医学精品课件：（参考翻译）05.3Iron Deficiency Anemia-Li Wang

IronDeficiencyAnemia

缺铁性贫血LiWangHematologyDepartment,theFirstAffiliatedHospitaloutlinesDefinition&EpidemiologyIronmetabolismEtiologyClinicalpresentationLaboratorytestingDiagnosis&differentialdiagnosisTreatmentDefinitionIrondeficiency:thecontentofironinthebodyislessthannormal.Irondepletion铁减少期:theearlieststageofirondeficiency.Irondeficiencyerythropoiesis红细胞生成缺铁期:amoreadvancedstageofirondeficiency,characterizedbydecreasedorabsentstorageiron,usuallylowserumironconcentrationandtransferrinsaturation转铁蛋白饱和度,butwithoutfrank直接的anemia.IDA缺铁性贫血:themostadvancedstageofirondeficiency,characterizedbydecreasedorabsentironstores,lowserumironconcentration,lowtransferrinsaturation,andlowbloodhemoglobinconcentration.LackofironLowserumironLowt.s.LowhemoglobinIDIDIEDAEpidemiologypopulationAgegroupIrondeficiencyIrondeficiencyanemiaShanghaiInfants婴儿75%-82.5%33.8%-45.7%F(12-49)43.32%11.39%TheprevalenceofIDAvariesbetweenage,sexes,economicgroupsetal等等IronmetabolismMostbodyironispresentinhemoglobinincirculatingredcells

FERRITIN

(铁蛋白)

and

HEMOSIDERIN

（含铁血黄素）storeiron

Themacrophagesofthereticuloendothelialsystem网状内皮系统storeironreleasedfromhemoglobinasferritin铁蛋白andhemosiderin含铁血黄素Totalironinhumanbody:TRANSFERRIN（转铁蛋白）

transportsirontothecellsFemale35mg/kgweightMale50mg/kgweightTransportofironTissueFe++Fe+++TransferrinErythropoiesisReceptorMitoHemoglobinFerritinTransferrin(转铁蛋白)+Fe+++SerumironErythroblast成红细胞TransferrinCompartmentTotalbodyIron(%)HemoglobinironStorageiron(ferritin,hemosiderin)

Myoglobin肌红蛋白ironLabilepool不稳定池OthertissueironTransportiron67273.52.20.20.08DistributionofironinhumanbodyIronsourceandabsorptionIronsource:1.dietaryiron膳食铁:Anaveragemaningests摄取15to20mgofirondaily

2.Hemeiron血红素铁:asfromhemoglobinandmyoglobin,normallycomprises包含about1/3ofdietaryiron

Heme亚铁血红素Smalllossofironeachdayinurine,faeces粪便,skinandnailsandinmenstruating

月经来潮femalesasblood(1-2mgdaily)

10%ofdailyironisabsorbed

absorb

excrete排泄1mgIronabsorption★Position:mostlythroughduodenum（十二指肠）anduppersectionofjejunum

（空肠上段）

★Theamountofironabsorbedisnormallytightlyregulated严格监管

accordingtobodyneeds.Activeerythropoiesisand/orirondeficiencyup-regulates上调

absorption;ironoverloaddown-regulates下调

absorption.InorganicironabsorptionDietaryinorganiciron膳食无机铁isabsorbedmainlyfromduodenalenterocyte

十二指肠上皮细胞

--Dietaryiron(Fe+++)intheacidenvironmentofthestomachischelated螯合byascorbicacid抗坏血酸,sugarsandaminoacids氨基酸.

--Thechelatedironisreducedtotheferrous亚铁state(Fe++)byferricreductase高铁还原酶inthealkaline碱性environmentoftheduodenum.

Adjunctadj.附属的Eggyolk蛋黄Spinachn.菠菜Fe+++Fe++Fe+++/Fe++Fe++chelatedIroncycleinhumansReticuloendothelialSystemPlasmaMature成熟ErythrocytesErythroidBoneMarrowIntestine肠liverCirculatingtransferrin120daystransferrinhemoglobinironCasepresentationMr.Zhangisa45yearoldmalewhopresentstotheclinicwithfatigueandpaleskinx2weeks.Hehasoccasionallyepigastricabdominalpain上腹部痛/discomfortwithyears.Hehadendoscopyexamineyearsago,theresultwas‘chronicgastritis慢性胃炎’.

