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1、NUTRITIONAL ANEMIA第一页，共三十九页。1 1New wordsNutritional Nutritional 营养的Megaloblastic巨幼细胞巨幼细胞HamorrhageHamorrhage出血Irritability激惹Lethargy嗜睡嗜睡FatigueFatigue疲乏疲乏(pf)(pf)Anorexia厌食厌食AppetiteAppetite食欲Microcytic小细胞的Hypochromic低色素的Thalassemia海洋性贫血(pnxu)(pnxu)Ferrous sulfate硫酸亚铁Hookworm钩虫Epistaxis鼻出血Reticulocy
2、te 网织红细胞第二页，共三十九页。2 2Nutritional anemiaMegaloblastic anemia vitamin B12 deficiency folic acid deficiencyIron deficiency anemia iron deficiency第三页，共三十九页。3 3Iron defeciency anemiaIntroduction Cause of Iron deficiency anemiaClinical featuresLaboratory findingsDiagnosisDefferential diagnosisTreatment 第四
3、页，共三十九页。4 4Iron Deficiency Anemia,IDAIncidence of IDA:10-70%(WHO)40%(6m-6y，China)第五页，共三十九页。5 5IDA is the most common cause of anemia in childhood.It usually results from inadequate dietary intake rather than loss of iron through hemorrhage.第六页，共三十九页。6 6Iron in milkBoth of breast and cows milk are lo
4、w in ironIron is better absorbed from breast milk(50%)compared to cows milk(10%)Formula milks are fortified with iron(4%)第七页，共三十九页。7 7Dietary sources of iron第八页，共三十九页。8 8Dietary sources of ironRed meatFortified breakfast cerealsDark green vegetablesBlack bread about 10-15%iron of dietary is absorbed
5、第九页，共三十九页。9 9Iron requirementsThe fetus absorbs iron from the mother across the across the placenta.placenta.Term infants have adequate reserve for the first 4 months of life.of life.Preterm infants have limited iron stores and because Preterm infants have limited iron stores and because of their hi
6、gher rate of growth,their iron reserves were of their higher rate of growth,their iron reserves were used up by used up by 8 weeks of age.Adolescents also need more iron because of 1.GrowthGrowth spurt 2.DietaryDietary deficiency 3.deficiency 3.Menstrual blood loss第十页，共三十九页。1010Reference nutrient in
7、take of iron are:6 months:4 mg/day12 months:8 mg/dayAdult male:9 mg/dayAdult female:15 mg/day第十一页，共三十九页。1111（一）（一）the decrease of iron stores low birthweight preterm infantshemorrhageCauses of iron deificiency第十二页，共三十九页。1212Causes of iron deificiency（二）（二）Nutritional deficiency is common in certain
8、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 unduly delayed 2.unmodified cows milk is introduced early.It is common in the first two years of age第十三页，共三十九页。1313Causes of iron deificiency(三）三）Mala
9、bsorption may be complicated by iron deficiencyThe children usually company with another malnutrition.第十四页，共三十九页。1414Causes of iron deificiency(四）四）Blood loss is a less common cause in children,but may occur with:MenstruationHookworm infectionRepeated venesection in babiesMeckels diverticulumRecurre
10、nt epistaxisIt is the important cause of IDA in older children第十五页，共三十九页。1515Clinical featuresMild iron deficiency anemia is asymptomaticMore severe may beirritabilityLethargyFatigueanorexia第十六页，共三十九页。1616Signs:pallor of the skin and mucous membranes.Hb70g/L,tachycardia and cardiac dilation occur,an
11、d systolic murmurs are often present IDA in infancy and early children is associated with developmental delay and poor growthClinical features第十七页，共三十九页。1717Laboratory findings第十八页，共三十九页。1818Serum iron(SI)62.7 umol/LSerum Ferritin(SF)0.9 umol/LLaboratory findings第十九页，共三十九页。1919IDAIDA外周血涂片外周血涂片(t pin
