小儿营养性贫血.pptx
1New wordsNutritional 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MicrocyticMicrocytic小细胞的小细胞的Hypochromic低色素的ThalassemiaThalassemia海洋性贫血海洋性贫血Ferrous sulfate硫酸亚铁Hookworm钩虫Epistaxis鼻出血Reticulocyte 网织红细胞第1页/共38页2Nutritional anemiaMegaloblastic anemia vitamin B12 deficiency folic acid deficiencyIron deficiency anemia iron deficiency第2页/共38页3Iron defeciency anemiaIntroduction Cause of Iron deficiency anemiaClinical featuresLaboratory findingsDiagnosisDefferential diagnosisTreatment 第3页/共38页4Iron Deficiency Anemia,IDAIncidence of IDA:10-70%(WHO)40%(6m-6y，China)第4页/共38页5IDA is the most common cause of anemia in childhood.It usually results from inadequate dietary intake rather than loss of iron through hemorrhage.第5页/共38页6Iron in milkBoth of breast and cows milk are low in ironIron is better absorbed from breast milk(50%)compared to cows milk(10%)Formula milks are fortified with iron(4%)第6页/共38页7Dietary sources of iron第7页/共38页8Dietary sources of ironRed meatFortified breakfast cerealsDark green vegetablesBlack bread about 10-15%iron of dietary is absorbed第8页/共38页9Iron requirementsThe 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第9页/共38页10Reference nutrient intake of iron are:6 months:4 mg/day12 months:8 mg/dayAdult male:9 mg/dayAdult female:15 mg/day第10页/共38页11（一）the decrease of iron stores low birthweight preterm infantshemorrhageCauses of iron deificiency第11页/共38页12Causes 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第12页/共38页13Causes of iron deificiency(三）Malabsorption may be complicated by iron deficiencyThe children usually company with another malnutrition.第13页/共38页14Causes of iron deificiency(四）Blood loss is a less common cause in children,but may occur with:MenstruationHookworm infectionRepeated venesection in babiesMeckels diverticulumRecurrent epistaxisIt is the important cause of IDA in older children第14页/共38页15Clinical featuresMild iron deficiency anemia is asymptomaticMore severe may beirritabilityLethargyFatigueanorexia第15页/共38页16Signs:pallor of the skin and mucous membranes.Hb70g/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 growthClinical features第16页/共38页17Laboratory findings第17页/共38页18Serum iron(SI)62.7 umol/LSerum Ferritin(SF)0.9 umol/LLaboratory findings第18页/共38页19IDAIDA外周血涂片红细胞形态外周血涂片红细胞形态Laboratory findings第19页/共38页20Iron deficiency anemia:low power view of peripheral blood film第20页/共38页21Microcytic and hypochromic anemia.MCHC 30%,MCV 80fl,MCH 27pgThe children with the clinical features of IDA and the cause of iron deficiencySI 10.7umol/LTransferin saturation 0.9umol/L Serum Ferritin(SF)20%50 10 20200Iron stores 34+0 14+Transferrin receptor N or NHbFN N第23页/共38页24Thalassemia minor IDA Thalassemia minorSI N or T IBC N HbF and A2 N Differential diagnosis第24页/共38页25第25页/共38页26TreatmentManagement will depend onThe severity of the anemiaThe cause of the iron deficiency The ability of the patient to tolerate medicinal iron preparations第26页/共38页27TreatmentOral iron preparations tablet(iron content)Elixir(iron content)Ferrous sulfate 325(65)300/5ml(60)Ferrous gluconate325(38)300/5ml(35)Ferrous fumarate325(107)100/5ml(33)Polysaccharide-iron 150(150)100/5ml(100)第27页/共38页28TreatmentOral 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第28页/共38页29Serum Irom7AM12N12MN7PMFigure.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.第29页/共38页30TreatmentBlood transfusion is indicated only when the anemia is very severeIts not necessary to attempt rapid correction of severe anemia by transfusionThe children with hemoglobin values less than 40g/L should be given only 2-3ml/Kg of RBCs第30页/共38页31Responses to Iron Therapy in IDA Time After Iron Time After Iron AdministrationAdministrationResponseResponse1224 hr1224 hrReplacement of intracellular iron enzymes;Replacement of intracellular iron enzymes;decreased irritability;decreased irritability;increased Appetite increased Appetite36-48 hr36-48 hrInitial bone marrow response;Initial bone marrow response;erythroid hyperplasiaerythroid hyperplasia48-72 hr48-72 hrReticulocytosis,peaking at 57 daysReticulocytosis,peaking at 57 days4-30 days4-30 daysIncrease in hemoglobin levelIncrease in hemoglobin level1-3 mo1-3 moRepletion of stores Repletion of stores 第31页/共38页32The case 8 years old boy from countrysideDiagnosis is IDA and Hookworm infection(Hb=65g/L)Three weeks late after treatment with Ferrous sulfate:Hb=70g/L第32页/共38页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量第33页/共38页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：第34页/共38页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/LMCV 62 82-92flMCH 22 27-31pgMCHC 280 320-360g/LRET 4.5%血小板(PLT)275 100-300 109/L白细胞(WBC)10.2 4.0-10 109/L第35页/共38页36肝功能：GPT 39U，GOT 40U，TB ，DB正常红细胞脆性降低，HbF 56%第36页/共38页37THANKS第37页/共38页38感谢您的观看！第38页/共38页
