IDA缺铁性贫血专题知识

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2017/10/10,#,Iron Deficiency Anemia,(IDA),Dr.Liu Chonghai,Iron-deficiency anemia affected about 1.48 billion people in,2023.,A,lack of dietary iron is estimated to cause approximately half of all anemia cases globally,.,Women,and young children are most commonly,affected.,In,2023 anemia due to iron deficiency resulted in about 54,000 deaths down from 213,000 deaths in 1990.,Disability-adjusted life year for iron-deficiency anemia per 100,000 inhabitants in 2023.,Metabolism of Iron,A.Iron distribution in the body,A.Iron distribution in the,body,B.The source of,iron,Endogenous,old RBC(2/3),Exogenous,through food(,1/10mg/d,),Animal,foods with high iron content and high heme iron,the absorption rate of 10-25%,Iron of vegetable,food,is,non-heme iron,the absorption rate of 1.7-7.9%,C.Physiological requirement of iron,:,1mg,1.5mg/kg/d,(15yr,),Premature 2mg/kg/d,Index,of iron nutrition,TIBC,and iron saturation in IDA,Etiology,of iron deficiency,1.Insufficient iron store,:premature,severe maternal iron deficiency,intra-uterus transfusion etc,.,2.Insufficient intake,:food,with insufficient iron,e.g,.fed with milk,flour or rice flour,only etc.,3.Absorptive problems,:chronic,diarrhea,steatorrhea,4.Growth demand,:young,infants,premature baby,adolescent children,girls after menarche etc.,5,.Blood loss,:chronic,gastrointestinal bleeding caused by peptic,ulcer,hook,worm,multiple polyps,angioma,diverticuloritis or inflammative enteropathy,or,acute blood loss with injury or epitaxisetc,.,3 stages,Iron depletion,ID:,Iron deficient erythropoiesis,IDE,Iron deficiency anemia,IDA,Impact on body health by,ID,1.Hematopoieticsystem:gradual,anemia,Stages Ferritin Serum iron,SI Hb,ID Low N N,IDE L L N,IDA L L L,Impact on body health by ID(continued),2.GI system,:,absorptive disorders;,3.Circulative system,:,cardiac contractivity decrease,heart enlargement,murmur and heart failure;,4.Neuroschycological system,:,insomnia,attention absent(aprosexia),apathy;,5.Immune system,:,compromised immunity,susceptible to infection;,6.,Skin and hair system,:dryness,of skin,sparse and brittle hairs,loss of polish,fragile nails,koilonychia,;,Clinical Manifestation,Age,:6 months 3yrs,General,:,anemic,pale,positional hypotension;,GI system,:,diarrhea,dyspepsia,nausea,vomiting,Hematopoietic System,:,hepatosplenomegaly(extramedullary hematopoiesis,),Circulatory system,:,tachycardia,murmurs,and heart enlargement;,Immune system,:,infection,;,Neuropsycological system,:,pica,apathy;,Lab,tests,-,Blood smear:,Microcytic and hypochromic RBC,BM smear,：,Cellularity,:hypercellularity,;,Iron,stain,:compromised,both intercellular and intracellular iron stains,.,Developing nucleated erythrocytes,:delayed cytoplasmicdevelopment;,Indices of iron,nutrition,SI,(serum iron,),Fn,(Ferritin,),TIBC,(total iron binding capacity,),FEP,(free erythrocyticprotopophrin),1,、,IDA:is a gradual process which can be divided,into,3,stages,ie,ID stage,IDE stage and IDA stage,.,2,、,Ferritin is the most sensitive marker for IDA;,3,、,Once Hbhas been recovered to normal level,iron agents should be used continuesllyfor another 2 months.,Diagnosis,and differential diagnosis,Diagnosis,:,History,clinical manifestation,lab,tests,Differential,diagnosis:(,Hypochromic and microcytic anemias),thalassemia,lead poisoning,chronic infection etc.,Treatment,1.Looking for etiology and modify feeding formula;,2.Medications:iron,agents,for,Oral:ferrous gluconate,ferrous,sulfate;,for,Inj:Ferrous dextran,;,dosage,:,3-6mg elemental iron/kg/day,3 divided doses,Responses:,reticulocyte,2-3d,5-7d to peak,2-3wks to normal.,Hb,1-2wks ,3-4wks correction anemia.,Caution:continue to give iron,for 4-6 months(India)6-8 wks(China),after Hb becomes normal.,Blood Transfusion,when it is necessary.,1.severe anemia with congestive cardiac failure,2.with severe infection,3.need surgery,Hb 60g/L,NO.,Prevention,1.Health propaganda and councilling;,2.Adequate diet for pregnant mothers;,3.Correct feeding for baby;,4.Treatment of diseases:GI disorders,parasitesetc.,Megaloblastic Anemia,Defination:,Nutritional,VitB12 or folic acid deficiency anemia was defined as the deficiency in either VitB12 or Folic acid.,In India,6.8%children had folate deficiency,32%showed vinB12 deficiency and combined deficiency,China-rare,Metabolism of VitB12 and Folic acid,Folic,acid,:,Food,:rich,in green vegetible,lack in sheep milk;,Absorptive site,:at,upper portion of jejunum,;,Vitamin,B12,:,Food:rich,in animal food,;,Absorptive,site,:terminus,of ileum;,Absorption,helping factor,:internal,factor.,Etiology,Decreased intake,（,vegetarian,-,VB12,goat milkFolic acid);,Increasing,demands,;,Impaired absorption(celiac disease,intestinal parasites),Disease,impacts,;,Congenital,defects:,1,、,congenital FA absorptive defects;,2,、,Juvenile pernicious anemia,;,3,、,congenital,transcobalamin defects,。,Clincal Manifestations,Age:peak at 6 mon 2 yrs;,Anemia:soil color of skin,edema,petechae;,GI system problems:dyspepsia,nausea,etc,.,C