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1、会计学1营养性贫血英文营养性贫血英文CONTENTSn nINDUCTIONINDUCTIONn nIRON METABOLISMIRON METABOLISMn nETIOLOGYETIOLOGY/PATHOGENESIS/PATHOGENESISn nMANIFESTATIONSMANIFESTATIONSn nLABORATORY FINDINGSLABORATORY FINDINGSn nDIAGNOSISDIAGNOSIS&DIFFERENTIAL&DIFFERENTIAL n nPREVENTION&TREATMENTPREVENTION&TREATMENT第1页/共43页INTR
2、ODUCTIONn nDefinition/describingDefinition/describingn nThe anemia caused by The anemia caused by insufficient dietary iron insufficient dietary iron uptake,in which the iron uptake,in which the iron storage and hemoglobin storage and hemoglobin synthesis decreased.synthesis decreased.HEMATOLOGY/ONC
3、OLOGY,CHILDRENS HOSPITAL第2页/共43页n nClinical characteristicsClinical characteristicsn n iron stores iron stores serum iron serum iron n n hemoglobin concentration,hemoglobin concentration,hypochromic microcytic anemia,hypochromic microcytic anemia,n ngood response to iron therapy.good response to iro
4、n therapy.n n6mo to 3 yrs.6mo to 3 yrs.n nIncidenceIncidence INTRODUCTIONHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第3页/共43页IRON METABOLISMn nCONTENTSn nNew born 75mg/kgNew born 75mg/kgn nChildren35-70mg/kgChildren35-70mg/kgn nAdults Adults n nM M 50mg/kg50mg/kgn nF 35mg/kgF 35mg/kgn nCMOPARTMENTCMOPARTM
5、ENTn nHemoglobin 64%Hemoglobin 64%n nStorage iron 30%Storage iron 30%n nferritinferritinn nhemosiderinhemosiderinn nMyloglobin Myloglobin 3%3%n nEnzyme iron 0.4%Enzyme iron 0.4%n nSerum Serum iron iron 0.4%0.4%HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第4页/共43页n nIron sourcesn nHemoglobin iron Hemoglobin
6、 iron n nDietary ironDietary ironHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALIRON METABOLISM第5页/共43页n nDietary ironDietary ironn nHigh in ironHigh in ironn nRed meat/liver kidney/Red meat/liver kidney/oily fish oily fish n nAverage ironAverage ironn nBeans/fortified cereals/Beans/fortified cereals/dark gr
7、een vegetables/dark green vegetables/dried fruit/nuts and seedsdried fruit/nuts and seedsn nPoor in iron Poor in iron n nmilkmilkHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALIRON METABOLISM第6页/共43页n nIron absorption general absorption1-20%n nMeat/Meat/fish/fish/chickenchicken10-25%10-25%n nCereals/vegetabl
8、esCereals/vegetables1%1%n nBreast/cows Breast/cows milkmilk50%/10%50%/10%HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALIRON METABOLISM第7页/共43页ABSORPTION&TRANSPORTABSORPTION&TRANSPORT Hemoglobin ironHemoglobin iron non hemoglobin iron non hemoglobin iron gastric juicegastric juice proteinaseproteinase proteo
9、lytic proteolytic HCl HCl heme heme ferric ferric hemolytichemolytic ferric ferric reductasereductase *Vit Vit C C ferrousferrous duodenumduodenum upper jujenum upper jujenum ferricferric mucosal cellsmucosal cells transferrin*transferrin*circulationcirculation GI tractGI tract liver liver/spleen/sp
10、leen marrow marrow (fig2)fig2)HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第8页/共43页FerritinFeTfRtransferritinFeFeIRON METABOLISMMucous cells第9页/共43页IRON METABOLISMn nIron stores and utilizing LiverSpleenMarrowRBCironFoodironSIFeFeheme+globin(fig2)HbFeFemarrowHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第10页/共43页I
11、RON METABOLISMn nRequirement and excretionRequirement and excretion demanddemand excretionexcretionadultsadults1mg/d1mg/d 1mg/d 1mg/d 1mg/d1mg/d 4mo-3yr 4mo-3yr 1mg/kg (15ug/kg/d)1mg/kg (15ug/kg/d)premature premature 2 2mg/kgmg/kgHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第11页/共43页HEMATOLOGY/ONCOLOGY,CHI
12、LDRENS HOSPITAL ETIOLOGY&PATHOGENESISETIOLOGY&PATHOGENESISn nETIOLOGYn nPoor iron storesPoor iron storesn nPoor dietary intake of Poor dietary intake of ironiron*n nOverdevelopOverdevelopn nChronic bleedingChronic bleeding第12页/共43页n nPoor iron storesPoor iron storesn nPremature birthPremature birthn
13、 nMultiple birth/Low weight birthMultiple birth/Low weight birthn nCord bloodCord bloodn nMother iron reserve Mother iron reserve n noverdevelopoverdevelopn nPoor dietary intake of ironPoor dietary intake of iron*n nBlood loss and iron depletionBlood loss and iron depletionHEMATOLOGY/ONCOLOGY,CHILDR
