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1.贫血贫血:Anemia2.出血出血:Bleeding3.白血病白血病:Leukaemia4.血栓血栓:Thrombus贫血的概念和分类:贫血的概念和分类:A decrease in normal number of red blood cells(RBCs)or less than the normal quantity of hemoglobin in the blood.However,it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity.缺铁性贫血缺铁性贫血-Fe,儿童,女性(减肥,月经儿童,女性(减肥,月经 男性铁排泄很少)男性铁排泄很少)影响儿童智力发育,疲劳心慌影响儿童智力发育,疲劳心慌 呼吸困难,颜面苍白呼吸困难,颜面苍白巨幼红细胞性贫血巨幼红细胞性贫血-B12,叶酸缺乏叶酸缺乏恶性贫血恶性贫血-骨髓骨髓缺铁性贫血:缺铁性贫血:铁剂:铁剂:富马酸亚铁富马酸亚铁 硫酸亚铁硫酸亚铁枸橼酸亚铁枸橼酸亚铁右旋糖酐铁右旋糖酐铁ReticulocyteRed cell干细胞干细胞Why small sized RBC and light coulour?HemoglobinHeamGlobinThalassemiaIronProtoporphyrinIron deficiencyChronic diseasesSideroblastic anemiaErythroblast(有核红细胞有核红细胞)ReticulocyteRed cellStem cell为啥细胞小色素低?Ferritin-iron storage protein,24 subunits,hollow spherical structure within which iron is stored.4500 Fe/protein.HemeGrowing Children,Preganant Women,Menstruating Women富马酸亚铁富马酸亚铁 硫酸亚铁硫酸亚铁 枸橼酸铁铵枸橼酸铁铵右旋糖酐铁右旋糖酐铁Ads of IronGastrointestinal side effects:1.Nausea,vomiting2.Abdominal pain3.ConstipationContraindications:1.Severe damage to liver and renal function,or untreated urinary tract infections (口服和静脉注射都有毒?口服和静脉注射都有毒?)2.Iron overload3.Non-iron deficiency anemiaHow to overcome?Vitamin C+Fe3+?Less B12Vitamin B12 and Folic Acid贫血的中医解释贫血的中医解释萎黄,黄胖萎黄,黄胖虚损,虚劳虚损,虚劳1.1.食物结构不合理食物结构不合理2.2.生长发育迅速生长发育迅速3.3.妊娠妊娠4.4.月经过多月经过多5.5.溃疡溃疡6.6.长期使用阿司匹林长期使用阿司匹林 中医食疗:中医食疗:正确的治疗:治疗溃疡,调理月经正确的治疗:治疗溃疡,调理月经 治疗痔疮,治疗痔疮,调整膳食调整膳食 改善体质,治疗过敏改善体质,治疗过敏 宝宝贫血宝宝贫血1.1.表现:四季总好得病表现:四季总好得病 鼻子眼角发黄鼻子眼角发黄 眼睑口唇苍白眼睑口唇苍白 精气神不太好精气神不太好2.2.原因:牛奶、蔬菜过敏原因:牛奶、蔬菜过敏 严重地偏食严重地偏食 膳食不合理膳食不合理 哺乳妇贫血哺乳妇贫血2.2.辅食辅食 蛋黄泥蛋黄泥 肝脏泥肝脏泥 苹果(苹果(Vc)Vc)含酸水果含酸水果 菠菜菠菜 血肠血肠 大枣大枣 瘦肉瘦肉 炒菜急火,加醋炒菜急火,加醋1.4-61.4-6个月宝宝就把母亲的铁用光个月宝宝就把母亲的铁用光 靠辅食物来补铁靠辅食物来补铁每每100100克的营养成分克的营养成分能量能量328328千卡千卡 蛋白质蛋白质15.215.2克克 脂肪脂肪28.228.2克克 碳水化合物碳水化合物3.43.4克克 胆固醇胆固醇15101510毫克毫克 维生素维生素A438A438微克微克 硫胺素硫胺素0.330.33毫克毫克 核黄素核黄素0.290.29毫克毫克 烟酸烟酸0.10.1毫克毫克 维生素维生素E5.06E5.06毫克毫克 钙钙112112毫克毫克 磷磷240240毫克毫克 钾钾9595毫克毫克 钠钠54.954.9毫克毫克 镁镁4141毫克毫克 铁铁6.56.5毫克毫克 锌锌3.793.79毫克毫克 硒硒27.0127.01微克微克 铜铜0.280.28毫克毫克 锰锰0.060.06毫克毫克 蛋黄泥米粉水蛋黄泥米粉水100100克猪肝含:克猪肝含:蛋白质蛋白质21.321.3克,克,脂肪脂肪4.54.5克,克,碳水化合物碳水化合物1.41.4克,克,钙钙 