急性肾小球肾炎AGN.ppt

NutritionalAnemia,营养性贫血DepartmentofPediatricsSoochowUniversityAffiliatedChildrensHospital,MainPoint要点,MasterironmetabolismtraitMasterclinicalfeatures,diagnosis,therapyandpreventionofnutritionalanemiaKnowwellpathogenesisandlaboratoryfindingsofnutritionalanemia,(一)nutritionalirondeficiencyanemia,NIDA-营养性缺铁性贫血,1、Introduction-简介Definition/describingAnemiaisdefinedasapathologicalprocess(syndrome)inwhichhemoglobin(Hb)concentrationinredcellsisabnormallylow,consideringvariationsastoage,gender,sea-levelaltitude,asaresultofseveralsituationssuchaschronicinfections,hereditarybloodconditions,deficiencyofoneormoreessentialnutrientsthatarenecessaryfortheformationofhemoglobine.g.:folicacid,B12,B6andCvitamins,andproteins.,Therefore,thereisnodoubtthatirondeficiencyisthecauseofmostanemia.Itiscalledirondeficiencyanemia.Theanemiacausedbyinsufficientdietaryironuptake,inwhichtheironstorageandhemoglobinsynthesisdecreased.,Clinicalcharacteristics-临床特征,ironstoresserumironhemoglobinconcentration,hypochromicmicrocyticanemiagoodresponsetoirontherapy6moto3yrs,2、IRONMETABOLISM-铁代谢,CONTENTSNewborn75mg/kgChildren35-70mg/kgAdultsM50mg/kgF35mg/kg,CMOPARTMENTHemoglobin64%Storageiron30%ferritinhemosiderinMyloglobin3%Enzymeiron0.4%Serumiron0.4%,Ironsources-铁来源,HemoglobinironDietaryiron,Dietaryiron-饮食铁,HighinironRedmeat/liverkidney/oilyfishAverageironBeans/fortifiedcereals/darkgreenvegetables/driedfruit/nutsandseedsPoorinironmilk,Ironabsorption-吸收,generalabsorption1-20%Meat/fish/chicken10-25%Cereals/vegetables1%Breast/cowsmilk50%/10%,Ironstoresandutilizing-储存和利用,Hb,Fe,Fe,heme+globin,RBCiron,Foodiron,LiverSpleenMarrow,SI,Requirementandexcretion需求和排泄,demandexcretionadults1mg/d1mg/d4mo-3yr1mg/kg(15ug/kg/d)premature2mg/kg,3、ETIOLOGY&PATHOGENESIS-病因和病理生理,ETIOLOGY-病因PoorironstoresPoordietaryintakeofiron*OverdevelopChronicbleeding,Poorironstores-铁贮存不足,PrematurebirthMultiplebirth/LowweightbirthCordbloodMotherironreserve,Poordietaryintakeofiron*-饮食摄入铁不足,MilkandcerealsFactorsinfluencingabsorptionDiarrheaandinfection,Overdevelop-发育需求,3-5mo/1yrPrematurebirthPuberty,Chronicbleeding-慢性失血,CowsmilkHookworminfectionMenstruatingOthers,Pathogenesis-病理生理iron+protoporphyrinIDAheme+globinshemoglobin,Hypochromic/microcyticanemiaID.Irondeficiency-铁缺乏IDE.Irondeficiencyerythropoiesis-缺铁性红细胞生成IDA.Irondeficiencyanemia-缺铁性贫血EnzymesImmunefunctionSkin/mucosal,4、CLINICALMANIFESTATIONS-临床表现,FeaturesAgeTheonsetoftheIDAThedegreeofanemia,PallorExtramedullaryhematopoiesisMild/SevereconditionDigestivesystemCardiacfunctionNeurology/intellectualImmunefunction,5、LABORATORYFINDINGS-实验室检查,IDA:microcytic/hypochromic+SIPeripheralblood：HemoglobinlevelRBCMCV80fl,MCH50ug/dl)ID：SF12ug/L/marrowiron,6、DIAGNOSIS&DIFFERENTIAL-诊断和鉴别,DiagnosisImpression：age,feeding,PBLDiagnosis：biochemicalchangeProvenbytherapy,DifferentialChronic&inflammatorydiseases-慢性或炎症性疾病Thalassemia-地中海贫血Pulmonaryhemosiderosis-肺含铁血黄素沉着Siderblasticanemia-铁粒幼细胞性贫血,7、TREATMENT-治疗,GeneralcareEradicatethecauses*Irontherapy*transfusion,Irontherapy-铁剂,Elementaliron：4-6mg/kg/dOralmedication-Types-AdministrationBetweenmealsVitaminCCourse,Table:Ferroussaltsanttheironcontents,FerrousSalts4mg/kg/dFerroussulfate（20%）20mg/kg/dferrousfumarate(30%）13mg/kg/dFerrousgluconate（11%）40mg/kg/d,IRONTHERAPYRESPONSE（fromNelson）,Transfusion-输血,IndicationsSevereanemiaInfectionPre-operationComponent：redbloodcellsVolume：Hb30g/L,3-5ml/kgHb30-60g/L,5-10ml/kgAttentions,8、PREVENTION-预防,EducationForpregnantwomenForintermBreastmilk/cowsmilkIronrichsupplementaryfoodIron-fortifiedfoodForprematureinfant,Review:thesecontentsafterclass,trytomakethesummaryon,ThecharacteristicsofironmetabolisminfetusandinfantsTheetiologyofIDALaboratoryfindingsaccordingtothestagesDifferentials:espwiththalassemiaImportanttreatment,(二)MegaloblasticAnemia-巨幼细胞性贫血,SimilaraspectstoIDAAgeAnemiabyinadequatedietaryintake,PathogenesisVitamin12NucleotideFolicacidTetrahydrofolicacidFolicacidreductaseDNASynthesis,Manifestation&Differential,PaleandpuffyneurologicalinvolvementLabfindings-Macrocyticnormochromicanemia-Neutropeniawith/thrombocytopenia-Marrowfilm:megaloblasticformsofnucleatedRBC-SerumVit