IDA(缺铁性贫血)#专业荟萃

1、,1,专业知识,Iron Deficiency Anemia (IDA),Dr. Liu Chonghai,2,专业知识,Iron-deficiency anemia affected about 1.48 billion people in 2015. A lack of dietary iron is estimated to cause approximately half of all anemia cases globally. Women and young children are most commonly affected. In 2015 anemia due to iro

2、n deficiency resulted in about 54,000 deaths down from 213,000 deaths in 1990.,3,专业知识,Disability-adjusted life year for iron-deficiency anemia per 100,000 inhabitants in 2004.,4,专业知识,Metabolism of Iron,A. Iron distribution in the body,5,专业知识,A. Iron distribution in the body,6,专业知识,B. The source of i

3、ron,Endogenous old RBC (2/3) Exogenous through food (1/10mg/d) Animal foods with high iron content and high heme iron, the absorption rate of 10-25% Iron of vegetable food is non-heme iron, the absorption rate of 1.7-7.9%,7,专业知识,C. Physiological requirement of iron:,1mg 1.5mg/kg/d (15yr) Premature 2

4、mg/kg/d,8,专业知识,9,专业知识,Index of iron nutrition,10,专业知识,TIBC and iron saturation in IDA,11,专业知识,Etiology of iron deficiency,1. Insufficient iron store: premature, severe maternal iron deficiency, intra-uterus transfusion etc. 2. Insufficient intake: food with insufficient iron, e.g. fed with milk, flo

5、ur or rice flour only etc. 3. Absorptive problems: chronic diarrhea, steatorrhea 4. Growth demand: young infants, premature baby, adolescent children, girls after menarche etc. 5. Blood loss: chronic gastrointestinal bleeding caused by peptic ulcer, hook worm, multiple polyps, angioma, diverticulori

6、tis or inflammative enteropathy, or acute blood loss with injury or epitaxisetc.,12,专业知识,3 stages,Iron depletion, ID: Iron deficient erythropoiesis, IDE Iron deficiency anemia, IDA,13,专业知识,Impact on body health by ID,1. Hematopoieticsystem: gradual anemia Stages Ferritin Serum iron, SI Hb ID Low N N

7、 IDE L L N IDA L L L,14,专业知识,Impact on body health by ID (continued),2. GI system: absorptive disorders; 3. Circulative system: cardiac contractivity decrease, heart enlargement, murmur and heart failure; 4. Neuroschycological system: insomnia, attention absent (aprosexia), apathy; 5. Immune system:

8、 compromised immunity, susceptible to infection; 6. Skin and hair system: dryness of skin, sparse and brittle hairs,loss of polish, fragile nails, koilonychia;,15,专业知识,Clinical Manifestation,Age:6 months 3yrs General: anemic pale, positional hypotension; GI system: diarrhea, dyspepsia, nausea, vomit

9、ing Hematopoietic System: hepatosplenomegaly (extramedullary hematopoiesis) Circulatory system: tachycardia, murmurs and heart enlargement; Immune system: infection; Neuropsycological system: pica, apathy;,16,专业知识,Lab tests-Blood smear:,17,专业知识,Microcytic and hypochromic RBC,18,专业知识,BM smear：,Cellul

10、arity: hypercellularity; Iron stain: compromised both intercellular and intracellular iron stains. Developing nucleated erythrocytes: delayed cytoplasmicdevelopment;,19,专业知识,20,专业知识,21,专业知识,Indices of iron nutrition,SI (serum iron) Fn (Ferritin) TIBC (total iron binding capacity) FEP (free erythrocy

11、ticprotopophrin),22,专业知识,1、IDA: is a gradual process which can be divided into 3 stages, ie, ID stage, IDE stage and IDA stage. 2、Ferritin is the most sensitive marker for IDA; 3、Once Hbhas been recovered to normal level, iron agents should be used continuesllyfor another 2 months.,23,专业知识,Diagnosis

12、 and differential diagnosis,Diagnosis: History clinical manifestation lab tests Differential diagnosis:(Hypochromic and microcytic anemias) thalassemia, lead poisoning, chronic infection etc.,24,专业知识,Treatment,1.Looking for etiology and modify feeding formula; 2. Medications: iron agents for Oral: f

13、errous gluconate, ferrous sulfate; for Inj: Ferrous dextran; dosage: 3-6mg elemental iron/kg/day, 3 divided doses Responses: reticulocyte 2-3d ,5-7d to peak, 2-3wks to normal. Hb 1-2wks , 3-4wks correction anemia. Caution: continue to give iron for 4-6 months(India) 6-8 wks(China) after Hb becomes n

14、ormal.,25,专业知识,Blood Transfusion,when it is necessary. 1. severe anemia with congestive cardiac failure 2. with severe infection 3. need surgery Hb 60g/L, NO.,26,专业知识,Prevention,1. Health propaganda and councilling; 2. Adequate diet for pregnant mothers; 3. Correct feeding for baby; 4. Treatment of

15、diseases: GI disorders, parasitesetc.,27,专业知识,Megaloblastic Anemia,28,专业知识,Defination:,Nutritional VitB12 or folic acid deficiency anemia was defined as the deficiency in either VitB12 or Folic acid.,29,专业知识,In India, 6.8% children had folate deficiency, 32% showed vinB12 deficiency and combined def

16、iciency China-rare,30,专业知识,Metabolism of VitB12 and Folic acid,Folic acid: Food: rich in green vegetible, lack in sheep milk; Absorptive site: at upper portion of jejunum; Vitamin B12: Food: rich in animal food; Absorptive site: terminus of ileum; Absorption helping factor: internal factor.,31,专业知识,

17、Etiology,Decreased intake （vegetarian-VB12, goat milkFolic acid ); Increasing demands; Impaired absorption (celiac disease, intestinal parasites) Disease impacts; Congenital defects: 1、congenital FA absorptive defects; 2、Juvenile pernicious anemia; 3、congenital transcobalamin defects。,32,专业知识,Clinca

18、l Manifestations,Age: peak at 6 mon 2 yrs; Anemia: soil color of skin, edema, petechae; GI system problems: dyspepsia, nausea, etc. Circulatory system: tachycardia, murmur, heart failure etc. Neurosphycological system: mental retardation, Ataxia, clonus with VitB12 defective.,33,专业知识,Lab tests,Blood

19、 smear: RBC morphology: macrocytic normochromic WBC morphology: neutrophil: large cell with hyper-fragmented nucleus Plt: enlarged size, reduced number,34,专业知识,Hyperfragmentedneutrophil,35,专业知识,Megloblastic anemia CBC,36,专业知识,BM smear:,Cellularity:hypercellularitywith bigger size of the RBCs; Morphology:imbalance development of cytoplasma: nucleus; WBC morphology:enlarged WBC with hyperfragmented; Megakaryocyte/plt:normal or decreased.,37,专业知识,38,专业知识,Determination of FA and Vitamin B12: FA: 3 ug/