内科学教学课件：Iron Deficiency Anemia

1、Iron Deficiency Anemia缺铁性贫血,outlines,Definition iron overload down-regulates 下调 absorption,Inorganic iron absorption,Dietary inorganic iron 膳食无机铁 is absorbed mainly from duodenal enterocyte 十二指肠上皮细胞 -Dietary iron (Fe+) in the acid environment of the stomach is chelated 螯合 by ascorbic acid 抗坏血酸, suga

2、rs and amino acids 氨基酸. -The chelated iron is reduced to the ferrous 亚铁 state (Fe+) by ferric reductase 高铁还原酶 in the alkaline 碱性 environment of the duodenum,Adjunct adj. 附属的 Egg yolk 蛋黄 Spinach n. 菠菜,Fe,Fe,Fe+/Fe,Fe,chelated,Iron cycle in humans,Case presentation,Mr. Zhang is a 45 year old male who

3、presents to the clinic with fatigue and pale skin x 2 weeks. He has occasionally epigastric abdominal pain 上腹部痛/discomfort with years. He had endoscopy examine years ago, the result was chronic gastritis 慢性胃炎. Q1: What is the possible diagnosis? Which symptoms support them? Q2: What should you do fu

4、rther,Causes: Too little iron in diet (摄入不足) dietary iron deficiency children senior a increased iron demand pregnancy breast feeding 母乳喂养 rapid growth in adolescence,Etiology,Malabsorption of iron (吸收障碍) -patients with conditions influencing gastric acidity 酸度 or small bowel absorption 小肠吸收 Parasit

5、osis 寄生虫病 for children Ulcer 溃疡 or cancer for adult,Blood loss (丢失过多) GI, peptic ulcer 消化道溃疡，stomach cancer，intestinal cancer； menstruation 月经 intravascular red cell destruction with iron loss in the urine,Clinical Presentation,GENERAL ANEMIAS SYMPTOMS: FATIGABILITY 易疲劳 DIZZINESS HEADACHE SCOTOMAS (

6、盲点) IRRITABILITY 易怒 ROARING PALPITATION 心悸,GLOSSITIS(舌炎), STOMATITIS(口腔炎) DYSPHAGIA 吞咽困难 ( Plummer-Vinson syndrome) ATROPHIC GASTRITIS 萎缩性胃炎 DRY, PALE SKIN SPOON SHAPED NAILS 匙状甲, KOILONYCHIA 反甲 HAIR LOSS PICA 异食癖(APETITE FOR NON FOOD SUBSTANCES SUCH AS AN ICE, CLAY) SPLENOMEGALY 脾肿大 (10%) INCREASED

7、 PLATELET COUNT,CHARACTERISTICS SYMPTOMS,SPOON SHAPED NAILS,Answers: Q1: Anemia Gastric disease Q2 ,Laboratory testing,ROUTINE BLOOD TEST microcytosis, hypochromia 小细胞低色素性贫血 Hemoglobin Hb 120 g/L(M); 110 g/L(F) 平均红细胞体积(mean corpuscular volume, MCV)80fl 平均红细胞血红蛋白量（MCH） 27 pg 平均红细胞血红蛋白浓度（MCHC） 32,Morp

8、hological classification of anemia,NORMAL,IDA,Smear of Blood,BONE MARROW SMEAR 骨髓涂片 high cellularity 增生活跃 mild to moderate erythroid hyperplasia (25-35%; N 16 18%) 红系增生为主 polychromatic and pyknotic cytoplasm of erythroblasts is vacuolated and irregular in outline (“核老浆幼”现象) absence of stainable iron

9、 内外铁阴性 Leukocytes and megakaryocytes 巨核细胞 are normal,Bone marrow,Serum Iron concentration (血清铁) The amount of iron binding with transferrin in the serum Total Iron Binding Capacity （总铁结合力） The total amount of transferrin which can combine with iron Transferrin saturation （转铁蛋白饱和度） 血清铁/总铁结合力 X100% Tr

10、ansferrin receptor concentration Ferritin concentration （铁蛋白,Iron Metabolism,Diagnosis,Anemia Hb 120 g/L (M); 110 g/L (F) Low MCV、MCH、MCHC (baseline) Evidence of Iron deficiency Iron stain in BM Iron metabolism Etiology diagnosis Gastroscopy Colonoscopy Gynaecological examination Answer to Q2: Blood

11、 Routine BM aspiration Ferritin concentration Gastroscopy,Differential Diagnosis,microcytosis, hipochromia 小细胞低色素性贫血 Sideroblastic Anemia (铁粒幼细胞性贫血) Thalassemia (地中海贫血) Chronic diseased anemia (慢性病性贫血) Atransferrinemia (转铁蛋白缺乏症,Case presentation,Mr. Zhang had: Blood routine BM smear 骨髓涂片 Stool occul

12、t blood test 粪便隐血试验 negative Gastrosocpy chronic gastritis Q3: What is the diagnosis? Q4: How to treat it,IDA,Treatment,Etiology management is essential: Removal of etiological factors Start with oral supplementation 补充 Avoiding taking iron with antacids 抗酸药 or antibiotics Improvement should be seen

13、 in a month reticulocytes（网织红细胞,Reticulocytes,ORAL SUPPLEMENTATION 200 mg of iron daily 1 hour before meal (e.g. 100 mg twice daily) How long 14 days + (Hg required level Hg current level) x 4 half of the dose 6-9 months to restore iron reserve Absorption is enhanced: vit C, meat, orange juice, fish is inhibited: cereals 谷类, tea, milk,PARENTERAL IRON SUBSTITUTION 肠外铁替代（？） Bad oral iron tolerance (nausea, diarrhoea) Necessity of quick management (CHD 冠心病, CHF 充血性心力衰竭) 50 - 100 mg daily I.v only in hospital