14、ENS HOSPITAL ETIOLOGY&PATHOGENESISETIOLOGY&PATHOGENESIS第13页/共43页n nPoor iron storesPoor iron storesn nPoor dietary intake of iron*n nMilk and cerealsMilk and cerealsn nFactors influencing Factors influencing absorptionabsorptionn nDiarrhea and infection Diarrhea and infection n nOverdevelopOverdevel
15、opn nBlood loss and iron depletionBlood loss and iron depletionHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL ETIOLOGY&PATHOGENESISETIOLOGY&PATHOGENESIS第14页/共43页 ETIOLOGY&PATHOGENESISETIOLOGY&PATHOGENESISn nPoor iron storesPoor iron storesn nPoor dietary intake of ironPoor dietary intake of iron*n nOverdeve
16、lopn n3-53-5mo/1yrmo/1yrn nPremature birthPremature birthn nPuberty Puberty n nChronic bleedingChronic bleedingHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第15页/共43页 ETIOLOGY&PATHOGENESISETIOLOGY&PATHOGENESISn nPoor iron storesPoor iron storesn noverdevelopoverdevelopn nPoor dietary intake of ironPoor diet
17、ary intake of iron*n nChronic bleedingn nCows milkCows milkn nHookworm infectionHookworm infectionn nMenstruating Menstruating n nOthers:Others:HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第16页/共43页n nPathogenesis iron iron +protoporphyrinprotoporphyrin IDA hemeheme+globins globins hemoglobinhemoglobinHEMA
18、TOLOGY/ONCOLOGY,CHILDRENS HOSPITALETIOLOGY&PATHOGENESISETIOLOGY&PATHOGENESIS第17页/共43页n nPathogenesisPathogenesisn nHypochromic/microcytic anemiaHypochromic/microcytic anemian nID.Iron deficiencyID.Iron deficiencyn nIDE.Iron deficiency erythropoiesisIDE.Iron deficiency erythropoiesisn nIDA.Iron defic
19、iency anemiaIDA.Iron deficiency anemian nEnzymesEnzymesn nImmune function Immune function n nSkin/mucosalSkin/mucosalHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALETIOLOGY&PATHOGENESISETIOLOGY&PATHOGENESIS第18页/共43页n nFeatures n nAgeAgen nThe onset of the The onset of the IDAIDAn nThe degree of The degree of
20、 anemiaanemiaHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALCLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS第19页/共43页n nPallorn nExtramedullary hematopoiesisn nMild/Severe condition n nDigestive systemDigestive systemn nCardiac functionCardiac functionn nNeurology/intellectual Neurology/intellectual n nImmune
21、functionImmune functionHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALCLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS第20页/共43页n nIDAIDA:microcytic/hypochromic+SImicrocytic/hypochromic+SI n nPeripheral bloodPeripheral blood：n nHemoglobin level Hemoglobin level n nRBC MCV RBC MCV 80fl,80fl,MCH MCH 26ug,26ug,MCH
22、C MCHC 0.31 0.31 n nBone marrowBone marrown nErythroid hyperplasia Erythroid hyperplasia n nStainable ironStainable iron HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALLABORATORY FINDINGS第21页/共43页n nIDA:hypochromic/microtytic hypochromic/microtytic anemiaanemia+SISI n nSISI：9-10.7umol/L 9-10.7umol/L(12.8-(12
23、.8-31.3umol/L)31.3umol/L)or or 62.7umol/L 62.7umol/L(350ug/dl)(350ug/dl)n nTSTS：15%0.9umol/L 0.9umol/L or or 50ug/dl)50ug/dl)n nID：SFSF 12ug/L 12ug/L/marrow ironmarrow ironHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALLABORATORY FINDINGS第22页/共43页HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALNormalIDIDEIDAMarrow iro
24、n+0SF(ug%)100 60 10-20FEP SITIBCTS HbMCVMCH 第23页/共43页HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第24页/共43页n nDiagnosisDiagnosisn nImpressionImpression：age,feeding,age,feeding,PBLPBLn nDiagnosisDiagnosis：biochemical biochemical changechangen nProven by therapyProven by therapyHEMATOLOGY/ONCOLOGY,CHILDRENS
25、HOSPITALDIAGNOSIS&DIFFERENTIALDIAGNOSIS&DIFFERENTIAL第25页/共43页n nDifferentialn nChronic&inflammatory Chronic&inflammatory diseasesdiseasesn nThalassemiaThalassemian nPulmonary Pulmonary hemosiderosishemosiderosisn nSiderblastic anemiaSiderblastic anemiaMagaloblastic anemiaHEMATOLOGY/ONCOLOGY,CHILDREN
26、S HOSPITALDIAGNOSIS&DIFFERENTIALDIAGNOSIS&DIFFERENTIAL第26页/共43页Megaloblastic AnemiaMegaloblastic Anemian nSimilar aspects to IDASimilar aspects to IDAn nAgeAgen nAnemia by inadequate dietary intakeAnemia by inadequate dietary intakeHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第27页/共43页Megaloblastic AnemiaM
