缺铁性贫血PPT课件

1,缺铁性贫血Iron Deficiency Anemia (IDA),2,内容 CONTENTS,简介INDUCTION铁代谢IRON METABOLISM流行病学EPIDEMIOLOGY 发病机制 ETIOLOGY /PATHOGENESIS临床表现 MANIFESTATIONS实验室检查 LABORATORY FINDINGS诊断和鉴别诊断 DIAGNOSIS & DIFFERENTIAL 治疗和预防 PREVENTION & TREATMENT,3,简介 INTRODUCTION,定义Definition 由于机体对铁是摄入不足，而导致体内储存铁耗尽，继而红细胞内铁缺乏，最终导致贫血。The anemia caused by insufficient iron uptake, in which the iron storage and hemoglobin synthesis decreased. 铁缺乏症的三个阶段There are three stages in iron dificiency储存铁耗竭 Iron deletion（ID) 红细胞内铁缺乏 Iron deficient erythropoiesis（IDE) 缺铁性贫血 Iron deficiency anemia（IDA),4,铁代谢IRON METABOLISM,铁总量CONTENTSNew born 75mg/kgChildren35-70mg/kgAdults M 50mg/kgF 35mg/kg,铁分布CMOPARTMENT血红蛋白Hemoglobin 64%储存铁 Storage iron 30%铁蛋白 Ferritin含铁血黄素hemosiderin肌红蛋白Myloglobin 3%含铁酶 Enzyme iron 0.4% 血清铁 Serum iron 0.4%,5,铁的储存和利用Iron stores and utilizing,LiverSpleenMarrow,RBCiron,Foodiron,SI,Fe,Fe,heme + globin,6,铁代谢IRON METABOLISM,铁的需要和排泄 Requirement and excretion demand 需要 excretion排泄Infants 1mg/d Children 0.5mg/d Young, nonpregnant women 2 mg/d Pregnant women 3 mg/d Men and postmenopausal women 1mg/d 0.5-1mg/d,7,Which people need more iron？哪些群体对铁的需要量多？,儿童children,妊娠妇女,哺乳母亲,pregnancy,lactation,8,铁来源 Iron sources血红蛋白内铁 Hemoglobin iron 食物中铁 Dietary iron铁通过胃肠道吸收，主要在十二指肠和空肠上段 duodenumpriximal jejunum,铁代谢IRON METABOLISM,9,食物中的铁 Dietary iron含铁高的食物 High in iron Red meat/ liver /kidney一般含铁食物Average iron Beans / fortified cereals/ dark green vegetables/ dried fruit/ nuts and seeds含铁少的食物 Poor in iron milk,铁代谢IRON METABOLISM,10,铁的吸收 Iron absorption一般吸收 General absorption 1-20%肉类 Meat/ fish/ chicken 10-25%谷物蔬菜 Cereals/vegetables 1%母乳/牛奶 Breast/cows milk 50%/10%,铁代谢IRON METABOLISM,11,铁的吸收和转运 ABSORPTION & TRANSPORT,12,Pathogenesis iron + protoporphyrin IDA heme + globins hemoglobin,发病机制PATHOGENESIS,13,病因和发病机制ETIOLOGY & PATHOGENESIS,病因学 ETIOLOGY铁储存减少 Poor iron stores铁摄入减少 Poor dietary intake of iron 铁需要增加 Overdevelop慢性失血铁丢失Chronic bleeding,14,对血液系统的影响：Hypochromic / microcytic anemiaID. Iron deficiencyIDE. Iron deficiency erythropoiesisIDA. Iron deficiency anemia组织代谢的影响：Enzymes activity decrease酶的活性下降，影响精神，行为，体力，生长发育迟缓对免疫系统的影响Immune function 下降对皮肤粘膜的改变Skin/mucosal,发病机制PATHOGENESIS,15,特点 Features 年龄 Age发病过程 The onset of the IDA贫血程度The degree of anemia,临床表现CLINICAL MANIFESTATIONS,16,一般改变General可以发生在任何年龄，在六个月到两岁的儿童中很常见Any age; commonly found in age 6 mths 2 yrs髓外造血Extramedullary hematopoiesisMild/ Severe condition 消化系统 Digestive system心血管系统Cardiac function神经系统 Nervous/ intellectual 免疫系统 Immune function,临床表现CLINICAL MANIFESTATIONS,17,临床表现CLINICAL MANIFESTATIONS,对皮肤粘膜的改变Skin/mucosal苍白：特别是嘴唇，颊粘膜，眼结膜Pallor : esp. lips, buccal and palpebral mucosa ，反甲 Koilonychia (spoon-shaped nails）粘膜溃疡糜烂 rough ，ulcer，erosion镜面舌 mirror surface