1111毫克,毫克,磷磷270270毫克,毫克,铁铁25.025.0毫克,毫克,锌锌5.785.78毫克,毫克,硫胺素硫胺素0.400.40毫克,毫克,核黄素核黄素2.11 2.11 毫克,毫克,尼克酸尼克酸16.216.2毫克,毫克,抗坏血酸抗坏血酸1818毫克;毫克;维生素维生素A A、B1.B2 B1.B2 猪肝泥粥猪肝泥粥苹果泥苹果泥菠菜每菠菜每100100克含:克含:水分水分91.891.8克,克,蛋白质蛋白质2.42.4克,克,脂肪脂肪0.50.5克,克,碳水化合物碳水化合物3.13.1克,克,粗纤维粗纤维0.70.7克,灰分克,灰分1.51.5克,克,胡萝卜素胡萝卜素 3.873.87毫克,毫克,维生素维生素B10.04B10.04毫克,毫克,维生素维生素B20.13B20.13毫克,毫克,尼克酸尼克酸0.60.6毫克,毫克,维生素维生素C 39C 39毫克,毫克,钙钙7272毫克,磷毫克,磷5353毫克,毫克,铁铁1.81.8毫克毫克,钾,钾502502毫克,毫克,钠钠98.698.6毫克,毫克,镁镁34.334.3毫克,氯毫克,氯200200毫克。毫克。儿童偏食引起的贫血:儿童偏食引起的贫血:1.1.延长进食间隔,增强饥饿感,延长进食间隔,增强饥饿感,有助于孩子体验饱腹感有助于孩子体验饱腹感 进食时间可延长到进食时间可延长到3 3小时小时 2.2.限制零食和高热量食物限制零食和高热量食物 3.3.限定吃饭时间,不超过限定吃饭时间,不超过2525分钟分钟 4.4.把喜欢和不喜欢的食物参合到把喜欢和不喜欢的食物参合到 一起给孩子吃一起给孩子吃 5.5.吃饭少说话,不要摆弄玩具吃饭少说话,不要摆弄玩具 或看电视或看电视 6.6.父母做榜样不要偏食父母做榜样不要偏食 7.7.父母做的饭菜也要可口父母做的饭菜也要可口孩子吃西红柿可以去皮:孩子吃西红柿可以去皮:1.1.开水烫开水烫 2.2.微波炉打微波炉打 3.3.炉火烤炉火烤 4.4.直接刮直接刮制成西红柿土豆排骨汤,适合孩子吃制成西红柿土豆排骨汤,适合孩子吃刮皮土豆应及时放到冷水中,防止氧化刮皮土豆应及时放到冷水中,防止氧化(酶的促进氧化作用)(酶的促进氧化作用)姜、陈皮开胃助消化姜、陈皮开胃助消化宝宝:要少盐,肾脏发育尚不完全宝宝:要少盐,肾脏发育尚不完全胃:仓廪官胃:仓廪官中医中医胃脘痛胃脘痛 饥饱痨饥饱痨胃脘痛食疗:胃脘痛食疗:1.1.枸杞子,绿豆枸杞子,绿豆 2.2.主食:主食:面条,面条,少吃米饭(酸)少吃米饭(酸)米粥加碱熬制米粥加碱熬制3.3.小米粥红糖,馒头小米粥红糖,馒头本草纲目本草纲目小米:小米:养肾气,去脾胃中热,益气。养肾气,去脾胃中热,益气。陈者:苦,寒。治胃热消渴,利小便。陈者:苦,寒。治胃热消渴,利小便。红糖:富含铁等,来自甘蔗。花生生吃,饭前红糖:富含铁等,来自甘蔗。花生生吃,饭前4-64-6粒。粒。心理调节:胃病源自七情;气功运动心理调节:胃病源自七情;气功运动 月经过多吃什么好?月经过多吃什么好?1.1.韭菜炒羊肝韭菜炒羊肝韭菜:消炎止血止痛韭菜:消炎止血止痛 兴奋离体子宫兴奋离体子宫 壮阳草壮阳草羊肝:养肝,明目羊肝:养肝,明目 补血,清虚热补血,清虚热 备料:羊肉备料:羊肉500500克,当归、生地各克,当归、生地各1515克,干姜克,干姜1010克。克。食用方法:羊肉洗净,切块,放砂锅中,并入洗净之食用方法:羊肉洗净,切块,放砂锅中,并入洗净之药及酱油、盐、糖、黄酒、清水各适量,红烧至肉烂。药及酱油、盐、糖、黄酒、清水各适量,红烧至肉烂。适用症:气虚所致月经量多。适用症:气虚所致月经量多。备料:黄芪备料:黄芪3030克,粳米克,粳米100100克。克。食用方法:先煎黄芪去渣、下米、煮作粥,空腹食之。食用方法:先煎黄芪去渣、下米、煮作粥,空腹食之。适用症:气虚不能摄血之月经过多适用症:气虚不能摄血之月经过多橘皮丁香茶橘皮丁香茶1.1.橘皮丁香茶治疗胃寒、胃痛橘皮丁香茶治疗胃寒、胃痛方法:橘皮方法:橘皮3 3克,丁香克,丁香3 3克,煎水代茶饮,克,煎水代茶饮,有理气、散寒、止痛的作用。有理气、散寒、止痛的作用。2.2.橘皮茶治疗食滞胃胀或气滞胃痛橘皮茶治疗食滞胃胀或气滞胃痛方法:用鲜橘皮半个或干橘皮方法:用鲜橘皮半个或干橘皮3 3克,切克,切丝,开水冲泡当茶饮,既能行气止痛又丝,开水冲泡当茶饮,既能行气止痛又可理气消胀可理气消胀丁丁 香香Flos Caryophylli来源:桃金娘科植物来源:桃金娘科植物 丁香干燥花蕾丁香干燥花蕾产地:坦桑尼亚,产地:坦桑尼亚,马来西亚马来西亚 海南广东引种海南广东引种【化学成分与药理作用化学成分与药理作用】1.1.挥发油:挥发油:15-20%15-20%2.2.主要成分:丁香酚,主要成分:丁香酚,78-95%78-95%1.1.刺激胃酸胃蛋白酶分泌刺激胃酸胃蛋白酶分泌2.2.抗病原微生物抗病原微生物3.3.