2022年医学专题-小儿营养性贫血(NUTRITIONAL-ANEMIA)

NUTRITIONALANEMIA第一页，共三十九页。1NewwordsNutritional营养的Megaloblastic巨幼细胞Hamorrhage出血Irritability激惹Lethargy嗜睡Fatigue疲乏(pífá)Anorexia厌食Appetite食欲Microcytic小细胞的Hypochromic低色素的Thalassemia海洋性贫血(pínxuè)Ferroussulfate硫酸亚铁Hookworm钩虫Epistaxis鼻出血Reticulocyte网织红细胞第二页，共三十九页。2NutritionalanemiaMegaloblasticanemiavitaminB12deficiencyfolicaciddeficiencyIrondeficiencyanemiairondeficiency第三页，共三十九页。3IrondefeciencyanemiaIntroductionCauseofIrondeficiencyanemiaClinicalfeaturesLaboratoryfindingsDiagnosisDefferentialdiagnosisTreatment第四页，共三十九页。4IronDeficiencyAnemia,IDAIncidenceofIDA:10-70%(WHO)40%(6m-6y，China)第五页，共三十九页。5IDAisthemostcommoncauseofanemiainchildhood.Itusuallyresultsfrominadequatedietary

intakeratherthanlossofironthroughhemorrhage.第六页，共三十九页。6IroninmilkBothofbreastandcow`smilkarelowinironIronisbetterabsorbedfrombreastmilk(50%)comparedtocow`smilk(10%)Formulamilksarefortifiedwithiron(4%)第七页，共三十九页。7Dietarysourcesofiron第八页，共三十九页。8DietarysourcesofironRedmeatFortifiedbreakfastcerealsDarkgreenvegetablesBlackbreadabout10-15%ironofdietaryisabsorbed第九页，共三十九页。9IronrequirementsThefetusabsorbsironfromthemotheracrosstheplacenta.Terminfantshaveadequatereserveforthefirst4monthsoflife.Preterminfantshavelimitedironstoresandbecauseoftheirhigherrateofgrowth,theirironreserveswereusedupby8weeksofage.Adolescentsalsoneedmoreironbecauseof1.Growthspurt2.Dietarydeficiency3.Menstrualbloodloss第十页，共三十九页。10Referencenutrientintakeofironare:6months:4mg/day12months:8mg/dayAdultmale:9mg/dayAdultfemale:15mg/day第十一页，共三十九页。11（一）thedecreaseofironstoreslowbirthweightpreterminfantshemorrhageCausesofirondeificiency第十二页，共三十九页。12Causesofirondeificiency（二）Nutritionaldeficiencyiscommonincertainat-riskgroupspreterminfantsrequireironsupplementsfrom6-8weeks.Terminfantswilldevelopirondeficiencyafter4monthsif1.mixedfeedingisundulydelayed2.unmodifiedcow`smilkisintroducedearly.Itiscommoninthefirsttwoyearsofage第十三页，共三十九页。13Causesofirondeificiency(三）MalabsorptionmaybecomplicatedbyirondeficiencyThechildrenusuallycompanywithanothermalnutrition.第十四页，共三十九页。14Causesofirondeificiency(四）Bloodlossisalesscommoncauseinchildren,butmayoccurwith:MenstruationHookworminfectionRepeatedvenesectioninbabiesMeckel`sdiverticulumRecurrentepistaxisItistheimportantcauseofIDAinolderchildren第十五页，共三十九页。15ClinicalfeaturesMildirondeficiencyanemiaisasymptomaticMoreseveremaybeirritabilityLethargyFatigueanorexia第十六页，共三十九页。16Signs:

