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1、小儿营养性贫血(NUTRITIONAL-ANEMIA)Nutritional anemiaMegaloblastic anemia vitamin B12 deficiency folic acid deficiencyIron deficiency anemia iron deficiency2 2Iron defeciency anemiaIntroduction Cause of Iron deficiency anemiaClinical featuresLaboratory findingsDiagnosisDefferential diagnosisTreatment 3 3Iro
2、n Deficiency Anemia,IDAIncidence of IDA:10-70%(WHO)40%(6m-6y,China)4 4IDA is the most common cause of anemia in childhood.It usually results from inadequate dietary intake rather than loss of iron through hemorrhage.5 5Iron in milkBoth of breast and cows milk are low in ironIron is better absorbed f
3、rom breast milk(50%)compared to cows milk(10%)Formula milks are fortified with iron(4%)6 6Dietary sources of iron7 7Dietary sources of ironRed meatFortified breakfast cerealsDark green vegetablesBlack bread about 10-15%iron of dietary is absorbed8 8Iron requirementsThe fetus absorbs iron from the Th
4、e fetus absorbs iron from the mothermother across across the placenta.the placenta.Term infants have adequate reserve for the first Term infants have adequate reserve for the first 4 months of life.of life.Preterm infants have limited iron stores and Preterm infants have limited iron stores and beca
5、use of their higher rate of growth,their iron because of their higher rate of growth,their iron reserves were used up by reserves were used up by 8 weeks of age.of age.Adolescents also need more iron because of Adolescents also need more iron because of 1.1.GrowthGrowth spurt 2.spurt 2.DietaryDietar
6、y deficiency 3.deficiency 3.MenstrualMenstrual blood lossblood loss9 9Reference nutrient intake of iron are:6 months:4 mg/day12 months:8 mg/dayAdult male:9 mg/dayAdult female:15 mg/day1010(一)(一)the decrease of iron stores low birthweight preterm infantshemorrhageCauses of iron deificiency1111Causes
7、of iron deificiency(二)(二)Nutritional deficiency is common 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 unduly delayed 2.unmodified cows milk is introduced early.It is common in the fir
8、st two years of age1212Causes of iron deificiency(三)三)Malabsorption may be complicated by iron deficiencyThe children usually company with another malnutrition.1313Causes of iron deificiency(四)四)Blood loss is a less common cause in children,but may occur with:MenstruationHookworm infectionRepeated v
9、enesection in babiesMeckels diverticulumRecurrent epistaxisIt is the important cause of IDA in older children1414Clinical featuresMild iron deficiency anemia is asymptomaticMore severe may beirritabilityLethargyFatigueanorexia1515Signs:pallor of the skin and mucous membranes.Hb70g/L,tachycardia and
10、cardiac dilation occur,and systolic murmurs are often present IDA in infancy and early children is associated with developmental delay and poor growthClinical features1616Laboratory findings1717Serum iron(SI)62.7 umol/LSerum Ferritin(SF)0.9 umol/LLaboratory findings1818IDAIDA外周血涂片红细胞形态外周血涂片红细胞形态Labo
11、ratory findings1919Iron deficiency anemia:low power view of peripheral blood film2020Microcytic and hypochromic anemia.MCHC Microcytic and hypochromic anemia.MCHC 30%,MCV 80fl,MCH 27pg30%,MCV 80fl,MCH 27pgThe children with the clinical features of IDA and The children with the clinical features of I
12、DA and the cause of iron deficiencythe cause of iron deficiencySI 10.7umol/LSI 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
13、+0 0 14+14+Transferrin receptor N orTransferrin receptor N or N NHbFHbFN N N N2323Thalassemia minor IDA Thalassemia minorSI N or T IBC N HbF and A2 N Differential diagnosis24242525TreatmentManagement will depend onThe severity of the anemiaThe cause of the iron deficiency The ability of the patient
14、to tolerate medicinal iron preparations2626TreatmentOral 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(35)300/5ml(35)Ferrous
15、 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)2727TreatmentOral administration of simple ferrous provides inexpensive and satisfactory therapy Ferrous sulfate is 20%elemental iron by weight.A daily total
16、 of ferrous sulfate is 4-6 mg/kg of elemental iron in three divided doses provides2828Serum 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 sustain the SI during nighttime hours.2929Tre
17、atmentBlood 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 RBCs3030Responses to Iron Therapy in IDA Time After Iron Time Afte
18、r Iron AdministrationAdministrationResponseResponse1224 hr1224 hrReplacement of intracellular iron enzymes;Replacement of intracellular iron enzymes;decreased irritability;decreased irritability;increased Appetite increased Appetite36-48 hr36-48 hrInitial bone marrow response;Initial bone marrow res
19、ponse;erythroid hyperplasiaerythroid hyperplasia48-72 hr48-72 hrReticulocytosis,peaking at 57 daysReticulocytosis,peaking at 57 days4-30 days4-30 daysIncrease in hemoglobin levelIncrease in hemoglobin level1-3 mo1-3 moRepletion of stores Repletion of stores 3131The case 8 years old boy from countrys
20、ideDiagnosis is IDA and Hookworm infection(Hb=65g/L)Three weeks late after treatment with Ferrous sulfate:Hb=70g/L3232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出血下列哪项是鉴别缺铁性贫血与海洋性贫血下列哪项是鉴别缺铁性贫血与海洋性贫血的重要依据的重要依据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3333病例1
21、010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:第一胎,第一产,孕出生史:第一胎,第一产,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,脾左肋下,脾左肋下2CM2CM实验室检查:实验室检查:3434项目项目 结果结果 参考值参考值红细胞红细胞(RBC)2.68 3.5-5.01012/L血红蛋白血红蛋白(HGB)67 110-150g/LMCV 62 82-92flMCH 22 27-31pgMCHC 280 320-360g/LRET 4.5%血小板血小板(PLT)275 100-300 109/L白细胞白细胞(WBC)10.2 4.0-10 109/L3535肝功能:GPT 39U,GOT 40U,TB ,DB正常红细胞脆性降低,HbF 56%3636THANKS3737此课件下载可自行编辑修改,仅供参考!此课件下载可自行编辑修改,仅供参考!感谢您的支持,我们努力做得更好!谢谢感谢您的支持,我们努力做得更好!谢谢
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