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1、NUTRITIONAL ANEMIA1 1小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第1页!New wordsNutritional Nutritional 营养的营养的MegaloblasticMegaloblastic巨幼细胞巨幼细胞HamorrhageHamorrhage出血出血IrritabilityIrritability激惹激惹LethargyLethargy嗜睡嗜睡FatigueFatigue疲乏疲乏AnorexiaAnorexia厌食厌食AppetiteAppetite食欲食欲MicrocyticMicrocytic小细胞的小细胞的Hypoc
2、hromic低色素的ThalassemiaThalassemia海洋性贫血海洋性贫血Ferrous sulfate硫酸亚铁Hookworm钩虫Epistaxis鼻出血Reticulocyte 网织红细胞2 2小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第2页!Nutritional anemiaMegaloblastic anemia vitamin B12 deficiency folic acid deficiencyIron deficiency anemia iron deficiency3 3小儿营养性贫血(NUTRITIONAL-ANEMIA)共3
3、8页,您现在浏览的是第3页!Iron Deficiency Anemia,IDAIncidence of IDA:10-70%(WHO)40%(6m-6y,China)4 4小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第4页!Iron in milkBoth of breast and cows milk are low in ironIron is better absorbed from breast milk(50%)pared to cows milk(10%)Formula milks are fortified with iron(4%)5 5小儿
4、营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第5页!Dietary sources of ironRed meatFortified breakfast cerealsDark green vegetablesBlack bread about 10-15%iron of dietary is absorbed6 6小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第6页!Reference nutrient intake of iron are:6 months:4 mg/day12 months:8 mg/dayAdult male
5、:9 mg/dayAdult female:15 mg/day7 7小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第7页!Causes of iron deificiency(二)(二)Nutritional deficiency is mon in certain at-risk groups preterm infants require iron supplements from 6-8 weeks.Term infants will develop iron deficiency after 4 months if 1.mixed feeding is
6、unduly delayed 2.unmodified cows milk is introduced early.It is mon in the first two years of age8 8小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第8页!Causes of iron deificiency(四)四)Blood loss is a less mon cause in children,but may occur with:MenstruationHookworm infectionRepeated venesection in babiesMeck
7、els diverticulumRecurrent epistaxisIt is the important cause of IDA in older children9 9小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第9页!Signs:pallor of the skin and mucous membranes.Hb70g/L,tachycardia and cardiac dilation occur,and systolic murmurs are often present IDA in infancy and early children is
8、associated with developmental delay and poor growthClinical features1010小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第10页!Serum iron(SI)62.7 umol/LSerum Ferritin(SF)0.9 umol/LLaboratory findings1111小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第11页!Iron deficiency anemia:low power view of peripheral blood film12
9、12小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第12页!diagnosisDetermination of the cause of IDA is most important for diagnosis1313小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第13页!Thalassemia minor IDA Thalassemia minorSI N or T IBC N HbF and A2 N Differential diagnosis1414小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的
10、是第14页!TreatmentManagement will depend onThe severity of the anemiaThe cause of the iron deficiency The ability of the patient to tolerate medicinal iron preparations1515小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第15页!TreatmentOral administration of simple ferrous provides inexpensive and satisfactory th
11、erapy Ferrous sulfate is 20%elemental iron by weight.A daily total of ferrous sulfate is 4-6 mg/kg of elemental iron in three divided doses provides1616小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第16页!TreatmentBlood transfusion is indicated only when the anemia is very severeIts not necessary to attempt
12、rapid correction of severe anemia by transfusionThe children with hemoglobin values less than 40g/L should be given only 2-3ml/Kg of RBCs1717小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第17页!The case 8 years old boy from countrysideDiagnosis is IDA and Hookworm infection(Hb=65g/L)Three weeks late after tr
13、eatment with Ferrous sulfate:Hb=70g/L1818小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第18页!病例1010个月男孩个月男孩面色苍白两个月,不发烧,不咳嗽,无皮肤黏膜面色苍白两个月,不发烧,不咳嗽,无皮肤黏膜出血,无血便及肉眼血尿,大小便正常。出血,无血便及肉眼血尿,大小便正常。出生史:胎,产,孕出生史:胎,产,孕3636周早产周早产喂养史:生后母乳喂养至今,喂养史:生后母乳喂养至今,6 6个月开始添加辅食。个月开始添加辅食。平素食欲较差。平素食欲较差。体检:皮肤黏膜苍黄,肝右肋下体检:皮肤黏膜苍黄,肝右肋下2CM2CM
14、,脾左肋下,脾左肋下2CM2CM实验室检查:实验室检查:1919小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第19页!肝功能:GPT 39U,GOT 40U,TB ,DB正常红细胞脆性降低,HbF 56%2020小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第20页!Iron defeciency anemiaIntroduction Cause of Iron deficiency anemiaClinical featuresLaboratory findingsDiagnosisDefferential diagnosis