Q1:Whatisthepossiblediagnosis?Whichsymptomssupportthem?Q2:Whatshouldyoudofurther?Causes:◆

Toolittleironindiet

(摄入不足)

◆dietaryirondeficiencychildrensenior

◆aincreasedirondemandpregnancybreastfeeding母乳喂养rapidgrowthinadolescenceEtiology◆

Malabsorptionofiron

(吸收障碍)--patientswithconditionsinfluencinggastricacidity酸度

orsmallbowelabsorption小肠吸收

Parasitosis寄生虫病

forchildren

Ulcer溃疡

orcancerforadult◆Bloodloss

(丢失过多)

◆GI,pepticulcer消化道溃疡，stomachcancer，intestinalcancer；

◆

menstruation月经

◆

intravascularredcelldestructionwithironlossintheurine

ClinicalPresentationGENERALANEMIA’SSYMPTOMS:FATIGABILITY

易疲劳DIZZINESSHEADACHESCOTOMAS

(盲点)IRRITABILITY

易怒ROARINGPALPITATION

心悸

GLOSSITIS(舌炎),STOMATITIS(口腔炎)

DYSPHAGIA

吞咽困难

(Plummer-Vinsonsyndrome)

ATROPHICGASTRITIS

萎缩性胃炎

DRY,PALESKIN

SPOONSHAPEDNAILS

匙状甲,KOILONYCHIA

反甲

HAIRLOSS

PICA异食癖(APETITEFORNONFOOD

SUBSTANCESSUCHASANICE,CLAY)

SPLENOMEGALY

脾肿大(<10%)

INCREASEDPLATELETCOUNT

CHARACTERISTICSSYMPTOMS:

SPOONSHAPEDNAILSAnswers:

Q1:AnemiaGastricdisease

Q2?LaboratorytestingROUTINEBLOODTESTmicrocytosis,hypochromia小细胞低色素性贫血

HemoglobinHb<120g/L(M);110g/L(F)平均红细胞体积(meancorpuscularvolume,MCV)<80fl平均红细胞血红蛋白量（MCH）<27pg平均红细胞血红蛋白浓度（MCHC）<32%MorphologicalclassificationofanemiaTypesMCV（fl）MCH(pg)MCHC(%)Normal80～9428～3232～38macrocytic

（大细胞性）>94>3232～38normocytic

（正细胞性）80～9428～3232～38microcytic

（小细胞性）<80<2832～38hypochromicmicrocytic

（小细胞低色素性）<80<28<32NORMALIDASmearofBloodBONEMARROWSMEAR骨髓涂片highcellularity增生活跃mildtomoderateerythroidhyperplasia(25-35%;N16–18%)红系增生为主polychromaticandpyknoticcytoplasmoferythroblastsisvacuolatedandirregularinoutline(“核老浆幼”现象)absenceofstainableiron内外铁阴性Leukocytesandmegakaryocytes巨核细胞arenormalBonemarrowSerumIronconcentration(血清铁)TheamountofironbindingwithtransferrinintheserumTotalIronBindingCapacity

（总铁结合力）ThetotalamountoftransferrinwhichcancombinewithironTransferrinsaturation

（转铁蛋白饱和度）血清铁/总铁结合力X100%TransferrinreceptorconcentrationFerritinconcentration

（铁蛋白）IronMetabolism

：DiagnosisAnemia

Hb<120g/L(M);<110g/L(F)LowMCV、MCH、MCHC(<baseline)EvidenceofIrondeficiencyIronstaininBMIronmetabolismEtiologydiagnosis

GastroscopyColonoscopyGynaecologicalexamination

AnswertoQ2:BloodRoutineBMaspirationFerritinconcentrationGastroscopy

DifferentialDiagnosismicrocytosis,hipochromia小细胞低色素性贫血

SideroblasticAnemia

(铁粒幼细胞性贫血)

Thalassemia

(地中海贫血)

Chronicdiseasedanemia(慢性病性贫血)

Atransferrinemia

(转铁蛋白缺乏症)CasepresentationMr.Zhanghad:BloodroutineBMsmear骨髓涂片Stooloccultbloodtest粪便隐血试验

‘negative’Gastrosocpy‘chronicgastritis’

Q3:Whatisthediagnosis?Q4:Howtotreatit?‘IDA’TreatmentEtiologymanagementisessential:

Removalofetiologicalfactors

Startwithoralsupplementation补充Avoidingtakingironwithantacids抗酸药orantibioticsImprovementshouldbeseeninamonth

reticuloc