ppt课件-马—营养性贫血(英文)

NUTRITIONAL ANEMIA Nutritional iron deficiency anemia (IDA) Ma Ma LianLian CONTENTS nINDUCTION nIRON METABOLISM nETIOLOGY /PATHOGENESIS nMANIFESTATIONS nLABORATORY FINDINGS nDIAGNOSIS & DIFFERENTIAL nPREVENTION & TREATMENT INTRODUCTION nDefinition / describing nThe anemia caused by insufficient dietary iron uptake, in which the iron storage and hemoglobin synthesis decreased. nClinical characteristics n iron stores serum iron nhemoglobin concentration , hypochromic microcytic anemia, ngood response to iron therapy. n6mo to 3 yrs. nIncidence INTRODUCTION IRON METABOLISM nCONTENTS nNew born 75mg/kg nChildren35-70mg/kg nAdults nM 50mg/kg nF 35mg/kg nCMOPARTMENT nHemoglobin 64% nStorage iron 30% nferritin nhemosiderin nMyloglobin 3% nEnzyme iron 0.4% nSerum iron 0.4% nIron sources nHemoglobin iron nDietary iron IRON METABOLISM nDietary iron nHigh in iron nRed meat/ liver kidney/ oily fish nAverage iron nBeans / fortified cereals/ dark green vegetables/ dried fruit/ nuts and seeds nPoor in iron nmilk IRON METABOLISM nIron absorption general absorption1-20% nMeat/ fish/ chicken10-25% nCereals/vegetables1% nBreast/cows milk50%/10% IRON METABOLISM ABSORPTION & TRANSPORT Hemoglobin iron non hemoglobin iron gastric juice proteinase proteolytic HCl heme ferric hemolytic ferric reductase *Vit C ferrous duodenum upper jujenum ferric mucosal cells transferrin* circulation GI tract liver /spleen marrow (fig2) Ferritin Fe TfR transferritinFe Fe IRON METABOLISM Mucous cells IRON METABOLISM nIron stores and utilizing Liver Spleen Marrow RBC iron Food iron SI FeFe heme + globin (fig2) Hb FeFe marrow IRON METABOLISM nRequirement and excretion demand excretion adults 1mg/d 1mg/d 1mg/d 4mo-3yr 1mg/kg (15ug/kg/d) premature 2mg/kg ETIOLOGY & PATHOGENESIS nETIOLOGY nPoor iron stores nPoor dietary intake of iron* nOverdevelop nChronic bleeding nPoor iron stores nPoor dietary intake of iron* nMilk and cereals nFactors influencing absorption nDiarrhea and infection nOverdevelop nBlood loss and iron depletion ETIOLOGY & PATHOGENESIS It is common in the first two years of age ETIOLOGY & PATHOGENESIS nPoor iron stores nPoor dietary intake of iron* nOverdevelop n3-5mo/ 1yr nPremature birth nPuberty nBlood loss and iron depletion /Chronic bleeding The children usually It is Common in the first two years of age company with another malnutrition. ETIOLOGY & PATHOGENESIS nPoor iron stores noverdevelop nPoor dietary intake of iron* nBlood loss and iron depletion / Chronic bleeding Cows milk Hookworm infection Menstruating Others: It is the important cause of IDA in older children nPathogenesis iron + protoporphyrin IDA heme + globins hemoglobin ETIOLOGY & PATHOGENESIS nPathogenesis nHypochromic / microcytic anemia nID. Iron deficiency nIDE. Iron deficiency erythropoiesis nIDA. Iron deficiency anemia nEnzymes nImmune function nSkin/mucosal ETIOLOGY & PATHOGENESIS nFeatures nAge nThe onset of the IDA nThe degree of anemia CLINICAL MANIFESTATIONS nPallor nExtramedullary hematopoiesis nMild/ Severe condition nDigestive system nCardiac function nNeurology/ intellectual nImmune function CLINICAL MANIFESTATIONS nIDA: microcytic/hypochromic + SI nPeripheral blood： nHemoglobin level nRBC MCV 62.7umol/L (350ug/dl) nTS： 0.9umol/L or 50ug/dl) nID： SF 12ug/L / marrow iron LABORATORY FINDINGS NormalIDIDEIDA Marrow iron+ +0 SF (ug %) 10060 10-20 FEP SI TIBC TS Hb MCV MCH Laboratory findings Normal Patient Iron deficiency anemia:low power view of peripheral blood film Bone marrow nDiagnosis nImpression：age, feeding, PBL nDiagnosis：biochemical change nProven by therapy DIAGNOSIS & DIFFERENTIAL diagnosis Determination of the cause of IDA is most important for diagnosis nDifferential nChronic & inflammatory diseases nThalassemia nPulmonary hemosiderosis nSiderblastic anemia DIAGNOSIS & DIFFERENTIAL TREATMENT nGeneral care nEradicate the causes* nIron therapy* ntransfusion nIron therapy nElemental iron： 4-6mg/kg/d nOral medication nTypes nAdministration nBetween meals nVitamin C nCourse TREATMENT Ferrous Salts4mg/kg/d Ferrous sulfate （20%）20mg/kg/d ferrous fumarate (30%）13mg/kg/d Ferrous gluconate（11%）40mg/kg/d Table: Ferrous salts ant the iron contents nIron therapy nInfusion iron nindication ntypes： TREATMENT IRON THERAPY RESPONSE（from Nelson） time response 12-24 hrReplacement of iron enzymes,subjective improvement 36-48 hrInitial marrow response: erythroid hyperplasia 48-72 hrReticulocytes peaking 5-7 4-30 daysHemoglobin level 1-3 mo Replenish of stores TREATMENT nTransfusion nIndications nSevere anemia nInfection nPre-operation nComponent： red blood cells nVolume：Hb 30g/L, 3-5ml/kg Hb 30-60g/L, 5-10ml/kg nAttentions PREVENTION nEducation nFor pregnant women nFor interm nBreast milk/cows milk nIron rich supplementary food nIron-fortified food nFor premature infant Review these contents after class, try to make the summary on: 1.The characteristics of iron metabolism in fetus and infants 2. The etiology of IDA 3. Laboratory findings according to the stages 4. Differentials: esp with thalassemia 5. Important treatment nFactor