NUTRITIONALANEMIA1小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第1頁!NewwordsNutritional營養(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Ferroussulfate硫酸亞鐵Hookworm鉤蟲Epistaxis鼻出血Reticulocyte網(wǎng)織紅細(xì)胞2小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第2頁!NutritionalanemiaMegaloblasticanemiavitaminB12deficiencyfolicaciddeficiencyIrondeficiencyanemiairondeficiency3小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第3頁!IronDeficiencyAnemia,IDAIncidenceofIDA:10-70%(WHO)40%(6m-6y，China)4小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第4頁!IroninmilkBothofbreastandcow`smilkarelowinironIronisbetterabsorbedfrombreastmilk(50%)paredtocow`smilk(10%)Formulamilksarefortifiedwithiron(4%)5小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第5頁!DietarysourcesofironRedmeatFortifiedbreakfastcerealsDarkgreenvegetablesBlackbreadabout10-15%ironofdietaryisabsorbed6小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第6頁!Referencenutrientintakeofironare:6months:4mg/day12months:8mg/dayAdultmale:9mg/dayAdultfemale:15mg/day7小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第7頁!Causesofirondeificiency（二）Nutritionaldeficiencyismonincertainat-riskgroupspreterminfantsrequireironsupplementsfrom6-8weeks.Terminfantswilldevelopirondeficiencyafter4monthsif1.mixedfeedingisundulydelayed2.unmodifiedcow`smilkisintroducedearly.Itismoninthefirsttwoyearsofage8小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第8頁!Causesofirondeificiency(四）Bloodlossisalessmoncauseinchildren,butmayoccurwith:MenstruationHookworminfectionRepeatedvenesectioninbabiesMeckel`sdiverticulumRecurrentepistaxisItistheimportantcauseofIDAinolderchildren9小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第9頁!Signs:

palloroftheskinandmucousmembranes.Hb<70g/L,tachycardiaandcardiacdilationoccur,andsystolicmurmursareoftenpresentIDAininfancyandearlychildrenisassociatedwithdevelopmentaldelayandpoorgrowthClinicalfeatures10小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第10頁!Serumiron(SI)<10.7umol/LTatalironbindingcapacity(TIBC)>62.7umol/LSerumFerritin(SF)<16ug/LFreeerythrocyteprotoporphyrin(FEP)>0.9umol/LLaboratoryfindings11小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第11頁!Irondeficiencyanemia:lowpowerviewofperipheralbloodfilm12小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第12頁!diagnosisDeterminationofthecauseofIDAismostimportantfordiagnosis13小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第13頁!ThalassemiaminorIDAThalassemiaminorSI ↓ Nor↑T IBC ↑ NHbFandA2 N ↑

Differentialdiagnosis14小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第14頁!TreatmentManagementwilldependonTheseverityoftheanemiaThecauseoftheirondeficiencyTheabilityofthepatienttotoleratemedicinalironpreparations15小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第15頁!TreatmentOraladministrationofsimpleferrousprovidesinexpensiveandsatisfactorytherapy

Ferroussulfateis20%elementalironbyweight.Adailytotalofferroussulfateis4-6mg/kgofelementalironinthreedivideddosesprovides16小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第16頁!TreatmentBloodtransfusionisindicatedonlywhentheanemiaisverysevereIt`snotnecessarytoattemptrapidcorrectionofsevereanemiabytransfusionThechildrenwithhemoglobinvalueslessthan40g/Lshouldbegivenonly2-3ml/KgofRBCs17小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第17頁!Thecase8yearsoldboyfromcountrysideDiagnosisisIDAandHookworminfection(Hb=65g/L)ThreeweekslateaftertreatmentwithFerroussulfate:Hb=70g/L18小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第18頁!病例10個月男孩面色蒼白兩個月，不發(fā)燒，不咳嗽，無皮膚黏膜出血，無血便及肉眼血尿，大小便正常。出生史：胎，產(chǎn)，孕36周早產(chǎn)喂養(yǎng)史：生后母乳喂養(yǎng)至今，6個月開始添加輔食。平素食欲較差。體檢：皮膚黏膜蒼黃，肝右肋下2CM，脾左肋下2CM實驗室檢查：19小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第19頁!肝功能：GPT39U，GOT40U，TB，DB正常紅細(xì)胞脆性降低，HbF56%20小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第20頁!IrondefeciencyanemiaIntroductionCauseofIrondeficiencyanemiaClinicalfeaturesLaboratoryfindingsDiagnosisDefferentialdiagnosisTreatment21小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第21頁!IDAisthemostmoncauseofanemiainchildhood.Itusuallyresultsfrominadequatedietary