palloroftheskinandmucousmembranes.Hb<70g/L,tachycardiaandcardiacdilationoccur,andsystolicmurmursareoftenpresentIDAininfancyandearlychildrenisassociatedwithdevelopmentaldelayandpoorgrowthClinicalfeatures第十七页，共三十九页。17Laboratoryfindings第十八页，共三十九页。18Serumiron(SI)<10.7umol/LTatalironbindingcapacity(TIBC)>62.7umol/LSerumFerritin(SF)<16ug/LFreeerythrocyteprotoporphyrin(FEP)>0.9umol/LLaboratoryfindings第十九页，共三十九页。19IDA外周血涂片(túpiàn)红细胞形态Laboratoryfindings第二十页，共三十九页。20Irondeficiencyanemia:lowpowerviewofperipheralbloodfilm第二十一页，共三十九页。21①Microcyticandhypochromicanemia.MCHC<30%,MCV<80fl,MCH<27pg②ThechildrenwiththeclinicalfeaturesofIDAandthecauseofirondeficiency③SI<10.7umol/L④Transferinsaturation<15%⑤Ironstoresdecreaseinbonemarrow⑥Freeerythrocyteprotoporphyrin(FEP)>0.9umol/L⑦SerumFerritin(SF)<16ug/L⑧Goodresponsetoirontherapy①+twoof②~⑧isnecessaryforthediagnosisdiagnosis第二十二页，共三十九页。22diagnosisDeterminationofthecauseofIDAismostimportantfordiagnosis第二十三页，共三十九页。23Differentialdiagnosis

thalassamieIDAchronicinflammationSI NorTIBC NPercentsaturtion >20% <10%10~20%Ferritin(ug/L) >50 <1020~200Ironstores 3~4+ 0 1~4+TransferrinreceptorNor NHbF N N第二十四页，共三十九页。24ThalassemiaminorIDAThalassemiaminorSI ↓ Nor↑T IBC ↑ NHbFandA2 N ↑

Differentialdiagnosis第二十五页，共三十九页。25第二十六页，共三十九页。26TreatmentManagementwilldependonTheseverityoftheanemiaThecauseoftheirondeficiencyTheabilityofthepatienttotoleratemedicinalironpreparations第二十七页，共三十九页。27TreatmentOralironpreparations

tablet(ironcontent)Elixir(ironcontent)Ferroussulfate325(65) 300/5ml(60)Ferrousgluconate 325(38) 300/5ml(35)Ferrousfumarate 325(107) 100/5ml(33)Polysaccharide-iron150(150) 100/5ml(100)第二十八页，共三十九页。28TreatmentOraladministrationofsimpleferrousprovidesinexpensiveandsatisfactorytherapy

Ferroussulfateis20%elementalironbyweight.Adailytotalofferroussulfateis4-6mg/kgofelementalironinthreedivideddosesprovides第二十九页，共三十九页。29SerumIrom7AM12N12MN7PMFigure.Oralironabsoption.Whenmedicinalironisgiven3timesaday,eachdoseraisestheSIforseveralhours.AfourthdoseatbedtimecanhelpsustaintheSIduringnighttimehours.第三十页，共三十九页。30TreatmentBloodtransfusionisindicatedonlywhentheanemiaisverysevereIt`snotnecessarytoattemptrapidcorrectionofsevereanemiabytransfusionThechildrenwithhemoglobinvalueslessthan40g/Lshouldbegivenonly2-3ml/KgofRBCs第三十一页，共三十九页。31ResponsestoIronTherapyinIDA

TimeAfterIronAdministrationResponse12–24hrReplacementofintracellularironenzymes;decreasedirritability;increasedAppetite36-48hrInitialbonemarrowresponse;erythroidhyperplasia48-72hrReticulocytosis,peakingat5–7days4-30daysIncreaseinhemoglobinlevel1-3moRepletionofstores第三十二页，共三十九页。32Thecase8yearsoldboyfromcountrysideDiagnosisisIDAandHookworminfection(Hb=65g/L)ThreeweekslateaftertreatmentwithFerroussulfate:Hb=70g/L第三十三页，共三十九页。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(xiàliè)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CHbF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CHb量第三十四页，共三十九页。34病例(bìnglì)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(tiānjiā)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：第三十五页，共三十九页。35项目结果(jiēguǒ)参考值红细胞(RBC)2.683.5-5.0×1012/L血红蛋白(HGB)67