小儿营养性贫血(NUTRITIONAL-ANEMIA).ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,NUTRITIONAL ANEMIA,1,New words,Nutritional,营养的,Megaloblastic,巨幼细胞,Hamorrhage,出血,Irritability,激惹,Lethargy,嗜睡,Fatigue,疲乏,Anorexia,厌食,Appetite,食欲,Microcytic,小细胞的,Hypochromic,低色素的,Thalassemia,海洋性贫血,Ferrous sulfate,硫酸亚铁,Hookworm,钩虫,Epistaxis,鼻出血,Reticulocyte,网织红细胞,2,Nutritional anemia,Megaloblastic,anemia,vitamin B12 deficiency,folic acid deficiency,Iron deficiency anemia,iron deficiency,3,Iron,defeciency,anemia,Introduction,Cause of Iron deficiency anemia,Clinical features,Laboratory findings,Diagnosis,Defferential,diagnosis,Treatment,4,Iron Deficiency Anemia,IDA,Incidence of IDA:,10-70%(WHO),40%(6m-6y,，,China),5,IDA is the most common cause of anemia in childhood.,It usually results from,inadequate dietary,intake,rather than loss of iron through,hemorrhage,.,6,Iron in milk,Both of breast and cows milk are,low,in iron,Iron is better absorbed from breast milk,(50%),compared to cows milk,(10%),Formula milks are fortified with iron,(4%),7,Dietary sources of iron,8,Dietary sources of iron,Red meat,Fortified breakfast cereals,Dark green vegetables,Black bread,about 10-15%iron of dietary is absorbed,9,Iron requirements,The fetus absorbs iron from the,mother,across the placenta.,Term infants have adequate reserve for the first,4 months,of life.,Preterm infants have limited iron stores and because of their higher rate of growth,their iron reserves were used up by,8 weeks,of age.,Adolescents also need more iron because of,1.,Growth,spurt 2.,Dietary,deficiency 3.,Menstrual,blood loss,10,Reference nutrient intake of iron are:,6 months:4 mg/day,12 months:8 mg/day,Adult male:9 mg/day,Adult female:15 mg/day,11,（一）,the decrease of iron stores,low,birthweight,preterm infants,hemorrhage,Causes of iron,deificiency,12,Causes of iron,deificiency,（二）,Nutritional deficiency is common in certain at-risk groups,preterm infants require iron supplements from 6-8 weeks.,Term infants will develop iron deficiency after 4 months if,1.mixed feeding is unduly delayed,2.unmodified cows milk is introduced early.,It is common in the first two years of age,13,Causes of iron,deificiency,(,三）,Malabsorption,may be complicated by iron deficiency,The children usually company with another malnutrition,.,14,Causes of iron,deificiency,(,四）,Blood loss is a less common cause in children,but may occur with:,Menstruation,Hookworm infection,Repeated,venesection,in babies,Meckels,diverticulum,Recurrent,epistaxis,It is the important cause of IDA in,older children,15,Clinical features,Mild iron deficiency anemia is asymptomatic,More severe may be,irritability,Lethargy,Fatigue,anorexia,16,Signs:,pallor,of the skin and mucous membranes.,Hb,70g/L,tachycardia and cardiac dilation occur,and systolic murmurs are often present,IDA in infancy and early children is associated with,developmental delay and poor growth,Clinical features,17,Laboratory findings,18,Serum iron(SI)62.7,umol,/L,Serum,Ferritin,(SF)0.9,umol,/L,Laboratory findings,19,IDA,外周血涂片红细胞形态,Laboratory findings,20,Iron deficiency anemia:low power view of peripheral blood film,21,Microcytic,and,hypochromic,anemia.MCHC 30%,MCV 80fl,MCH 27pg,The children with the clinical features of IDA and the cause of iron deficiency,SI 10.7umol/L,Transferin,saturation 0.9umol/L,Serum,Ferritin,(SF)20%50 10 20200,Iron stores 34+0 14+,Transferrin,receptor N or N,HbF,N N,24,Thalassemia,minor,IDA,Thalassemia,minor,SI,N,or,TIBC,N,HbF,and A2 N,Differential diagnosis,25,26,Treatment,Management will depend on,The severity of the anemia,The cause of the iron deficiency,The ability of the patient to tolerate medicinal iron preparations,27,Treatment,Oral iron preparations,tablet(iron content)Elixir(iron content),Ferrous sulfate 325(65)300/5ml(60),Ferrous,gluconate,325(38)300/5ml(35),Ferrous,fumarate,325(107)100/5ml(33),Polysaccharide-iron 150(150)100/5ml(100),28,Treatment,Oral administration of simple ferrous provides inexpensive and satisfactory therapy,Ferrous sulfate,is 20%elemental iron by weight.A daily total of ferrous sulfate is 4-6 mg/kg of elemental iron in three divided doses provides,29,Serum,Irom,7,AM,12,N,12,MN,7,PM,Figure.,Oral iron,absoption,.When medicinal iron is given 3 times a day,each dose raises the SI for several hours.A fourth dose at bedtime can help sustain the SI during nighttime hours.,30,Treatment,Blood transfusion is indicated only when the anemia is very severe,Its not necessary to attempt rapid correction of severe anemia by transfusion,The children with hemoglobin values less than 40g/L should be given only 2-3ml/Kg of,RBCs,31,Responses to Iron Therapy in IDA,Time After Iron,Administration,Response,1224 hr,Replacement of intracellular iron enzymes;,decreased irritability;,increased Appetite,36-48 hr,Initial bone marrow response;,erythroid,hyperplasia,48-72 hr,Reticulocytosis,peaking at 57 days,4-30 days,Increase in hemoglobin level,1-3 mo,Repletion of stores,32,The case,8 years old boy from countryside,Diagnosis is IDA and Hookworm infection(,Hb,=65g/L),Three weeks late after treatment with,Ferrous sulfate,:,Hb,=70g/L,33,婴儿期缺铁性贫血最常见的原因是,A,胎儿期储铁不足,B,饮食中铁的缺乏,C,出血,下列哪项是鉴别缺铁性贫血与海洋性贫血的重要依据,A,临床表现,B,细胞形态,C,HbF,和,HbA2,检查,缺铁性贫血铁剂治疗后，最先改善的是,A,食欲,B,网织红细胞,C,Hb,量,34,病例,10,个月男孩,面色苍白两个月，不发烧，不咳嗽，无皮肤黏膜出血，无血便及肉眼血尿，大小便正常。,出生史：第一胎，第一产，孕,36,周早产,喂养史：生后母乳喂养至今，,6,个月开始添加辅食。平素食欲较差。,体检：皮肤黏膜苍黄，肝右肋下,2CM,，脾左肋下,2CM,实验室检查：,35,项目 结果 参考值,红细胞(,RBC,)2.68 3.5-5.01012/L,血红蛋白(,HGB)67 110-150g/L,MCV 62 82-92fl,MCH 22 27-31pg,MCHC 280 320-360g/L,RET 4.5%,血小板(,PLT,)275 100-300,109/L,白细胞(,WBC,)10.2 4.0-10,109/L,36,肝功能：,GPT 39U,，,GOT 40U,，,TB,，,DB,正常,红细胞脆性降低，,HbF,56%,37,THANKS,38,