intakeratherthanlossofironthroughhemorrhage.22小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第22頁!Dietarysourcesofiron23小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第23頁!IronrequirementsThefetusabsorbsironfromthemotheracrosstheplacenta.Terminfantshaveadequatereserveforthefirst4monthsoflife.Preterminfantshavelimitedironstoresandbecauseoftheirhigherrateofgrowth,theirironreserveswereusedupby8weeksofage.Adolescentsalsoneedmoreironbecauseof1.Growthspurt2.Dietarydeficiency3.Menstrualbloodloss24小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第24頁!（一）thedecreaseofironstoreslowbirthweightpreterminfantshemorrhageCausesofirondeificiency25小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第25頁!Causesofirondeificiency(三）MalabsorptionmaybeplicatedbyirondeficiencyThechildrenusuallypanywithanothermalnutrition.26小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第26頁!ClinicalfeaturesMildirondeficiencyanemiaisasymptomaticMoreseveremaybeirritabilityLethargyFatigueanorexia27小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第27頁!Laboratoryfindings28小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第28頁!IDA外周血涂片紅細(xì)胞形態(tài)Laboratoryfindings29小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第29頁!①Microcyticandhypochromicanemia.MCHC<30%,MCV<80fl,MCH<27pg②ThechildrenwiththeclinicalfeaturesofIDAandthecauseofirondeficiency③SI<10.7umol/L④Transferinsaturation<15%⑤Ironstoresdecreaseinbonemarrow⑥Freeerythrocyteprotoporphyrin(FEP)>0.9umol/L⑦SerumFerritin(SF)<16ug/L⑧Goodresponsetoirontherapy①+twoof②~⑧isnecessaryforthediagnosisdiagnosis30小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第30頁!Differentialdiagnosis

thalassamieIDAchronicinflammationSI NorTIBC NPercentsaturtion >20% <10%10~20%Ferritin(ug/L) >50 <1020~200Ironstores 3~4+ 0 1~4+TransferrinreceptorNor NHbF N N31小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第31頁!32小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第32頁!TreatmentOralironpreparations

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)33小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第33頁!SerumIrom7AM12N12MN7PMFigure.Oralironabsoption.Whenmedicinalironisgiven3timesaday,eachdoseraisestheSIforseveralhours.AfourthdoseatbedtimecanhelpsustaintheSIduringnighttimehours.34小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第34頁!ResponsestoIronTherapyinIDA

TimeAfterIronAdministrationResponse12–24hrReplacementofintracellularironenzymes;decreasedirritability;increasedAppetite36-48hrInitialbonemarrowresponse;erythroidhyperplasia48-72hrReticulocytosis,peakingat5–7days4-30daysIncreaseinhemoglobinlevel1-3moRepletionofstores35小兒營養(yǎng)性貧血(NUTRITIONAL-ANEMIA)共38頁，您現(xiàn)在瀏覽的是第35頁!嬰兒期缺鐵性貧血最常見的原因是A胎兒期儲鐵不足B飲食中鐵的缺乏C出血下列哪項是鑒別缺鐵性貧血與海洋性貧血的重要依據(jù)A臨