IDA缺鐵性貧血培訓(xùn)課件

IronDeficiencyAnemia

(IDA)

Dr.LiuChonghaiIron-deficiencyanemiaaffectedabout1.48billionpeoplein2015.Alackofdietaryironisestimatedtocauseapproximatelyhalfofallanemiacasesglobally.Womenandyoungchildrenaremostcommonlyaffected.In2015anemiaduetoirondeficiencyresultedinabout54,000deaths–downfrom213,000deathsin1990.Disability-adjustedlifeyearforiron-deficiencyanemiaper100,000inhabitantsin2004.

MetabolismofIronA.IrondistributioninthebodyA.Irondistributioninthebody

B.ThesourceofironEndogenous

oldRBC(2/3)Exogenous

throughfood(1/10mg/d)Animalfoodswithhighironcontentandhighhemeiron,theabsorptionrateof10-25%Ironofvegetablefoodisnon-hemeiron,theabsorptionrateof1.7-7.9%C.Physiologicalrequirementofiron:1mg～1.5mg/kg/d(<15yr)Premature2mg/kg/dIndexofironnutritionTIBCandironsaturationinIDAEtiologyofirondeficiency1.Insufficientironstore:premature,severematernalirondeficiency,intra-uterustransfusionetc.2.Insufficientintake:foodwithinsufficientiron,e.g.fedwithmilk,flourorriceflouronlyetc.3.Absorptiveproblems:chronicdiarrhea,steatorrhea4.Growthdemand:younginfants,prematurebaby,adolescentchildren,girlsaftermenarcheetc.5.Bloodloss:chronicgastrointestinalbleedingcausedbypepticulcer,hookworm,multiplepolyps,angioma,diverticuloritisorinflammativeenteropathy,oracutebloodlosswithinjuryorepitaxisetc.3stagesIrondepletion,ID:Irondeficienterythropoiesis,IDEIrondeficiencyanemia,IDAImpactonbodyhealthbyID1.Hematopoieticsystem:gradualanemiaStagesFerritinSerumiron,SIHbIDLowNNIDELLNIDALLL

ImpactonbodyhealthbyID(continued)2.GIsystem:absorptivedisorders;3.Circulativesystem:cardiaccontractivitydecrease,heartenlargement,murmurandheartfailure;4.Neuroschycologicalsystem:insomnia,attentionabsent(aprosexia),apathy;5.Immunesystem:compromisedimmunity,susceptibletoinfection;6.Skinandhairsystem:drynessofskin,sparseandbrittlehairs,lossofpolish,fragilenails,koilonychia;

ClinicalManifestationAge:6months~3yrsGeneral:anemicpale,positionalhypotension;GIsystem:diarrhea,dyspepsia,nausea,vomitingHematopoieticSystem:hepatosplenomegaly(extramedullaryhematopoiesis)Circulatorysystem:tachycardia,murmursandheartenlargement;Immunesystem:infection;Neuropsycologicalsystem:pica,apathy;

Labtests--Bloodsmear:

MicrocyticandhypochromicRBCBMsmear：Cellularity:hypercellularity;Ironstain:compromisedbothintercellularandintracellularironstains.Developingnucleatederythrocytes:delayedcytoplasmicdevelopment;IndicesofironnutritionSI(serumiron)Fn(Ferritin)TIBC(totalironbindingcapacity)FEP(freeerythrocyticprotopophrin)1、IDA:isagradualprocesswhichcanbedividedinto3stages,ie,IDstage,IDEstageandIDAstage.2、FerritinisthemostsensitivemarkerforIDA;3、OnceHbhasbeenrecoveredtonormallevel,ironagentsshouldbeusedcontinuesllyforanother2months.DiagnosisanddifferentialdiagnosisDiagnosis:

HistoryclinicalmanifestationlabtestsDifferentialdiagnosis:(Hypochromicandmicrocyticanemias)?thalassemia,?leadpoisoning,?chronicinfectionetc.

Treatment1.Lookingforetiologyandmodifyfeedingformula;2.Medications:ironagents

forOral:ferrousgluconate,ferroussulfate;forInj:Ferrousdextran;dosage:3-6mgelementaliron/kg/day,3divideddosesResponses:reticulocyte2-3d,5-7dtopeak,2-3wkstonormal.

Hb1-2wks,3-4wkscorrectionanemia.Caution:continuetogiveironfor4-6months(India)6-8wks(China)afterHbbecomesnormal.BloodTransfusionwhenitisnecessary.1.severeanemiawithcongestivecardiacfailure2.withsevereinfection3.needsurgeryHb<60g/L,redcelltransfusion,4-6ml/kgHB>60g/L,NO.

Prevention1.Healthpropagandaandcouncilling;2.Adequatedietforpregnantmothers;3.Correctfeedingforbaby;4.Treatmentofdiseases:GIdisorders,parasitesetc.MegaloblasticAnemiaDefination:

NutritionalVitB12orfolicaciddeficiencyanemiawasdefinedasthedeficiencyineitherVitB12orFolicacid.InIndia,6.8%childrenhadfolatedeficiency,32%showedvinB12deficiencyandcombineddeficiencyChina--rare

MetabolismofVitB12andFolicacidFolicacid:Food:richingreenvegetible,lackinsheepmilk;Absorptivesite:atupperportionofjejunum;VitaminB12:Food:richinanimalfood;Absorptivesite:terminusofileum;Absorptionhelpingfactor:internalfactor.

EtiologyDecreasedintake（vegetarian--VB12,goatmilk—Folicacid);Increasingdemands;Impairedabsorption(celiacdisease,intestinalparasites)Diseaseimpacts;Congenitaldefects:1、congenitalFAabsorptivedefects;2、Juvenileperniciousanemia;3、congenitaltranscobalamindefects。ClincalManifestationsAge:peakat6mon~2yrs;Anemia:soilcolorofskin,edema,petechae;GIsystemproblems:dyspepsia,nausea,etc.Circulatorysystem:tachycardia,murmur,heartfailureetc.Neurosphycologicalsystem:mentalretardation,Ataxia,clonuswithVitB12defective.LabtestsBloodsmear:RBCmorphology:macrocyticnormochromicWBCmorphology:neutrophil:largecellwithhyper-fragmentednucleusPlt:enlargedsize,reducednumberHyperfragmentedneutrophilMegloblasticanemiaCBC

BMsmear:Cellularity:hypercellularitywithbiggersizeoftheRBCs;Morphology:imbalancedevelopmentofcytoplasma:nucleus;WBCmorphology:enlargedWBCwithhyperfragmented;Megakaryocyte/plt:norma