缺铁性贫血 (2)

Etiology病因Clinical manifestations临床表现Differential diagnosis鉴别诊断Treatment治疗,Iron-Deficiency Anemia,Iron helps red blood cells carry oxygen to the body and plays a key role in brain and muscle function. A lack of iron in the blood can lead to iron-deficiency anemia, a common nutritional deficiency . Every red blood cell in the body contains iron in its hemoglobin, the protein that carries oxygen to the bodys tissues from the lungs. Iron gives hemoglobin the strength to carry (bind to) oxygen in the blood, so that oxygen gets to where it needs to go. People who become iron deficient means that the body cant make hemoglobin, so it makes fewer red blood cells. This is a condition called anemia. Iron is essential to hemoglobin production.,Etiology,Blood LossGastrointestinal Tract胃肠道Menstrual Blood Loss月经失血Urinary Blood Loss (Rare)尿失血(罕见)Blood in Sputum (Rarer)血痰(罕见)Increased Iron Utilization利用率,生长发育快PregnancyInfancy出生后3-5月Adolescence青春期Polycythemia Vera红细胞增多Malabsorption吸收不良Tropical Sprue热带口炎性腹泻Gastrectomy胃切除术Chronic atrophic gastritis慢性萎缩性胃炎insufficient iron in the diet.铁摄入不足 乳类/谷类食物含铁低,Clinical manifestations,GeneralHemopoietic systemRespiratory& Cardiovascular systemGastrointestinal systemCNS system,Groups of people at higher risk,Girls and women their bodies cant store as much iron and lose blood during menstruation. Infants and children affected by mothers, drink excessive amounts of milk Athletes exercise often tend to lose more ironVegetarians iron from plant sources is more difficult absorbed,General,GeneralAny age; commonly found in age 6 mths 2 yrsPallor 苍白: esp. lips, buccal mucosa口腔黏膜Koilonychia 凹甲(spoon-shaped nailsTinnitus耳鸣Fainting or feeling faintfatigue and weaknessSleepiness Hemopoietic system造血系统 Enlargement of liver and spleen肝脾,Respiratory & cardiovascular systemPalpitation 心悸Dyspnea 呼吸困难Tachypnea呼吸急促Tachycardia心跳过速Enlargement of heartEven heart failure心力衰竭Gastrointestinal system消化系统Angular stomatitis口角炎Glossitis 舌炎(inflammation or infection of the tongue)Angular cheilitis 传染性口角炎(inflammatory lesions at the mouths corners)Pagophagia or pica 食冰癖,异食癖Unusual obsessive food cravingsIce chewing,CNS manifestations: central nervous systemIrritability易怒decreasing learning ability of infantLoss of concentrationreduced myelination 髓鞘形成of the spinal cord,symptoms,lack energy or the skin may be pale,more tired,physically weak,unable to concentrate,have headaches,more prone to infections,heart pain or angina 心绞痛,be irritable easily,鉴别诊断 （Differential diagnosis),诊断：初步： age年龄,deit,growth, hemogram血象确诊： Iron metabolism and biochemical 铁代谢生化证实： 治疗,Diagnosis,Useful tests include the following:Complete blood count全血球计数Serum iron血清铁, total iron-binding capacity 总铁结合力(TIBC), and serum ferritin血清铁蛋白Evaluation for hemosiderinuria含铁血黄素尿 , hemoglobinuria血红蛋白尿, pulmonary hemosiderosis肺含铁血黄素沉积,Further investigations for differential diagnosis,Peripheral blood smear末梢血像 Blood is smeared on a glass slide for microscopic examination of RBCs, which can sometimes indicate the cause of the anemia.Reticulocyte count网织红细胞计数 A measure of young RBCs, this helps to determine if RBC production is at normal levels.Bone marrow aspiration骨髓穿刺This test can help determine whether cell production is happening normally in the bone marrow.Hemoglobin Electrophoresis血红素电泳分析 and fetal hemoglobin 胎血红蛋白 Used to identify various abnormal hemoglobins in the blood and to diagnose sickle cell anemia, the thalassemias, and other inherited forms of anemia.Enzymes level,Treatment,Iron-rich dietEtiological treatment去病因治疗Iron therapy (replacement therapy补充疗法，铁剂治疗)Blood transfusion therapy输血治疗,Iron-rich diet,Meats - beef, pork, lamb, liver, and other organ meatsPoultry - chicken, duck, turkey, liver Fish - shellfish, including clams蛤蚌, mussels蚌类 , and oysters, sardines沙丁鱼Leafy greens of the cabbage family甘蓝类 , such as broccoli西兰花, turnip greens萝卜叶, and collards羽衣甘蓝Legumes豆类, such as lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas豇豆(Egg yolks蛋黄Iron-enriched white bread, pasta, rice, and cereals谷类,Etiological treatment,Correct bad habit (picky eater 挑食)Lead poisoning Parasite infection寄生虫感染blood loss ( hookworm十二指肠虫)Congenital abnormality of gastrointestinal tract胃肠道的先天性异常Body changes - An increased iron requirement and increased red blood cell production is required when the body is going through changes such as growth spurts in children and adolescents.,Iron therapy (replacement therapy),In the meanwhile addition supply of Vit C will increase iron absorption. 4-6 mg/kg/day (Ferrous sulfate硫酸亚铁) Iron therapy should produced an increase in the re