblastic AnemiaDefination:Defination:Nutritional VitB12 or folic acid deficiency anemia was defined as the deficiency in either VitB12 or Folic acid.In India,6.8%children
16、had folate deficiency,32%showed vinB12 deficiency and combined deficiency China-rareMetabolism of VitB12 and Folic acidMetabolism of VitB12 and Folic acidFolic acid:Food:rich in green vegetible,lack in sheep milk;Absorptive site:at upper portion of jejunum;Vitamin B12:Food:rich in animal food;Absorp
17、tive site:terminus of ileum;Absorption helping factor:internal factor.EtiologyEtiologyDecreased intake（vegetarian-VB12,goat milkFolic acid);Increasing demands;Impaired absorption(celiac disease,intestinal parasites)Disease impacts;Congenital defects:1、congenital FA absorptive defects;2、Juvenile pern
18、icious anemia;3、congenital transcobalamin defects。Clincal ManifestationsClincal ManifestationsAge:peak at 6 mon 2 yrs;Anemia:soil color of skin,edema,petechae;GI system problems:dyspepsia,nausea,etc.Circulatory system:tachycardia,murmur,heart failure etc.Neurosphycological system:mental retardation,
19、Ataxia,clonus with VitB12 defective.Lab Lab teststestsBlood smear:RBC morphology:macrocytic normochromicWBC morphology:neutrophil:large cell with hyper-fragmented nucleusPlt:enlarged size,reduced numberHyperfragmentedneutrophilHyperfragmentedneutrophilMegloblastic anemia Megloblastic anemia CBCCBCBM
20、 smearBM smear:Cellularity:hypercellularitywith bigger size of the RBCs;Morphology:imbalance development of cytoplasma:nucleus;WBC morphology:enlarged WBC with hyperfragmented;Megakaryocyte/plt:normal or decreased.Determination of FA and Vitamin B12:FA:3 ug/L B12：100ng/LDiagnosis and Differential Di
21、agnosisDiagnosis and Differential DiagnosisDiagnosis:causes;histories and lab tests results;pay attention to congenital factors;Differential diagnosis:1.Spherocytosis;2.Erythroleukemia(M6)3.Congenital dysplasiaof brain development.ManagementsManagements1.General managements:eliminate causes and appropriate feeding;2.Specific treatment:FA reagent(5-15mg/d+VitC 300mg)and VitB12 reagents3.Transfusion:multiple transfusion if necessary.PreventionPrevention1.Appropriate feeding;2.Avoid singular diet;3.Avoid feeding with sheep milk only.4.Patients with ileum resectedneeds supplement of vitB12.