tongue (smooth, red tongue),18,呼吸和循环系统 Respiratory & cardiovascular system心悸 Palpitation呼吸困难 Dyspnea呼吸急促 Tachypnea心动过速 Tachycardia血压升高 Increased artery blood pressure心脏扩大 Enlargement of heart心力衰竭 Even heart failure,19,临床表现CLINICAL MANIFESTATIONS,消化系统 Digestive system口角炎 Angular stomatitis舌炎 Glossitis唇炎 Angular cheilitis 异食癖 Pagophagia or pica,20,临床表现CLINICAL MANIFESTATIONS,神经系统症状 CNS manifestations: 易激动 Irritability婴幼儿的学习能力下降decreasing learning ability of infant注意力不集中 Loss of concentration感觉麻木 Paresthesia 耳鸣 Tinnitus虚弱乏力 Fainting or feeling faint发育迟缓 Slow development血液系统 Hemopoietic systemEnlargement of liver and spleen,21,IDA:小细胞低色素性贫血+血清铁 microcytic/hypochromic + SI外周血Peripheral blood：血红蛋白 Hemoglobin level 红细胞 RBC MCV 80fl, MCH 26ug, MCHC 350ug/dl) TS： 0.9umol/L or 50ug/dl)ID： SF 12ug/L / marrow ironAcronyms and Abbreviations 血清铁 SI：serum iron；总铁结合力TIBC：total iron binding capacity；转铁蛋白饱和度 TS：transferrin saturation,实验室检查LABORATORY FINDINGS,23,实验室检查Laboratory findings,Normal,Patient,24,Bone marrow,25,诊断 Diagnosis印象 Impression：age, feeding, PBL诊断 Diagnosis：biochemical change证实 Proven by therapy,诊断和鉴别诊断DIAGNOSIS & DIFFERENTIAL,26,诊断 diagnosis,Determination of the cause of IDA is most important for diagnosis,确定缺铁性贫血的病因是最重要的,27,慢性或炎性疾病 Chronic & inflammatory diseases血红蛋白病性贫血 Thalassemia铁粒幼细胞性贫血Siderblastic anemia,鉴别诊断 DIFFERENTIAL Diagnosis,28,Note the florid increase in Prussian blue staining granules in the erythroblasts, most with circumnuclear locations,DIFFERENTIAL-IDA AND SA,铁粒幼细胞性贫血SA,普鲁氏蓝染色细胞内铁缺如prussian blue iron stain：negative,铁缺性贫血IDA,29,有家族史，有溶血表现，脾肿大，黄疸 Faimly History， Hemolytic anemia Jaundice Splenomegaly 血片：多量靶形红细胞 target cell 珠蛋白肽链合成数量异常：HbF、HbA2 血清铁蛋白SF、骨髓可染铁IRON STAIN 、血清铁SI和 铁饱和度TS常,2.海洋性贫血 Thalassemia,鉴别诊断DIFFERENTIAL-IDA AND Thalassemia,30,慢性感染、炎症、恶性肿瘤伴发的贫血肝病、肾病、内分泌疾病继发的贫血称“慢性系统疾病性贫血”或“继发性贫血”,3.慢性病性贫血（anemia of chronic disease，ACD）,鉴别诊断 DIFFERENTIAL Diagnosis,31,几种小细胞低色素性贫血特点比较,32,治疗 TREATMENT,病因治疗 Eradicate the causes补铁治疗 Iron therapy输血治疗 transfusion,33,补铁治疗 Iron therapy补铁剂量Elemental iron： 4-6mg/kg/d口服补铁Oral medication硫酸亚铁 ferrous sulfate 0.3 3/d琥珀酸亚铁ferrous succinate 0.2 3/d多糖铁复合物polysaccharide-iron complex 150mg 2/d服用：两餐直接，加维生素C Administration：Between meals，Vitamin C,治疗 TREATMENT,34,铁治疗Iron therapy注射铁剂 Infusion iron 右旋糖酐铁 dextranumIndication：severe gastrointestinal reaction Oral medication duodenumpriximal jejunum lesion impact absorption口服铁剂不能耐受或十二指肠，空肠上段有病变影响铁剂吸收,治疗 TREATMENT,35,铁治疗反应IRON THERAPY RESPONSE,36,治疗 TREATMENT,输血指征 Transfusion Indications 重度贫血Severe anemia感染 Infection 拟行手术Pre-operation输血成分Component： red blood cells输血量 Volume：Hb 30g/L, 3-5ml/kg Hb 30-60g/L, 5-10ml/kg,37,预防PREVENTION,保健教育 Education孕期妇女 For pregnant women母乳喂养/牛奶 Breast milk