小儿营养性贫血(NUTRITIONAL-ANEMIA)

NUTRITIONALANEMIA1小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第1页!NewwordsNutritional营养的Megaloblastic巨幼细胞Hamorrhage出血Irritability激惹Lethargy嗜睡Fatigue疲乏Anorexia厌食Appetite食欲Microcytic小细胞的Hypochromic低色素的Thalassemia海洋性贫血Ferroussulfate硫酸亚铁Hookworm钩虫Epistaxis鼻出血Reticulocyte网织红细胞2小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第2页!NutritionalanemiaMegaloblasticanemiavitaminB12deficiencyfolicaciddeficiencyIrondeficiencyanemiairondeficiency3小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第3页!IronDeficiencyAnemia,IDAIncidenceofIDA:10-70%(WHO)40%(6m-6y，China)4小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第4页!IroninmilkBothofbreastandcow`smilkarelowinironIronisbetterabsorbedfrombreastmilk(50%)paredtocow`smilk(10%)Formulamilksarefortifiedwithiron(4%)5小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第5页!DietarysourcesofironRedmeatFortifiedbreakfastcerealsDarkgreenvegetablesBlackbreadabout10-15%ironofdietaryisabsorbed6小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第6页!Referencenutrientintakeofironare:6months:4mg/day12months:8mg/dayAdultmale:9mg/dayAdultfemale:15mg/day7小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第7页!Causesofirondeificiency（二）Nutritionaldeficiencyismonincertainat-riskgroupspreterminfantsrequireironsupplementsfrom6-8weeks.Terminfantswilldevelopirondeficiencyafter4monthsif1.mixedfeedingisundulydelayed2.unmodifiedcow`smilkisintroducedearly.Itismoninthefirsttwoyearsofage8小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第8页!Causesofirondeificiency(四）Bloodlossisalessmoncauseinchildren,butmayoccurwith:MenstruationHookworminfectionRepeatedvenesectioninbabiesMeckel`sdiverticulumRecurrentepistaxisItistheimportantcauseofIDAinolderchildren9小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第9页!Signs:

palloroftheskinandmucousmembranes.Hb<70g/L,tachycardiaandcardiacdilationoccur,andsystolicmurmursareoftenpresentIDAininfancyandearlychildrenisassociatedwithdevelopmentaldelayandpoorgrowthClinicalfeatures10小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第10页!Serumiron(SI)<10.7umol/LTatalironbindingcapacity(TIBC)>62.7umol/LSerumFerritin(SF)<16ug/LFreeerythrocyteprotoporphyrin(FEP)>0.9umol/LLaboratoryfindings11小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第11页!Irondeficiencyanemia:lowpowerviewofperipheralbloodfilm12小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第12页!diagnosisDeterminationofthecauseofIDAismostimportantfordiagnosis13小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第13页!ThalassemiaminorIDAThalassemiaminorSI ↓ Nor↑T IBC ↑ NHbFandA2 N ↑

Differentialdiagnosis14小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第14页!TreatmentManagementwilldependonTheseverityoftheanemiaThecauseoftheirondeficiencyTheabilityofthepatienttotoleratemedicinalironpreparations15小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第15页!TreatmentOraladministrationofsimpleferrousprovidesinexpensiveandsatisfactorytherapy

Ferroussulfateis20%elementalironbyweight.Adailytotalofferroussulfateis4-6mg/kgofelementalironinthreedivideddosesprovides16小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第16页!TreatmentBloodtransfusionisindicatedonlywhentheanemiaisverysevereIt`snotnecessarytoattemptrapidcorrectionofsevereanemiabytransfusionThechildrenwithhemoglobinvalueslessthan40g/Lshouldbegivenonly2-3ml/KgofRBCs17小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第17页!Thecase8yearsoldboyfromcountrysideDiagnosisisIDAandHookworminfection(Hb=65g/L)ThreeweekslateaftertreatmentwithFerroussulfate:Hb=70g/L18小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第18页!病例10个月男孩面色苍白两个月，不发烧，不咳嗽，无皮肤黏膜出血，无血便及肉眼血尿，大小便正常。出生史：胎，产，孕36周早产喂养史：生后母乳喂养至今，6个月开始添加辅食。平素食欲较差。体检：皮肤黏膜苍黄，肝右肋下2CM，脾左肋下2CM实验室检查：19小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第19页!肝功能：GPT39U，GOT40U，TB，DB正常红细胞脆性降低，HbF56%20小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第20页!IrondefeciencyanemiaIntroductionCauseofIrondeficiencyanemiaClinicalfeaturesLaboratoryfindingsDiagnosisDefferentialdiagnosisTreatment21小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第21页!IDAisthemostmoncauseofanemiainchildhood.Itusuallyresultsfrominadequatedietary