止泻作用止泻作用温里药温里药降胃气降胃气【性状性状】香气浓郁香气浓郁,味辛辣,有麻舌感,味辛辣,有麻舌感公丁香公丁香母丁香母丁香女子:氷冷酒,女子:氷冷酒,一点,一点,两点,两点,三点三点 状元:丁香花,状元:丁香花,百头,百头,千头,千头,寓头寓头质量好的丁香:质量好的丁香:质坚实,富油性;质坚实,富油性;气芳香浓烈,味辛辣,有麻舌感。气芳香浓烈,味辛辣,有麻舌感。以完整、朵大、油性足、颜色深红、以完整、朵大、油性足、颜色深红、香气浓郁、入水下沉者为佳。香气浓郁、入水下沉者为佳。大叶丁香大叶丁香丁香丁香消化系统消化系统温里药:肉桂,附子,干姜,吴茱萸温里药:肉桂,附子,干姜,吴茱萸 胡椒,花椒,小茴香,丁香胡椒,花椒,小茴香,丁香行气药:陈皮,青皮,沉香行气药:陈皮,青皮,沉香消食药消食药 山山 楂,降解脂肪的酶,促进胃蛋白酶分泌楂,降解脂肪的酶,促进胃蛋白酶分泌 提高胃蛋白酶活性,荤食提高胃蛋白酶活性,荤食 莱菔子莱菔子 神神 曲,荤素均可曲,荤素均可 麦麦 芽,素食芽,素食 谷谷 芽芽 鸡内金鸡内金 鸡矢藤鸡矢藤 隔山消隔山消 阿阿 魏魏山山 楂楂Fructus Crataegi来源:蔷薇科植物山楂来源:蔷薇科植物山楂 的干燥成熟果实的干燥成熟果实产地:山东河北河南产地:山东河北河南 辽宁辽宁【化学成分与药理作用化学成分与药理作用】山楂酸山楂酸脂肪酶脂肪酶1.促进消化:油腻食物促进消化:油腻食物2.降血脂:活血化瘀降血脂:活血化瘀3.降血压降血压4.强心强心5.治疗冻伤治疗冻伤性性状状1.1.对胃肠道平滑肌的作用对胃肠道平滑肌的作用 陈皮挥发油对胃肠道有陈皮挥发油对胃肠道有温和的刺激作用,促进消化液分泌,排除肠管内积温和的刺激作用,促进消化液分泌,排除肠管内积气。陈皮煎剂可直接抑制肠管平滑肌,对抗乙酰胆气。陈皮煎剂可直接抑制肠管平滑肌,对抗乙酰胆碱,具有解痉作用。碱,具有解痉作用。2.2.祛痰平喘作用祛痰平喘作用 陈皮挥发油有祛痰作用。煎剂、陈皮挥发油有祛痰作用。煎剂、醇提物有松弛气管平滑肌的平喘作用。醇提物有松弛气管平滑肌的平喘作用。此外还有增强心肌收缩力、抗炎、增强免疫、抗氧此外还有增强心肌收缩力、抗炎、增强免疫、抗氧化等作用。化等作用。本品性温,味苦、辛。理气健脾,燥湿化痰。本品性温,味苦、辛。理气健脾,燥湿化痰。用于胸脘胀满,食少吐泻,咳嗽痰多;用量用于胸脘胀满,食少吐泻,咳嗽痰多;用量3 310g10g,水煎服。,水煎服。Enterohepatic Circulation?CLINICAL PHARMACOLOGY1.Nucleoprotein synthesis 2.Maintenance of erythropoiesis.3.To stimulate specifically the production of red blood cells,white blood cells,and platelets in persons suffering from certain megaloblastic anemias.AdsB12:1.Hypersensitivuty2.Increase cancer growth 3.Inactivated by VCWhen take Folic Acid?叶酸不足,补充叶酸不足,补充B12如何?如何?Aplastic AnemiaA rare and serious blood disorder in which bone marrow stops making enough new blood cells 与缺铁性贫血的区别?与巨幼红细胞性贫血区别?与缺铁性贫血的区别?与巨幼红细胞性贫血区别?Etiology:Acquired:More commonInherited:Fanconi anemiaCauses:1.Drugs:Cytotoxic drug,Anti-inflammatory,Anti-convulsant2.Virus3.Chemicals4.ImmuneThe latest theory is:The latest theory is:there there is is an an intrinsic intrinsic derangement derangement of of hemopoietic hemopoietic proliferative proliferative capacity,capacity,which which is is consistent consistent with with life.life.The The immune immune mechanism mechanism attempt attempt to to destroy destroy the the abnormal abnormal cells cells(self(self cure)cure)and and the the clinical clinical course course and and complications depend on the plications