缺鐵性貧血 (2)

1、Etiology病因Clinical manifestations臨床表現(xiàn)Differential diagnosis鑒別診斷Treatment治療,Iron-Deficiency Anemia,Iron helps red blood cells carry oxygen to the body and plays a key role in brain and muscle function. A lack of i

2、ron in the blood can lead to iron-deficiency anemia, a common nutritional deficiency . Every red blood cell in the body contains iron in its hemoglobin, the protein that carries oxygen to the body's tissues

3、 from the lungs. Iron gives hemoglobin the strength to "carry" (bind to) oxygen in the blood, so that oxygen gets to where it needs to go. People who become iron deficient means that the body can't m

4、ake hemoglobin, so it makes fewer red blood cells. This is a condition called anemia. Iron is essential to hemoglobin production.,Etiology,Blood LossGastrointestinal Tract胃腸道Menstrual Blood Loss月經(jīng)失血Ur

5、inary Blood Loss (Rare)尿失血(罕見)Blood in Sputum (Rarer)血痰(罕見)Increased Iron Utilization利用率,生長發(fā)育快PregnancyInfancy出生后3-5月Adolescence青春期Polycythemia Vera紅細(xì)胞增多Malabsorption吸收不良Tropical Sprue熱帶口炎性腹瀉Gastrectomy胃切除術(shù)Chro

6、nic atrophic gastritis慢性萎縮性胃炎insufficient iron in the diet.鐵攝入不足 乳類/谷類食物含鐵低,Clinical manifestations,GeneralHemopoietic systemRespiratory& Cardiovascular systemGastrointestinal systemCNS system,Groups of p

7、eople at higher risk,Girls and women their bodies can't store as much iron and lose blood during menstruation. Infants and children affected by mothers, drink excessive amounts of milk Athletes exercise often ten

8、d to lose more ironVegetarians iron from plant sources is more difficult absorbed,,General,,GeneralAny age; commonly found in age 6 mths ~ 2 yrsPallor 蒼白: esp. lips, buccal mucosa口腔黏膜Koilonychia 凹甲(spoon-shaped nail

9、sTinnitus耳鳴Fainting or feeling faintfatigue and weaknessSleepiness Hemopoietic system造血系統(tǒng) Enlargement of liver and spleen肝脾,,Respiratory & cardiovascular systemPalpitation 心悸Dyspnea 呼吸困難Tachypnea呼吸急促Tachyca

10、rdia心跳過速Enlargement of heartEven heart failure心力衰竭Gastrointestinal system消化系統(tǒng)Angular stomatitis口角炎Glossitis 舌炎(inflammation or infection of the tongue)Angular cheilitis 傳染性口角炎(inflammatory lesions at the mouth'

11、s corners)Pagophagia or pica 食冰癖,異食癖Unusual obsessive food cravingsIce chewing,,CNS manifestations: central nervous systemIrritability易怒decreasing learning ability of infantLoss of concentrationreduced myelination

12、 髓鞘形成of the spinal cord,symptoms,lack energy or the skin may be pale,,more tired,physically weak,unable to concentrate,have headaches,more prone to infections,heart pain or angina 心絞痛,be irritable easily,,,,,,,鑒別診斷 （Diff

13、erential diagnosis),診斷：初步： age年齡,deit,growth, hemogram血象確診： Iron metabolism and biochemical 鐵代謝生化證實： 治療,Diagnosis,Useful tests include the following:Complete blood count全血球計數(shù)Serum iron血清鐵, total

14、 iron-binding capacity 總鐵結(jié)合力(TIBC), and serum ferritin血清鐵蛋白Evaluation for hemosiderinuria含鐵血黃素尿 , hemoglobinuria血紅蛋白尿, pulmonary hemosiderosis肺含鐵血黃素沉積,Further investigations for differential diagnosis,Peripheral

15、 blood smear末梢血像 Blood is smeared on a glass slide for microscopic examination of RBCs, which can sometimes indicate the cause of the anemia.Reticulocyte count網(wǎng)織紅細(xì)胞計數(shù) A measure of young RBCs, this helps to determine

16、if RBC production is at normal levels.Bone marrow aspiration骨髓穿刺This test can help determine whether cell production is happening normally in the bone marrow.Hemoglobin Electrophoresis血紅素電泳分析 and fetal hemoglobin 胎血

17、紅蛋白 Used to identify various abnormal hemoglobins in the blood and to diagnose sickle cell anemia, the thalassemias, and other inherited forms of anemia.Enzymes level,Treatment,Iron-rich dietEtiological treatment去病因治

18、療Iron therapy (replacement therapy補充療法，鐵劑治療)Blood transfusion therapy輸血治療,Iron-rich diet,Meats - beef, pork, lamb, liver, and other organ meatsPoultry - chicken, duck, turkey, liver Fish - shellfish, including clams蛤

19、蚌, mussels蚌類 , and oysters, sardines沙丁魚Leafy greens of the cabbage family甘藍(lán)類 , such as broccoli西蘭花, turnip greens蘿卜葉, and collards羽衣甘藍(lán)Legumes豆類, such as lima beans and green peas; dry beans and peas, such as pinto bean

20、s, black-eyed peas豇豆(Egg yolks蛋黃Iron-enriched white bread, pasta, rice, and cereals谷類,,Etiological treatment,Correct bad habit (picky eater 挑食)Lead poisoning Parasite infection寄生蟲感染blood loss ( hookworm十二指腸蟲)Congeni

21、tal abnormality of gastrointestinal tract胃腸道的先天性異常Body changes - An increased iron requirement and increased red blood cell production is required when the body is going through changes such as growth spurts in children

22、 and adolescents.,Iron therapy (replacement therapy),In the meanwhile addition supply of Vit C will increase iron absorption. 4-6 mg/kg/day (Ferrous sulfate硫酸亞鐵) Iron therapy should produced an increase in the reticu

23、locyte 網(wǎng)織紅細(xì)胞count within few days, reaching a maximum at 7 to 12 days. Patients should be continue iron therapy for two months after Hb levels is normal to reestalbish adequate iron stores.,治 療 (Treatment),鐵劑治療元素鐵劑量： 4