內(nèi)科學(xué)課件 10、IDA 2015英文

IronDeficiencyAnemia缺鐵性貧血

JCDENGDefinition

amicrocyticandhypochromicanemia,resultedfromlowstoresofiron.Threestages:IrondepletionID缺鐵IrondeficiencyerythropoiesisIDE缺鐵性紅細(xì)胞生成IrondeficiencyanemiaIDA

epidemiologyIrondeficiencycausesabouthalfofallanemiacases.affectswomenmoreoftenthanmen.Commonlyseenindevelopingcountries.Morbidity:infant(6m-2y):75%-82.5%pregnantwomen:66.7%adolescents(10y-17y):13.2%Hemoglobinmolecule血紅蛋白分子

gobin

珠蛋白heme

血紅素Globinproteinconsistingof4polypeptidechains(α2β2，α2δ2，α2γ2)Onehemepigmentattachedtoeachpolypeptidechaineachhemecontainsporphyrin

（卟啉）andFe2+thatcancombinereversiblywithoneoxygenmoleculeMetabolismsofironBodyirondistributionsfunctioniron:

Hb,

myoglobin

肌紅蛋白,iron-containingenzymes,

transferrin

轉(zhuǎn)鐵蛋白

storageiron:

ferritin

鐵蛋白,

hemosiderin

含鐵血黃素

MetabolismsofironBodyirondistributiontotalbodyironAdultmales–50mg/kgAdultfemales–40mg/kgMetabolismsofironSourcesofironrecyclingFe–oldordestructiveRBCdietaryFehemeiron:animalsourcenon-hemeiron:plantsource

IronenrichedinsomefoodsIronpanaddsironMetabolismsofironIronabsorptionDuodenum十二指腸

upsidejejunum空腸absorbability

.Sourceoffood

.Ioniciron（Fe2+，F(xiàn)e3+）

.Epitheliummediation上皮調(diào)節(jié)MetabolismsofironTransport

intestinalcellsFe2+

bloodFe3++transferrin

membraneofmarrowRBCFe3++transferrin+transferrinR.Mitochondria線粒體

Fe2++porphyrin+globin

HemoglobinMetabolismsofironDietaryintake1-1.5mg/dExcretion1mg/d

excretionintakeCauses病因Moreironrequirement,lessironintakeinfants,teenagers,pregnantwomenorlactatingwomen

increasedphysiologicrequirementsforironCausesMalabsorptionofiron

subtotalgastrectomy

胃大部切除術(shù)

GItractdisease

CausesChronicbloodloss

GItractbleedinginmales，

excessivemenstrualflowinfemales

Pathogenesis發(fā)病機(jī)制Impactonironmetabolism

ferritin

鐵蛋白

serumiron：transferrin轉(zhuǎn)鐵蛋白-associatedFe2+

totalironbindingcapacity(TIBC)總鐵結(jié)合力:thetotalamoutoftransferrinPercentoftransferrinsaturation

轉(zhuǎn)鐵蛋白飽和度:=serumiron/TIBC

X100%

PathogenesisImpactonRBCfreeerythrocyteprotoporphyrinFEP游離原卟啉

microcyticandhypochromicanemia

小細(xì)胞低色素貧血anemiaMCV:meancorpuscularvolume正細(xì)胞性貧血Normocyticanemia大細(xì)胞性貧血macrocyticanemia小細(xì)胞性貧血microcyticanemiaPathogenesisImpactontissueandcellmetabolism

decreasedactivityofiron-containingenzyme:

peroxidase

過氧化物酶,

cytochrome

oxidase

細(xì)胞色素氧化酶,etc.

spirit,behavior,growth,intelligence…influenced

microcytic,hypochromicanemiaImpactonRBCImpactontissueandcell

Skin,mucosa,etc.eachsystemNegativeironmetabolismIrondeficiency：impactonironmetablism

ferritin,hemosiderinserumiron,TFRsaturation

TIBCdecreasedactivityofiron-containingenzyme

HbfallsClinicalmanifestationsPresentationsof

underlyingdisease

anemia

irondeficiency

SymptomsofanemiaFatigueDizzinessHeadachePalpitation

心悸Dyspnea

呼吸困難Disturbancesinmenstruation

月經(jīng)不調(diào)Lethargy

嗜睡Poorattention注意力不集中WhoareIDApatients？SymptomsofirondeficiencyIrritabilityPoorworkperformanceIncreasedfrequencyofinfectionDefect

ofepithelialtissuePica

Pica

異食癖Thehabitualingestionofunusualsubstancesearth,clay，iceUsuallyisamanifestationofirondeficiencyespeciallyafterhookworminfestation鉤蟲感染

andisrelievedwhenthedeficiencyistreatedIninfants:developmentaldelays;behavioraldisturbancesInpregnantwomen:anincreaseinpretermdelivery;anincreaseindeliveringalow-birth-weightchildGlossitis

舌炎

Koilonychia

匙狀甲LaboratoryexaminationsBloodtest

hemoglobin

MCV <80fl

microcytic,hypochromic

anemiaBloodroutinecountLaboratoryexaminationsBonemarrowsmear

mildtomoderateerythroidhyperplasia(25-35%;N16–18%)輕中度紅系增生bonemarrowshowingstainableiron

decreaseorabsence.

BonemarrowsmearBonemarrowstainableironIDAIroninsideofRBCIronoutsideofRBCLaboratoryexaminationsIronmetabolismmarkers

serumironconcentration

serumferritinlevels

(<12ug/l)totaliron-bindingcapacity

saturationoftransferrin

(<15%)serumtransferrinreceptors

sTfR

PorphyrinmetabolismmarkerFEPincreased

diagnosisToconfirmIDAToconfirmthepossiblecausesDifferentialdiagnosis

microcyticanemia

Sideroblasticanemia鐵粒幼細(xì)胞性貧血Thalassemia

海洋性貧血Anemiaofchronicdisease慢性病性貧血

CaseA50yearoldmancomestoseeyoubecauseoffatigue,abdominalpainandachangeinbowelhabitfor3month.Heisfoundtohaveahemoglobinof60g/LandMCVof76fl.Stool:O.B.(+).Marrowstainableirontest(-).Heishealthypreviously.Question1:Next,whichoneisthemostimportantexamination?SerumferritinB.GIX-BariumC.ColonoscopyD.abdominalCTscanTreatmentPrincipleoftreatment:

eradicationofthecause,storageironsupplement

TreatmentTreatmentoftheunderlyingdiseaseIronsupplementtherapy

Oralirontherapy

口服鐵劑

Intramuscularirontherapy肌注鐵劑

treatmentOralirontherapyInorganiciron:ferroussulfate硫酸亞鐵

,organiciron:ferrousgluconate

葡萄糖酸亞鐵，

polyferose

多糖鐵復(fù)合物ironabsorptionenhanced:vitC,meat,orangejuice,fishinhibited:spinach菠菜,tea,milk,coffeeDurationoftreatment:4-6monthsExpectedresponse:reticulocytecountincreasein

5to10days

treatmentIntramuscularirontherapyIndication:intolerancetooralironordisorderofGItractAgent：iron–dextran

右旋糖酐鐵Dosage:100mgim

qd

irontobeinjected(mg)

=(150-Hb)x0.33x

weight(kg)Adverseeffects:painatthe