IDA(缺铁性贫血)

,1,Iron Deficiency Anemia (IDA),Dr. Liu Chonghai,2,Iron-deficiency anemia affected about 1.48 billion people in 2015.A lack of dietary iron is estimated to cause approximately half of all anemia cases globally.Women and young children are most commonly affected.In 2015 anemia due to iron deficiency resulted in about 54,000 deaths down from 213,000 deaths in 1990.,3,Disability-adjusted life year for iron-deficiency anemia per 100,000 inhabitants in 2004.,4,Metabolism of Iron,A. Iron distribution in the body,5,A. Iron distribution in the body,6,B. The source of iron,Endogenous old RBC (2/3)Exogenous through food (1/10mg/d) Animal foods with high iron content and high heme iron, the absorption rate of 10-25% Iron of vegetable food is non-heme iron, the absorption rate of 1.7-7.9%,7,C. Physiological requirement of iron:,1mg 1.5mg/kg/d (15yr)Premature 2mg/kg/d,8,9,Index of iron nutrition,10,TIBC and iron saturation in IDA,11,Etiology of iron deficiency,1. Insufficient iron store: premature, severe maternal iron deficiency, intra-uterus transfusion etc.2. Insufficient intake: food with insufficient iron, e.g. fed with milk, flour or rice flour only etc.3. Absorptive problems: chronic diarrhea, steatorrhea4. Growth demand: young infants, premature baby, adolescent children, girls after menarche etc.5. Blood loss: chronic gastrointestinal bleeding caused by peptic ulcer, hook worm, multiple polyps, angioma, diverticuloritis or inflammative enteropathy, or acute blood loss with injury or epitaxisetc.,12,3 stages,Iron depletion, ID:Iron deficient erythropoiesis, IDEIron deficiency anemia, IDA,13,Impact on body health by ID,1. Hematopoieticsystem: gradual anemiaStages Ferritin Serum iron, SI Hb ID Low N NIDE L L NIDA L L L,14,Impact on body health by ID (continued),2. GI system: absorptive disorders;3. Circulative system: cardiac contractivity decrease, heart enlargement, murmur and heart failure;4. Neuroschycological system: insomnia, attention absent (aprosexia), apathy;5. Immune system: compromised immunity, susceptible to infection;6. Skin and hair system: dryness of skin, sparse and brittle hairs,loss of polish, fragile nails, koilonychia;,15,Clinical Manifestation,Age:6 months 3yrsGeneral: anemic pale, positional hypotension;GI system: diarrhea, dyspepsia, nausea, vomitingHematopoietic System: hepatosplenomegaly (extramedullary hematopoiesis)Circulatory system: tachycardia, murmurs and heart enlargement;Immune system: infection;Neuropsycological system: pica, apathy;,16,Lab tests-Blood smear:,17,Microcytic and hypochromic RBC,18,BM smear：,Cellularity: hypercellularity; Iron stain: compromised both intercellular and intracellular iron stains.Developing nucleated erythrocytes: delayed cytoplasmicdevelopment;,19,20,21,Indices of iron nutrition,SI (serum iron)Fn (Ferritin)TIBC (total iron binding capacity)FEP (free erythrocyticprotopophrin),22,1、IDA: is a gradual process which can be divided into 3 stages, ie, ID stage, IDE stage and IDA stage.2、Ferritin is the most sensitive marker for IDA; 3、Once Hbhas been recovered to normal level, iron agents should be used continuesllyfor another 2 months.,23,Diagnosis and differential diagnosis,Diagnosis: History clinical manifestation lab testsDifferential diagnosis:(Hypochromic and microcytic anemias) thalassemia, lead poisoning, chronic infection etc.,24,Treatment,1.Looking for etiology and modify feeding formula;2. Medications: iron agents for Oral: ferrous gluconate, ferrous sulfate; for Inj: Ferrous dextran; dosage: 3-6mg elemental iron/kg/day, 3 divided doses Responses: reticulocyte 2-3d ,5-7d to peak, 2-3wks to normal. Hb 1-2wks , 3-4wks correction anemia. Caution: continue to give iron for 4-6 months(India) 6-8 wks(China) after Hb becomes normal.,25,Blood Transfusion,when it is necessary. 1. severe anemia with congestive cardiac failure 2. with severe infection 3. need surgeryHb 60g/L, NO.,26,Prevention,1. Health propaganda and councilling;2. Adequate diet for pregnant mothers;3. Correct feeding for baby;4. Treatment of diseases: GI disorders, parasitesetc.,27,Megaloblastic Anemia,28,Defination:,Nutritional VitB12 or folic acid deficiency anemia was defined as the deficiency in either VitB12 or Folic acid.,29,In India, 6.8% children had folate deficiency, 32% showed vinB12 deficiency and combined deficiency China-rare,30,Metabolism of VitB12 and Folic acid,Folic acid:Food: rich in green vegetible, lack in sheep milk;Absorptive site: at upper portion of jejunum;Vitamin B12:Food: rich in animal food;Absorptive site: terminus of ileum; Absorption helping factor: internal factor.,31,Etiology,Decreased intake （vegetarian-VB12, goat milkFolic acid );Increasing demands;Impaired absorption (celiac disease, intestinal parasites)Disease impacts;Congenital defects:1、congenital FA absorptive defects; 2、Juvenile pernicious anemia;3、congenital transcobalamin defects。,32,Clincal Manifestations,Age: peak at 6 mon 2 yrs;Anemia: soil color of skin, edema, petechae;GI system problems: dyspepsia, nausea, etc.Circulatory system: tachycardia, murmur, heart failure etc.Neurosphycological system: mental retardation, Ataxia, clonus with VitB12 defective.,33,Lab tests,Blood smear:RBC morphology: macrocytic normochromicWBC morphology: neutrophil: large cell with hyper-fragmented nucleusPlt: enlarged size, reduced number,34,Hyperfragmentedneutrophil,35,Megloblastic anemia CBC,36,BM smear:,Cellularity:hypercellularitywith bigger size of the RBCs;Morphology:imbalance development of cytoplasma: nucleus;WBC morphology:enlarged WBC with hyperfragmented;Megakaryocyte/plt:normal or decreased.,37,38,Determination of FA and Vitamin B1