depend on the balance.AnemiaInfectionFeverBleedingTreatment of Aplastic Anemia1.Withdrawal of etiological agents.2.Supportive,blood transfusion et al.3.Restoration of marrow activity:(1)Bone marrow transplant(2)Immunosuppressive treatment Prednisolone Cyclosporin Splenectomy(3)Androgens(4)Growth factors输去掉白细胞的血有何好处?输去掉白细胞的血有何好处?Agents Used in ThrombusHeparinIV InjectionIndications of HeparinAdverse reactions of Heparin1.Bleeding2.Heparin-induced ThrombocytopeniaCoumarinsDicoumarolWarfarinAcenocoumarolTarget-Vitamin K epoxide reductaseInhibition of ProthrombinVII,IX,XProtein C and S1.Relationship between Dosage and Speed of Onset?2.The only differnece among oral coumarins in producing and maintaining hypoprothrombinemia is?Toxicity of Coumarins1.Hemorrhagic Disorder in the Fetus.2.Birth defect of abnormal bone formation3.Hemorrhgaic infarction during the first weeks of therapyAntiplatelet DrugsADP-Adenosine Diphosphate,to induce platelet aggregationTXA2-Thromboxane A2,platelet activation and vassolconstriction5-HT-Serotonin Aspirinlow dase,irreversible inhibition of TXA2,Ridogrelstrong inhibition of TXA2Persantinvasodilator,in combination with aspirinClopidogrel and Ticlopidine-Fibrinolytic DrugsAnistreplase Classification:Thrombolytic enzyme Action/Kinetics:Prepared by acylating human plasma derived from lys-plasminogen and purified streptokinase derived from group C beta-hemolytic streptococci.When prepared,anistreplase is an inactive derivative of a fibrinolytic enzyme although the compound can still bind to fibrin.Anistreplase is activated by deacylation and subsequent release of the anisoyl group in the blood stream.The production of plasmin from plasminogen occurs in both the blood stream and the thrombus leading to thrombolysis.Lyses thrombi obstructing coronary arteries and reduces the size of infarcts.t1/2:70-120 min.Bleeding Drugs:Vitamin KThrombinAdrenocorticosteroids 291.Glucocorticoid Excess:Cushings syndrome2.Glucocorticoid Deficiency3.Mineralocorticoid Excess:Primary AldosteronismAddisons disease A disease caused by partial or total failure of adrenocortical function,which