医学课件 _1

第二临床学院内科教研室 Anemia content Definition Classification Clinic feature History taking Examination Investigation Treatment definition Reduction of red cells volumn below reference value 外周血红细胞容量低于正常值 Not a disease but a sign of an underlying disease Criterion 我国标准：在我国海平面地区，成年男性 Hb低于 120g/L, 女性低于 110g/L, 孕妇低于 100g/L。 高原地区居民 Hb正常值高。 Spurious anemia 假性贫血： due to changed plasma volumn e.g. pregnant Type of anemia (mean corpuscular volume) Microcytic Normocytic 缺铁性贫血、 铁粒幼细胞贫血 、 地中海贫血 巨幼细胞贫血、伴 网织红细胞大量增 生的溶血性贫血、 骨髓增生异常综合 征 再障、 纯红再障、 溶血性贫血、 骨髓病性贫血 、急性失血 Based on MCV 红细胞平均体积 80-100fl Macrocytic Type of anemia Based on degree 4.5ug/gHb。 IRON DEFICENCY - STAGES ID reduction in iron stores without reduced serum iron levels Hb (N), MCV (N), iron absorption (), transferin saturation (N), serum ferritin (), marrow iron () IDE iron stores are exhausted, but the blood hemoglobin level remains normal Hb (N), MCV (N), TIBC (), serum ferritin (), transferrin saturation (), marrow iron (absent) IDA blood hemoglobin concentration falls below the lower limit of normal Hb (), MCV (), TIBC (), serum ferritin (), transferrin saturation (), marrow iron (absent) 诊断与鉴别诊断 一、诊断： （一） ID（贮存铁耗尽）符合 1条以上 血清铁蛋白 （ 4.5ug/gHb； Hb 尚正常。 （三） IDA： IDE的 + ； 小细胞低色素性贫血： Hb正常， MCV、 MCH 、 MCHC均 正常。 （四）病因诊断： 只有明确病因， IDA才能根治。有时病因比贫 血本身更严重。 鉴别诊断 铁粒幼细胞性贫血； sideroblast anemia 地中海贫血； thalassemia 慢性疾病性贫血。 Chronic disease anemia Management History and physical examination is sufficient to exclude serious disease (e.g pregnant women, adolescents) - CURE ANEMIA History and/or physical examination is insufficient (e.g old men, postmenopausal women) - FIND ETIOLOGY OF ANEMIA AND CURE (CAUSAL TREATMENT) Benzidine test Gastroscopy Colonoscopy Gynaecological examination Treatment iron： oral iron. Enhanced : fish, meat, vit C inhibited: milk, cereals, tea how long to judge the effect? - 5-10天网织红细胞升高； - 2周后 Hb升高； - 2月恢复正常； - Hb恢复正常后补充 4-6月。 Causal treatment PARENTERAL IRON SUBSTITUTION Bad oral iron tolerance (nausea, diarrhoea) Necessity of quick management (CHD, CHF) 50 - 100 mg daily I.v only in hospital (risk of shock) I.m in outpatient department summary Definition Metabolism of iron M