12、)(t pin)红细胞形态红细胞形态Laboratory findings第二十页，共三十九页。2020Iron deficiency anemia:low power view of peripheral blood film第二十一页，共三十九页。2121Microcytic and hypochromic anemia.MCHC 30%,MCV 80fl,MCH 27pgThe children with the clinical features of IDA and the cause The children with the clinical features of IDA an
13、d the cause of iron deficiencyof iron deficiencySI 10.7umol/LTransferin saturation 15%Transferin saturation 0.9umol/LFree 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 recep
14、tor N orTransferrin receptor N or N NHbFHbFN N N N第二十四页，共三十九页。2424Thalassemia minor IDA Thalassemia minorSI N or T IBC N HbF and A2 N Differential diagnosis第二十五页，共三十九页。2525第二十六页，共三十九页。2626TreatmentManagement will depend onThe severity of the anemiaThe cause of the iron deficiency The ability of the
15、patient to tolerate medicinal iron preparations第二十七页，共三十九页。2727TreatmentOral 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(3
16、5)300/5ml(35)Ferrous fumarateFerrous fumarate325(107)325(107)100/5ml(33)100/5ml(33)Polysaccharide-iron 150(150)Polysaccharide-iron 150(150)100/5ml(100)100/5ml(100)第二十八页，共三十九页。2828TreatmentOral administration of simple ferrous provides inexpensive and satisfactory therapy Ferrous sulfate is 20%elemen
17、tal iron by weight.A daily total of ferrous sulfate is 4-6 mg/kg of elemental iron in three divided doses provides第二十九页，共三十九页。2929Serum Irom7AM12N12MN7PMFigure.Oral iron absoption.When medicinal iron is given 3 times a day,each dose raises the SI for several hours.A fourth dose at bedtime can help s
18、ustain the SI during nighttime hours.第三十页，共三十九页。3030TreatmentBlood transfusion is indicated only when the anemia is very severeIts not necessary to attempt rapid correction of severe anemia by transfusionThe children with hemoglobin values less than 40g/L should be given only 2-3ml/Kg of RBCs第三十一页，共
19、三十九页。3131Responses to Iron Therapy in IDA Time After Iron Time After Iron AdministrationAdministrationResponse1224 hrReplacement of intracellular iron enzymes;Replacement of intracellular iron enzymes;decreased irritability;decreased irritability;increased Appetite increased Appetite36-48 hrInitial
20、bone marrow response;erythroid hyperplasia48-72 hrReticulocytosis,peaking at 57 days4-30 daysIncrease in hemoglobin level1-3 moRepletion of stores 第三十二页，共三十九页。3232The case 8 years old boy from countrysideDiagnosis is IDA and Hookworm infection(Hb=65g/L)Three weeks late after treatment with Ferrous s
21、ulfate:Hb=70g/L第三十三页，共三十九页。3333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出血下列下列(xili)(xili)哪项是鉴别缺铁性贫血与海洋性贫哪项是鉴别缺铁性贫血与海洋性贫血的重要依据血的重要依据A 临床表现 B 细胞形态 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量第三十四页，共三十九页。3434病例(bngl)(bngl)1010个月男孩面色苍白两个月，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。出生史：第
22、一胎，第一产，孕36周早产周早产喂养史：生后母乳喂养至今，6 6个月开始添加(tin ji)(tin ji)辅食。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，脾左肋下，脾左肋下2CM实验室检查：实验室检查：第三十五页，共三十九页。3535项目项目项目项目 结果结果结果结果(ji gu)(ji gu)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-
23、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/L第三十六页，共三十九页。3636肝功能：GPT 39U，GOT 40U，TB ，DB正常(zhngchng)(zhngchng)红细胞脆性降低，HbF 56%第三十七页，共三十九页。3737THANKS第三十八页，共三十九页。3838内容(nirng)总结NUTRITIONAL ANEMIA。TIBCN。Ferrous gluconate325(38)300/5ml(35)。Ferrous fumarate325(107)100/5ml(33)。Polysaccharide-iron 150(150)100/5ml(100)。体检：皮肤(p f)黏膜苍黄，肝右肋下2CM，脾左肋下2CM。38第三十九页，共三十九页。