is characterized by a bronzelike pigmentation of the skin and mucous membranes,anemia,weakness,and low blood pressure.Effects of GlucocorticosteroidsMechanism of Action1.Physiologic Effects(1)Direct Effects(2)Indirect Effects(3)Permissive Effects2.Pharmacological Effects(1)Anti-Inflammatory Effect(2)Immunosuppressive Effect(3)Anti-Shock Effect(4)To lower body T(5)To stimulate bone marrow red cell production(6)To raise BPClinical Pharmacology of Glucocorticoids1.Adrenocortical Insufficiency(1)Chronic(Addisons Disease)InfectionHypotension and Low blood suger levelShock or deathWhen in stress,what about the dose?(2)Acute(Addisons Disease)Large dose,IV,and slowly to Maintenance Dose2.Severe Infection3.Auto-immune disease4.Shock5.Aplastic anemia6.Local use7.Replacement therapyCase 5 Iron Deficiency Anemia Secondary to Idiopathic Thrombocytopenic Purpura(ITP)A patient,45 years old,from Fuxin,Liaoning,was diagnosed to be iron deficiency anemia secondary to Idiopathic Thrombocytopenic Purpura(ITP)and had been treated using medicines.Because of money problem.She stopped treatment by herself when recovered.Two tears later,today,her anemia with ITP took place again.Symptoms:chest pain,mouth blood bubble,gingival bleeding,fatigue,difficult walking.What medicines should be prescribed for the patient?What about their Ads and contraindications?How to explain the symtoms?Prednison(12Tabs/day)Ferrous Fumarate血康血康Case 6 LeukemiaAnother patient,female,52,got leukemia,and treated using medicines and recovered.Someday,the patient came back to the hospital to check again,and told her doctor:When using those medicines,my hair was lost,and after stop the use of the drug,my hair came back again,but all hair all over my body changed into curls.The doctor told her:everything is okay,I had met with a patient with blood type change after treatment but never seen such a case before.What agents might be used for the treatment of the patient?Why those agents can change hair or blood type?InterferonHydroxycarbamideUbenimex CapsulesImatinib Mesylate Capsules
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