1、 NUTRITIONAL IRON DEFICIENCY ANEMIAJie Yu MD.ProfessorThe Department of Pediatrics Hematology/Oncology,Childrens HospitalCONTENTSINDUCTIONIRON METABOLISMETIOLOGY/PATHOGENESISMANIFESTATIONSLABORATORY FINDINGSDIAGNOSIS&DIFFERENTIAL PREVENTION&TREATMENTINTRODUCTIONDefinition/describingThe anemia caused
2、 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 INTRODUC
3、TIONHEMATOLOGY/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 Dietar
4、y 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 absorpt
5、ion1-20%Meat/fish/chicken10-25%Cereals/vegetables1%Breast/cows milk50%/10%HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALIRON METABOLISMABSORPTION&TRANSPORT HemoglobinironnonhemoglobinirongastricjuiceproteinaseproteolyticHClhemeferric hemolytic ferricreductase *VitC ferrousduodenumupperjujenumferricmucosalce
6、llstransferrin*circulation GItract liver/spleenmarrow(fig2)HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALFerritinFeTfRtransferritinFeFeIRON METABOLISMMucouscellsIRON METABOLISMIron stores and utilizingLiverSpleenMarrowRBCironFoodironSIFeFeheme+globin(fig2)HbFeFemarrowHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALIR
7、ON 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 bleedingPo
8、or 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 ab
9、sorptionDiarrhea 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 ETIOL
10、OGY&PATHOGENESISPoor iron storesoverdevelopPoor dietary intake of iron*Chronic bleedingCows milkHookworm infectionMenstruating Others:HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALPathogenesisiron +protoporphyrin IDA heme+globins hemoglobinHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALETIOLOGY&PATHOGENESISPathogene
11、sisHypochromic/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 HOSPITALCLINIC
12、AL 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 B
13、one 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 FINDINGS
14、HEMATOLOGY/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&DIFFERENTIALDifferentialChro
15、nic&inflammatory diseasesThalassemiaPulmonary hemosiderosisSiderblastic anemiaMagaloblastic anemiaHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALDIAGNOSIS&DIFFERENTIALMegaloblastic AnemiaSimilar aspects to IDAAgeAnemia by inadequate dietary intakeHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALMegaloblastic AnemiaHEMA
16、TOLOGY/ONCOLOGY,CHILDRENS HOSPITALPathogenesisVitamin12Folic acidFolic acid reductaseDNA Synthesis Tetrahydrofolic acid Nucleotide Megaloblastic AnemiaManifestation&DifferentialPale and puffyNeurological involvement Lab findingsMacrocytic normochromic anemiaNeutropenia with/thrombocytopenia Marrow f
17、ilm: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;B
18、6;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,CHILDRE
19、NS 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 TREATMEN
20、T 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 HOSPITALTREATMENTTransfus
21、ion 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 prematur
22、e 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 tha
23、lassemia5.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
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