1、1,缺鐵性貧血 Iron Deficiency Anemia (IDA) 河北醫(yī)科大學(xué)第二醫(yī)院 血液內(nèi)科 邢麗娜,2,內(nèi)容 CONTENTS,簡介INDUCTION 鐵代謝IRON METABOLISM 流行病學(xué)EPIDEMIOLOGY 發(fā)病機制 ETIOLOGY /PATHOGENESIS 臨床表現(xiàn) MANIFESTATIONS 實驗室檢查 LABORATORY FINDINGS 診斷和鑒別診斷 DIAGNOSIS commonly found in age 6 mths 2 yrs 髓外造血Extramedullary hematopoiesis Mild/ Severe conditio

2、n 消化系統(tǒng) Digestive system 心血管系統(tǒng)Cardiac function 神經(jīng)系統(tǒng) Nervous/ intellectual 免疫系統(tǒng) Immune function,臨床表現(xiàn)CLINICAL MANIFESTATIONS,17,臨床表現(xiàn)CLINICAL MANIFESTATIONS,對皮膚粘膜的改變Skin/mucosal 蒼白：特別是嘴唇，頰粘膜，眼結(jié)膜 Pallor : esp. lips, buccal and palpebral mucosa ，反甲 Koilonychia (spoon-shaped nails） 粘膜潰瘍糜爛 rough ，ulcer，eros

3、ion 鏡面舌 mirror surface tongue (smooth, red tongue),18,呼吸和循環(huán)系統(tǒng) Respiratory & cardiovascular system 心悸 Palpitation 呼吸困難 Dyspnea 呼吸急促 Tachypnea 心動過速 Tachycardia 血壓升高 Increased artery blood pressure 心臟擴大 Enlargement of heart 心力衰竭 Even heart failure,19,臨床表現(xiàn)CLINICAL MANIFESTATIONS,消化系統(tǒng) Digestive system 口角

4、炎 Angular stomatitis 舌炎 Glossitis 唇炎 Angular cheilitis 異食癖 Pagophagia or pica,20,臨床表現(xiàn)CLINICAL MANIFESTATIONS,神經(jīng)系統(tǒng)癥狀 CNS manifestations: 易激動 Irritability 嬰幼兒的學(xué)習(xí)能力下降decreasing learning ability of infant 注意力不集中 Loss of concentration 感覺麻木 Paresthesia 耳鳴 Tinnitus 虛弱乏力 Fainting or feeling faint 發(fā)育遲緩 Slow

5、development 血液系統(tǒng) Hemopoietic system Enlargement of liver and spleen,21,IDA:小細胞低色素性貧血+血清鐵 microcytic/hypochromic + SI 外周血Peripheral blood： 血紅蛋白 Hemoglobin level 紅細胞 RBC MCV 80fl, MCH 26ug, MCHC 0.31 骨髓 Bone marrow 紅系增生活躍 Erythroid hyperplasia 鐵染色減少 Stainable iron,實驗室檢查LABORATORY FEATURES,22,IDA: hypo

6、chromic /microcytic anemia+ SI SI： 62.7umol/L (350ug/dl) TS： 0.9umol/L or 50ug/dl) ID： SF 12ug/L / marrow iron Acronyms and Abbreviations 血清鐵 SI：serum iron；總鐵結(jié)合力TIBC：total iron binding capacity； 轉(zhuǎn)鐵蛋白飽和度 TS：transferrin saturation,實驗室檢查LABORATORY FINDINGS,23,實驗室檢查Laboratory findings,Normal,Patient,24,

7、Bone marrow,25,診斷 Diagnosis 印象 Impression：age, feeding, PBL 診斷 Diagnosis：biochemical change 證實 Proven by therapy,診斷和鑒別診斷DIAGNOSIS & DIFFERENTIAL,26,診斷 diagnosis,Determination of the cause of IDA is most important for diagnosis,確定缺鐵性貧血的病因是最重要的,27,慢性或炎性疾病 Chronic & inflammatory diseases 血紅蛋白病性貧血 Thala

8、ssemia 鐵粒幼細胞性貧血Siderblastic anemia,鑒別診斷 DIFFERENTIAL Diagnosis,28,Note the florid increase in Prussian blue staining granules in the erythroblasts, most with circumnuclear locations,DIFFERENTIAL-IDA AND SA,鐵粒幼細胞性貧血SA,普魯氏藍染色細胞內(nèi)鐵缺如prussian blue iron stain：negative,鐵缺性貧血IDA,29,有家族史，有溶血表現(xiàn)，脾腫大，黃疸 Faimly

9、History， Hemolytic anemia Jaundice Splenomegaly 血片：多量靶形紅細胞 target cell 珠蛋白肽鏈合成數(shù)量異常：HbF、HbA2 血清鐵蛋白SF、骨髓可染鐵IRON STAIN 、血清鐵SI和 鐵飽和度TS常,2.海洋性貧血 Thalassemia,鑒別診斷 DIFFERENTIAL-IDA AND Thalassemia,30,慢性感染、炎癥、惡性腫瘤伴發(fā)的貧血 肝病、腎病、內(nèi)分泌疾病繼發(fā)的貧血稱 “慢性系統(tǒng)疾病性貧血”或“繼發(fā)性貧血”,3.慢性病性貧血（anemia of chronic disease，ACD）,鑒別診斷 DIFFER

10、ENTIAL Diagnosis,31,幾種小細胞低色素性貧血特點比較,32,治療 TREATMENT,病因治療 Eradicate the causes 補鐵治療 Iron therapy 輸血治療 transfusion,33,補鐵治療 Iron therapy 補鐵劑量Elemental iron： 4-6mg/kg/d 口服補鐵Oral medication 硫酸亞鐵 ferrous sulfate 0.3 3/d 琥珀酸亞鐵ferrous succinate 0.2 3/d 多糖鐵復(fù)合物polysaccharide-iron complex 150mg 2/d 服用：兩餐直接，加維生

11、素C Administration：Between meals，Vitamin C,治療 TREATMENT,34,鐵治療Iron therapy 注射鐵劑 Infusion iron 右旋糖酐鐵 dextranum Indication：severe gastrointestinal reaction Oral medication duodenumpriximal jejunum lesion impact absorption 口服鐵劑不能耐受或十二指腸，空腸上段有病變影響鐵劑吸收,治療 TREATMENT,35,鐵治療反應(yīng)IRON THERAPY RESPONSE,36,治療 TREA

12、TMENT,輸血指征 Transfusion Indications 重度貧血Severe anemia 感染 Infection 擬行手術(shù)Pre-operation 輸血成分Component： red blood cells 輸血量 Volume：Hb 30g/L, 3-5ml/kg Hb 30-60g/L, 5-10ml/kg,37,預(yù)防PREVENTION,保健教育 Education 孕期婦女 For pregnant women 母乳喂養(yǎng)/牛奶 Breast milk/cows milk 含鐵的輔食 Iron rich supplementary food 強化鐵食物 Iron-fortified food 早產(chǎn)兒 For premature infant,38,促