27、egaloblastic AnemiaHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALPathogenesisVitamin12Folic acidFolic acid reductaseDNA Synthesis Tetrahydrofolic acid Nucleotide 第28页/共43页Megaloblastic AnemiaMegaloblastic Anemian nManifestation&DifferentialManifestation&Differentialn nPale and puffyPale and puffyn nNeurolog
28、ical involvement Neurological involvement n nLab findingsLab findingsn nMacrocytic normochromic anemiaMacrocytic normochromic anemian nNeutropenia with/thrombocytopenia Neutropenia with/thrombocytopenia n nMarrow film:megaloblastic forms of nucleated Marrow film:megaloblastic forms of nucleated RBCR
29、BCn nSerum Vit B12 and/or folic acidSerum Vit B12 and/or folic acidHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第29页/共43页第30页/共43页第31页/共43页Megaloblastic AnemiaMegaloblastic Anemian nTREATMENT TREATMENT n nGeneral careGeneral caren nDrug therapy Drug therapy n nVitamin B12Vitamin B12：25-100ug/25-100ug/次，次，2
30、-3 2-3 timestimes/w w，weeks or to Hb normalweeks or to Hb normal；One high doseOne high dose：500500ugug im im n nFolic acidFolic acid：5-10 5-10mg,tid,mg,tid,2-3 2-3w w，n nEffect Effect n nOther drugOther drug：Vitamin CVitamin C；B6 B6；iron in iron in recoveryrecovery n nTransfusionTransfusionHEMATOLOG
31、Y/ONCOLOGY,CHILDRENS HOSPITAL第32页/共43页 TREATMENTn nGeneral caren nEradicate the causes*n nIron therapy*n ntransfusionHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第33页/共43页n nIron therapyIron therapyn nElemental ironElemental iron：4-6mg/kg/d4-6mg/kg/dn nOral medicationOral medicationn nTypesTypesn nAdminist
32、rationAdministrationn nBetween mealsBetween mealsn nVitamin CVitamin Cn nCourseCourse HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL TREATMENT第34页/共43页Ferrous Salts4mg/kg/dFerrous sulfate（20%）20mg/kg/dferrous fumarate(30%）13mg/kg/dFerrous gluconate（11%）40mg/kg/dHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALTable:Fe
33、rrous salts ant the iron contents第35页/共43页n nIron therapyn nInfusion iron Infusion iron n nindicationindicationn ntypestypes：HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL TREATMENT第36页/共43页 IRON THERAPY RESPONSEIRON THERAPY RESPONSE（from Nelsonfrom Nelson）time response12-24 hrReplacement of iron enzymes,su
34、bjective improvement36-48 hrInitial marrow response:erythroid hyperplasia48-72 hrReticulocytes peaking 5-74-30 daysHemoglobin level 1-3 mo Replenish of storesHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第37页/共43页TREATMENTn nTransfusion n nIndications Indications n nSevere anemiaSevere anemian nInfection In
35、fection n nPre-operationPre-operationn nComponentComponent：red blood cells red blood cellsn nVolumeVolume：Hb 30g/L,3-5ml/kg Hb 30g/L,3-5ml/kg Hb 30-60g/L,5-10ml/kg Hb 30-60g/L,5-10ml/kgn nAttentionsAttentionsHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第38页/共43页PREVENTIONn nEducationn nFor pregnant womenn
36、nFor interm n nBreast milk/cows Breast milk/cows milkmilkn nIron rich Iron rich supplementary food supplementary food n nIron-fortified foodIron-fortified foodn nFor premature infantHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第39页/共43页HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALReview these contents after class
37、,try to make the summary on:1.The characteristics of iron metabolism in fetus and infants2.The etiology of IDA3.Laboratory findings according to the stages4.Differentials:esp with thalassemia5.Important treatment第40页/共43页n nFactors influencing iron Factors influencing iron absorptionabsorption n nPo
38、sitive factorsPositive factorsn nAscorbic acid/gastric Ascorbic acid/gastric acid/amino acidacid/amino acidn nNegative factorsNegative factorsn nPhosphate/phytate/Phosphate/phytate/n nTea/coffee Tea/coffee IRON METABOLISMHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第41页/共43页IRON METABOLISM Concepts n nSISIn nserum ironserum ironn nTIBCTIBCn ntotal total iron iron binding binding capacitycapacityn nTSTSn ntransferrin saturationtransferrin saturationHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第42页/共43页