小儿营养性贫血(NUTRITIONAL-ANEMIA).pptx
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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
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