1、小兒營(yíng)養(yǎng)性貧血New wordsNutritional 營(yíng)養(yǎng)的Megaloblastic巨幼細(xì)胞Hamorrhage出血Irritability激惹Lethargy嗜睡Fatigue疲乏Anorexia厭食Appetite食欲Microcytic小細(xì)胞的Hypochromic低色素的Thalassemia海洋性貧血Ferrous sulfate硫酸亞鐵Hookworm鉤蟲(chóng)Epistaxis鼻出血Reticulocyte 網(wǎng)織紅細(xì)胞2020/11/42Nutritional anemiaMegaloblastic anemia vitamin B12 deficiency folic acid

2、deficiencyIron deficiency anemia iron deficiency2020/11/43Iron defeciency anemiaIntroduction Cause of Iron deficiency anemiaClinical featuresLaboratory findingsDiagnosisDefferential diagnosisTreatment 2020/11/44Iron Deficiency Anemia, IDAIncidence of IDA: 10-70% (WHO) 40% (6m-6y，China)2020/11/45IDA

3、is the most common cause of anemia in childhood. It usually results from inadequate dietary intake rather than loss of iron through hemorrhage.2020/11/46Iron 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

4、 fortified with iron (4%)2020/11/47Dietary sources of iron2020/11/48Dietary sources of ironRed meatFortified breakfast cerealsDark green vegetablesBlack bread about 10-15% iron of dietary is absorbed2020/11/49Iron requirementsThe fetus absorbs iron from the mother across the placenta.Term infants ha

5、ve 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 loss2020/11/410

6、Reference nutrient intake of iron are:6 months: 4 mg/day12 months: 8 mg/dayAdult male: 9 mg/dayAdult female: 15 mg/day2020/11/411（一）the decrease of iron stores low birthweight preterm infantshemorrhageCauses of iron deificiency2020/11/412Causes of iron deificiency （二）Nutritional deficiency is common

7、 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 age2020/11/413Causes of iron deificienc

8、y(三）Malabsorption may be complicated by iron deficiencyThe children usually company with another malnutrition.2020/11/414Causes of iron deificiency(四）Blood loss is a less common cause in children, but may occur with:MenstruationHookworm infectionRepeated venesection in babiesMeckels diverticulumRecu

9、rrent epistaxisIt is the important cause of IDA in older children2020/11/415Clinical featuresMild iron deficiency anemia is asymptomaticMore severe may beirritabilityLethargyFatigueanorexia2020/11/416Signs: pallor of the skin and mucous membranes. Hb70g/L, tachycardia and cardiac dilation occur, and

10、 systolic murmurs are often present IDA in infancy and early children is associated with developmental delay and poor growthClinical features2020/11/417Laboratory findings2020/11/418Serum iron (SI) 62.7 umol/LSerum Ferritin (SF) 0.9 umol/LLaboratory findings2020/11/419IDA外周血涂片紅細(xì)胞形態(tài)Laboratory finding

11、s2020/11/420Iron deficiency anemia:low power view of peripheral blood film2020/11/421Microcytic 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 1

12、0 20200Iron stores 34+0 14+Transferrin receptor N or NHbFN N2020/11/424Thalassemia minor IDA Thalassemia minorSI N or TIBC N HbF and A2 N Differential diagnosis2020/11/4252020/11/426TreatmentManagement will depend onThe severity of the anemiaThe cause of the iron deficiency The ability of the patien

13、t to tolerate medicinal iron preparations2020/11/427TreatmentOral 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)2020/11/428TreatmentOral admin

14、istration 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 provides2020/11/429Serum Irom7AM12N12MN7PMFigure. Oral iron absoption. When medicinal iron

15、 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.2020/11/430TreatmentBlood transfusion is indicated only when the anemia is very severeIts not necessary to attempt rapid correction of severe anemia by transfusi

16、onThe children with hemoglobin values less than 40g/L should be given only 2-3ml/Kg of RBCs2020/11/431Responses to Iron Therapy in IDA Time After Iron AdministrationResponse1224 hrReplacement of intracellular iron enzymes; decreased irritability; increased Appetite36-48 hrInitial bone marrow respons

17、e; erythroid hyperplasia48-72 hrReticulocytosis, peaking at 57 days4-30 daysIncrease in hemoglobin level1-3 moRepletion of stores 2020/11/432The 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/L2020/11/433嬰兒期缺鐵性貧血最常見(jiàn)的原因是A胎兒期儲(chǔ)鐵不足 B飲食中鐵的缺乏 C出血下列哪項(xiàng)是鑒別缺鐵性貧血與海洋性貧血的重要依據(jù)A 臨床表現(xiàn) B 細(xì)胞形態(tài) C HbF和HbA2檢查缺鐵性貧血鐵劑治療后，最先改善的是A 食欲 B 網(wǎng)織紅細(xì)胞 C Hb量2020/11/434病例10個(gè)月男孩面色蒼白兩個(gè)月，不發(fā)燒，不咳嗽，無(wú)皮膚黏膜出血，無(wú)血便及肉眼血尿，大小便正常。出生史：第一胎，第一產(chǎn)，孕36周早產(chǎn)喂養(yǎng)史：生后母乳喂養(yǎng)至今，6個(gè)月開(kāi)始添加輔食。平素食欲較差。體檢：皮膚黏膜蒼黃，肝右肋下2CM，脾左肋下2CM實(shí)