intakeratherthanlossofironthroughhemorrhage.22小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第22页!Dietarysourcesofiron23小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第23页!IronrequirementsThefetusabsorbsironfromthemotheracrosstheplacenta.Terminfantshaveadequatereserveforthefirst4monthsoflife.Preterminfantshavelimitedironstoresandbecauseoftheirhigherrateofgrowth,theirironreserveswereusedupby8weeksofage.Adolescentsalsoneedmoreironbecauseof1.Growthspurt2.Dietarydeficiency3.Menstrualbloodloss24小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第24页!（一）thedecreaseofironstoreslowbirthweightpreterminfantshemorrhageCausesofirondeificiency25小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第25页!Causesofirondeificiency(三）MalabsorptionmaybeplicatedbyirondeficiencyThechildrenusuallypanywithanothermalnutrition.26小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第26页!ClinicalfeaturesMildirondeficiencyanemiaisasymptomaticMoreseveremaybeirritabilityLethargyFatigueanorexia27小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第27页!Laboratoryfindings28小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第28页!IDA外周血涂片红细胞形态Laboratoryfindings29小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第29页!①Microcyticandhypochromicanemia.MCHC<30%,MCV<80fl,MCH<27pg②ThechildrenwiththeclinicalfeaturesofIDAandthecauseofirondeficiency③SI<10.7umol/L④Transferinsaturation<15%⑤Ironstoresdecreaseinbonemarrow⑥Freeerythrocyteprotoporphyrin(FEP)>0.9umol/L⑦SerumFerritin(SF)<16ug/L⑧Goodresponsetoirontherapy①+twoof②~⑧isnecessaryforthediagnosisdiagnosis30小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第30页!Differentialdiagnosis

thalassamieIDAchronicinflammationSI NorTIBC NPercentsaturtion >20% <10%10~20%Ferritin(ug/L) >50 <1020~200Ironstores 3~4+ 0 1~4+TransferrinreceptorNor NHbF N N31小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第31页!32小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第32页!TreatmentOralironpreparations

tablet(ironcontent)Elixir(ironcontent)Ferroussulfate325(65) 300/5ml(60)Ferrousgluconate 325(38) 300/5ml(35)Ferrousfumarate 325(107) 100/5ml(33)Polysaccharide-iron150(150) 100/5ml(100)33小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第33页!SerumIrom7AM12N12MN7PMFigure.Oralironabsoption.Whenmedicinalironisgiven3timesaday,eachdoseraisestheSIforseveralhours.AfourthdoseatbedtimecanhelpsustaintheSIduringnighttimehours.34小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第34页!ResponsestoIronTherapyinIDA

TimeAfterIronAdministrationResponse12–24hrReplacementofintracellularironenzymes;decreasedirritability;increasedAppetite36-48hrInitialbonemarrowresponse;erythroidhyperplasia48-72hrReticulocytosis,peakingat5–7days4-30daysIncreaseinhemoglobinlevel1-3moRepletionofstores35小儿营养性贫血(NUTRITIONAL-ANEMIA)共38页，您现在浏览的是第35页!婴儿期缺铁性贫血最常见的原因是A胎儿期储铁不足B饮食中铁的缺乏C出血下列哪项是鉴别缺铁性贫血与海洋性贫血的重要依据A临