内科学课件 10、IDA 2015英文

IronDeficiencyAnemia缺铁性贫血

JCDENGDefinition

amicrocyticandhypochromicanemia,resultedfromlowstoresofiron.Threestages:IrondepletionID缺铁IrondeficiencyerythropoiesisIDE缺铁性红细胞生成IrondeficiencyanemiaIDA

epidemiologyIrondeficiencycausesabouthalfofallanemiacases.affectswomenmoreoftenthanmen.Commonlyseenindevelopingcountries.Morbidity:infant(6m-2y):75%-82.5%pregnantwomen:66.7%adolescents(10y-17y):13.2%Hemoglobinmolecule血红蛋白分子

gobin

珠蛋白heme

血红素Globinproteinconsistingof4polypeptidechains(α2β2，α2δ2，α2γ2)Onehemepigmentattachedtoeachpolypeptidechaineachhemecontainsporphyrin

（卟啉）andFe2+thatcancombinereversiblywithoneoxygenmoleculeMetabolismsofironBodyirondistributionsfunctioniron:

Hb,

myoglobin

肌红蛋白,iron-containingenzymes,

transferrin

转铁蛋白

storageiron:

ferritin

铁蛋白,

hemosiderin

含铁血黄素

MetabolismsofironBodyirondistributiontotalbodyironAdultmales–50mg/kgAdultfemales–40mg/kgMetabolismsofironSourcesofironrecyclingFe–oldordestructiveRBCdietaryFehemeiron:animalsourcenon-hemeiron:plantsource

IronenrichedinsomefoodsIronpanaddsironMetabolismsofironIronabsorptionDuodenum十二指肠

upsidejejunum空肠absorbability

.Sourceoffood

.Ioniciron（Fe2+，Fe3+）

.Epitheliummediation上皮调节MetabolismsofironTransport

intestinalcellsFe2+

bloodFe3++transferrin

membraneofmarrowRBCFe3++transferrin+transferrinR.Mitochondria线粒体

Fe2++porphyrin+globin

HemoglobinMetabolismsofironDietaryintake1-1.5mg/dExcretion1mg/d

excretionintakeCauses病因Moreironrequirement,lessironintakeinfants,teenagers,pregnantwomenorlactatingwomen

increasedphysiologicrequirementsforironCausesMalabsorptionofiron

subtotalgastrectomy

胃大部切除术

GItractdisease

CausesChronicbloodloss

GItractbleedinginmales，

excessivemenstrualflowinfemales

Pathogenesis发病机制Impactonironmetabolism

ferritin

铁蛋白

serumiron：transferrin转铁蛋白-associatedFe2+

totalironbindingcapacity(TIBC)总铁结合力:thetotalamoutoftransferrinPercentoftransferrinsaturation

转铁蛋白饱和度:=serumiron/TIBC

X100%

PathogenesisImpactonRBCfreeerythrocyteprotoporphyrinFEP游离原卟啉

microcyticandhypochromicanemia

小细胞低色素贫血anemiaMCV:meancorpuscularvolume正细胞性贫血Normocyticanemia大细胞性贫血macrocyticanemia小细胞性贫血microcyticanemiaPathogenesisImpactontissueandcellmetabolism

decreasedactivityofiron-containingenzyme:

peroxidase

过氧化物酶,

cytochrome

oxidase

细胞色素氧化酶,etc.

spirit,behavior,growth,intelligence…influenced

microcytic,hypochromicanemiaImpactonRBCImpactontissueandcell

Skin,mucosa,etc.eachsystemNegativeironmetabolismIrondeficiency：impactonironmetablism

ferritin,hemosiderinserumiron,TFRsaturation

TIBCdecreasedactivityofiron-containingenzyme

HbfallsClinicalmanifestationsPresentationsof

underlyingdisease

anemia

irondeficiency

SymptomsofanemiaFatigueDizzinessHeadachePalpitation

心悸Dyspnea

呼吸困难Disturbancesinmenstruation

月经不调Lethargy

嗜睡Poorattention注意力不集中WhoareIDApatients？SymptomsofirondeficiencyIrritabilityPoorworkperformanceIncreasedfrequencyofinfectionDefect

ofepithelialtissuePica

Pica

异食癖Thehabitualingestionofunusualsubstancesearth,clay，iceUsuallyisamanifestationofirondeficiencyespeciallyafterhookworminfestation钩虫感染

andisrelievedwhenthedeficiencyistreatedIninfants:developmentaldelays;behavioraldisturbancesInpregnantwomen:anincreaseinpretermdelivery;anincreaseindeliveringalow-birth-weightchildGlossitis

舌炎

Koilonychia

匙状甲LaboratoryexaminationsBloodtest

hemoglobin

MCV <80fl

microcytic,hypochromic

anemiaBloodroutinecountLaboratoryexaminationsBonemarrowsmear

mildtomoderateerythroidhyperplasia(25-35%;N16–18%)轻中度红系增生bonemarrowshowingstainableiron

decreaseorabsence.

BonemarrowsmearBonemarrowstainableironIDAIroninsideofRBCIronoutsideofRBCLaboratoryexaminationsIronmetabolismmarkers

serumironconcentration

serumferritinlevels

(<12ug/l)totaliron-bindingcapacity

saturationoftransferrin

(<15%)serumtransferrinreceptors

sTfR

PorphyrinmetabolismmarkerFEPincreased

diagnosisToconfirmIDAToconfirmthepossiblecausesDifferentialdiagnosis

microcyticanemia

Sideroblasticanemia铁粒幼细胞性贫血Thalassemia

海洋性贫血Anemiaofchronicdisease慢性病性贫血

CaseA50yearoldmancomestoseeyoubecauseoffatigue,abdominalpainandachangeinbowelhabitfor3month.Heisfoundtohaveahemoglobinof60g/LandMCVof76fl.Stool:O.B.(+).Marrowstainableirontest(-).Heishealthypreviously.Question1:Next,whichoneisthemostimportantexamination?SerumferritinB.GIX-BariumC.ColonoscopyD.abdominalCTscanTreatmentPrincipleoftreatment:

eradicationofthecause,storageironsupplement

TreatmentTreatmentoftheunderlyingdiseaseIronsupplementtherapy

Oralirontherapy

口服铁剂

Intramuscularirontherapy肌注铁剂

treatmentOralirontherapyInorganiciron:ferroussulfate硫酸亚铁

,organiciron:ferrousgluconate

葡萄糖酸亚铁，

polyferose

多糖铁复合物ironabsorptionenhanced:vitC,meat,orangejuice,fishinhibited:spinach菠菜,tea,milk,coffeeDurationoftreatment:4-6monthsExpectedresponse:reticulocytecountincreasein

5to10days

treatmentIntramuscularirontherapyIndication:intolerancetooralironordisorderofGItractAgent：iron–dextran

右旋糖酐铁Dosage:100mgim

qd

irontobeinjected(mg)

=(150-Hb)x0.33x

weight(kg)Adverseeffects:painatthe