15、Treatment 2121小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第21页!IDA is the most mon cause of anemia in childhood.It usually results from inadequate dietary intake rather than loss of iron through hemorrhage.2222小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第22页!Dietary sources of iron2323小儿营养性贫血(NUTRITIONAL-ANEM
16、IA)共38页,您现在浏览的是第23页!Iron requirementsThe fetus absorbs iron from the The fetus absorbs iron from the mothermother across across the placenta.the placenta.Term infants have adequate reserve for the first Term infants have adequate reserve for the first 4 months of life.of life.Preterm infants have li
17、mited iron stores and Preterm infants have limited iron stores and because of their higher rate of growth,their iron because of their higher rate of growth,their iron reserves were used up by reserves were used up by 8 weeks of age.of age.Adolescents also need more iron because of Adolescents also n
18、eed more iron because of 1.1.GrowthGrowth spurt 2.spurt 2.DietaryDietary deficiency 3.deficiency 3.MenstrualMenstrual blood lossblood loss2424小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第24页!(一)(一)the decrease of iron stores low birthweight preterm infantshemorrhageCauses of iron deificiency2525小儿营养性贫血(N
19、UTRITIONAL-ANEMIA)共38页,您现在浏览的是第25页!Causes of iron deificiency(三)三)Malabsorption may be plicated by iron deficiencyThe children usually pany with another malnutrition.2626小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第26页!Clinical featuresMild iron deficiency anemia is asymptomaticMore severe may beirritabi
20、lityLethargyFatigueanorexia2727小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第27页!Laboratory findings2828小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第28页!IDAIDA外周血涂片红细胞形态外周血涂片红细胞形态Laboratory findings2929小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第29页!Microcytic and hypochromic anemia.MCHC Microcytic and hypochromic
21、 anemia.MCHC 30%,MCV 80fl,MCH 27pg30%,MCV 80fl,MCH 27pgThe children with the clinical features of IDA and The children with the clinical features of IDA and the cause of iron deficiencythe cause of iron deficiencySI 10.7umol/LSI 10.7umol/LTransferin saturation 15%Transferin saturation 0.9umol/LFree
22、erythrocyte protoporphyrin(FEP)0.9umol/L Serum Ferritin(SF)16 ug/L Serum Ferritin(SF)20%20%10%1020%50 50 10 20200 10 20200Iron storesIron stores 34+34+0 0 14+14+Transferrin receptor N orTransferrin receptor N or N NHbFHbFN N N N3131小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第31页!3232小儿营养性贫血(NUTRITIONAL-
23、ANEMIA)共38页,您现在浏览的是第32页!TreatmentOral iron preparations tablet(iron content)Elixir(iron content)tablet(iron content)Elixir(iron content)Ferrous sulfate 325(65)Ferrous sulfate 325(65)300/5ml(60)300/5ml(60)Ferrous gluconateFerrous gluconate325(38)325(38)300/5ml(35)300/5ml(35)Ferrous fumarateFerrous fu
24、marate325(107)325(107)100/5ml(33)100/5ml(33)Polysaccharide-iron 150(150)Polysaccharide-iron 150(150)100/5ml(100)100/5ml(100)3333小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第33页!Serum Irom7AM12N12MN7PMFigure.Oral iron absoption.When medicinal iron is given 3 times a day,each dose raises the SI for several
25、 hours.A fourth dose at bedtime can help sustain the SI during nighttime hours.3434小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第34页!Responses to Iron Therapy in IDA Time After Iron Time After Iron AdministrationAdministrationResponseResponse1224 hr1224 hrReplacement of intracellular iron enzymes;Replacem
26、ent of intracellular iron enzymes;decreased irritability;decreased irritability;increased Appetite increased Appetite36-48 hr36-48 hrInitial bone marrow response;Initial bone marrow response;erythroid hyperplasiaerythroid hyperplasia48-72 hr48-72 hrReticulocytosis,peaking at 57 daysReticulocytosis,p
27、eaking at 57 days4-30 days4-30 daysIncrease in hemoglobin levelIncrease in hemoglobin level1-3 mo1-3 moRepletion of stores Repletion of stores 3535小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第35页!婴儿期缺铁性贫血最常见的原因是婴儿期缺铁性贫血最常见的原因是A胎儿期储铁不足 B饮食中铁的缺乏 C出血下列哪项是鉴别缺铁性贫血与海洋性贫血下列哪项是鉴别缺铁性贫血与海洋性贫血的重要依据的重要依据A 临床表现 B 细胞形
28、态 C HbF和HbA2检查缺铁性贫血铁剂治疗后,最先改善的是缺铁性贫血铁剂治疗后,最先改善的是A 食欲 B 网织红细胞 C Hb量3636小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第36页!项目项目项目项目 结果结果结果结果 参考值参考值参考值参考值红细胞红细胞红细胞红细胞(RBCRBC)2.68 3.5-5.01012/L)2.68 3.5-5.01012/L血红蛋白血红蛋白血红蛋白血红蛋白(HGB)67 110-150g/LHGB)67 110-150g/LMCV 62 82-92flMCV 62 82-92flMCH 22 27-31pgMCH 22 27-31pgMCHC 280 320-360g/LMCHC 280 320-360g/LRET 4.5%RET 4.5%血小板血小板血小板血小板(PLTPLT)275 100-300)275 100-300 109/L109/L白细胞白细胞白细胞白细胞(WBCWBC)10.2 4.0-10)10.2 4.0-10 109/L109/L3737小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第37页!THANKS3838小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页,您现在浏览的是第38页!