营养性贫血英文.pptx

NUTRITIONAL IRON DEFICIENCY ANEMIAJie Yu MD.ProfessorThe Department of Pediatrics Hematology/Oncology,Childrens HospitalCONTENTSINDUCTIONIRON METABOLISMETIOLOGY/PATHOGENESISMANIFESTATIONSLABORATORY FINDINGSDIAGNOSIS&DIFFERENTIAL PREVENTION&TREATMENTINTRODUCTIONDefinition/describingThe anemia caused by insufficient dietary iron uptake,in which the iron storage and hemoglobin synthesis decreased.HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALClinical characteristics iron stores serum iron hemoglobin concentration,hypochromic microcytic anemia,good response to iron therapy.6mo to 3 yrs.Incidence INTRODUCTIONHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALIRON METABOLISMCONTENTSNew born 75mg/kgChildren35-70mg/kgAdults M 50mg/kgF 35mg/kgCMOPARTMENTHemoglobin 64%Storage iron 30%ferritinhemosiderinMyloglobin 3%Enzyme iron 0.4%Serum iron 0.4%HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALIron sourcesHemoglobin iron Dietary ironHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALIRON METABOLISMDietary ironHigh in ironRed meat/liver kidney/oily fish Average ironBeans/fortified cereals/dark green vegetables/dried fruit/nuts and seedsPoor in iron milkHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALIRON METABOLISMIron absorption general absorption1-20%Meat/fish/chicken10-25%Cereals/vegetables1%Breast/cows milk50%/10%HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALIRON METABOLISMABSORPTION&TRANSPORT HemoglobinironnonhemoglobinirongastricjuiceproteinaseproteolyticHClhemeferric hemolytic ferricreductase *VitC ferrousduodenumupperjujenumferricmucosalcellstransferrin*circulation GItract liver/spleenmarrow(fig2)HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALFerritinFeTfRtransferritinFeFeIRON METABOLISMMucouscellsIRON METABOLISMIron stores and utilizingLiverSpleenMarrowRBCironFoodironSIFeFeheme+globin(fig2)HbFeFemarrowHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALIRON METABOLISMRequirement and excretion demand excretionadults1mg/d 1mg/d 1mg/d 4mo-3yr 1mg/kg (15ug/kg/d)premature 2mg/kgHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL ETIOLOGY&PATHOGENESISETIOLOGYPoor iron storesPoor dietary intake of iron*OverdevelopChronic bleedingPoor iron storesPremature birthMultiple birth/Low weight birthCord bloodMother iron reserve overdevelopPoor dietary intake of iron*Blood loss and iron depletionHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL ETIOLOGY&PATHOGENESISPoor iron storesPoor dietary intake of iron*Milk and cerealsFactors influencing absorptionDiarrhea and infection OverdevelopBlood loss and iron depletionHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL ETIOLOGY&PATHOGENESIS ETIOLOGY&PATHOGENESISPoor iron storesPoor dietary intake of iron*Overdevelop3-5mo/1yrPremature birthPuberty Chronic bleedingHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL ETIOLOGY&PATHOGENESISPoor iron storesoverdevelopPoor dietary intake of iron*Chronic bleedingCows milkHookworm infectionMenstruating Others:HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALPathogenesisiron +protoporphyrin IDA heme+globins hemoglobinHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALETIOLOGY&PATHOGENESISPathogenesisHypochromic/microcytic anemiaID.Iron deficiencyIDE.Iron deficiency erythropoiesisIDA.Iron deficiency anemiaEnzymesImmune function Skin/mucosalHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALETIOLOGY&PATHOGENESISFeatures AgeThe onset of the IDAThe degree of anemiaHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALCLINICAL MANIFESTATIONSPallorExtramedullary hematopoiesisMild/Severe condition Digestive systemCardiac functionNeurology/intellectual Immune functionHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALCLINICAL MANIFESTATIONSIDA:microcytic/hypochromic+SIPeripheral blood：Hemoglobin level RBC MCV 80fl,MCH 26ug,MCHC 0.31 Bone marrowErythroid hyperplasia Stainable iron HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALLABORATORY FINDINGSIDA:hypochromic/microtytic anemia+SISI：9-10.7umol/L(12.8-31.3umol/L)or 62.7umol/L(350ug/dl)TS：0.9umol/L or 50ug/dl)ID：SF 12ug/L/marrow ironHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALLABORATORY FINDINGSHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALNormalIDIDEIDAMarrow iron+0SF(ug%)100 60 10-20FEP SITIBCTS HbMCVMCH HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALDiagnosisImpression：age,feeding,PBLDiagnosis：biochemical changeProven by therapyHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALDIAGNOSIS&DIFFERENTIALDifferentialChronic&inflammatory diseasesThalassemiaPulmonary hemosiderosisSiderblastic anemiaMagaloblastic anemiaHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALDIAGNOSIS&DIFFERENTIALMegaloblastic AnemiaSimilar aspects to IDAAgeAnemia by inadequate dietary intakeHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALMegaloblastic AnemiaHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALPathogenesisVitamin12Folic acidFolic acid reductaseDNA Synthesis Tetrahydrofolic acid Nucleotide Megaloblastic AnemiaManifestation&DifferentialPale and puffyNeurological involvement Lab findingsMacrocytic normochromic anemiaNeutropenia with/thrombocytopenia Marrow film:megaloblastic forms of nucleated RBCSerum Vit B12 and/or folic acidHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALMegaloblastic AnemiaTREATMENT General careDrug therapy Vitamin B12：25-100ug/次，2-3 times/w，weeks or to Hb normal；One high dose：500ug im Folic acid：5-10mg,tid,2-3w，Effect Other drug：Vitamin C；B6；iron in recovery TransfusionHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL TREATMENTGeneral careEradicate the causes*Iron therapy*transfusionHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALIron therapyElemental iron：4-6mg/kg/dOral medicationTypesAdministrationBetween mealsVitamin CCourse HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL TREATMENTFerrous Salts4mg/kg/dFerrous sulfate（20%）20mg/kg/dferrous fumarate(30%）13mg/kg/dFerrous gluconate（11%）40mg/kg/dHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALTable:Ferrous salts ant the iron contentsIron therapyInfusion iron indicationtypes：HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL TREATMENT IRON THERAPY RESPONSE（from Nelson）time response12-24 hrReplacement of iron enzymes,subjective improvement36-48 hrInitial marrow response:erythroid hyperplasia48-72 hrReticulocytes peaking 5-74-30 daysHemoglobin level 1-3 mo Replenish of storesHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALTREATMENTTransfusion Indications Severe anemiaInfection Pre-operationComponent：red blood cellsVolume：Hb 30g/L,3-5ml/kg Hb 30-60g/L,5-10ml/kgAttentionsHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALPREVENTIONEducationFor pregnant womenFor interm Breast milk/cows milkIron rich supplementary food Iron-fortified foodFor premature infantHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALReview these contents after class,try to make the summary on:1.The characteristics of iron metabolism in fetus and infants2.The etiology of IDA3.Laboratory findings according to the stages4.Differentials:esp with thalassemia5.Important treatmentFactors influencing iron absorption Positive factorsAscorbic acid/gastric acid/amino acidNegative factorsPhosphate/phytate/Tea/coffee IRON METABOLISMHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALIRON METABOLISM Concepts SIserum ironTIBCtotal iron binding capacityTStransferrin saturationHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL