缺鐵性貧血幻燈片ppt課件

1、1,缺鐵性貧血Iron Deficiency Anemia (IDA),,2,內容 CONTENTS,簡介INDUCTION鐵代謝IRON METABOLISM流行病學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 & DIFFERENTIAL 治療

2、和預防 PREVENTION & TREATMENT,3,簡介 INTRODUCTION,定義Definition 由于機體對鐵是攝入不足，而導致體內儲存鐵耗盡，繼而紅細胞內鐵缺乏，最終導致貧血。The anemia caused by insufficient iron uptake, in which the iron storage and hemoglobin synthesis decreas

3、ed. 鐵缺乏癥的三個階段There are three stages in iron dificiency儲存鐵耗竭 Iron deletion（ID) 紅細胞內鐵缺乏 Iron deficient erythropoiesis（IDE) 缺鐵性貧血 Iron deficiency anemia（IDA),4,鐵代謝IRON METABOLISM,鐵總量CONTENTSNew born 75mg/kgChildren3

4、5-70mg/kgAdults M 50mg/kgF 35mg/kg,鐵分布CMOPARTMENT血紅蛋白Hemoglobin 64%儲存鐵 Storage iron 30%鐵蛋白 Ferritin含鐵血黃素hemosiderin肌紅蛋白Myloglobin 3%含鐵酶 Enzyme iron 0.4% 血清鐵 Serum iron 0

5、.4%,5,鐵的儲存和利用Iron stores and utilizing,LiverSpleenMarrow,RBCiron,Foodiron,,,,,,SI,Fe,Fe,heme + globin,6,鐵代謝IRON METABOLISM,鐵的需要和排泄 Requirement and excretion

6、 demand 需要 excretion排泄Infants 1mg/d Children 0.5mg/d Young, nonpregnant women 2 mg/d Pregnant

7、women 3 mg/d Men and postmenopausal women 1mg/d 0.5-1mg/d,7,Which people need more iron？哪些群體對鐵的需要量多？,兒童children,妊娠婦女,哺乳母親,pregnancy,lactation,8,鐵來源 Iron source

8、s血紅蛋白內鐵 Hemoglobin iron 食物中鐵 Dietary iron鐵通過胃腸道吸收，主要在十二指腸和空腸上段 duodenum–priximal jejunum,鐵代謝IRON METABOLISM,9,食物中的鐵 Dietary iron含鐵高的食物 High in iron Red meat/ liver /kidney一般含鐵食物Av

9、erage iron Beans / fortified cereals/ dark green vegetables/ dried fruit/ nuts and seeds含鐵少的食物 Poor in iron milk,鐵代謝IRON METABOLISM,10,鐵的吸收 Iron absorption一般吸收 General absorption 1-20%肉類

10、 Meat/ fish/ chicken 10-25%谷物蔬菜 Cereals/vegetables 1%母乳/牛奶 Breast/cow’s milk 50%/10%,鐵代謝IRON METABOLISM,11,鐵的吸收和轉運 ABSORPTION & TRANSPORT,12,Pathogenesis ir

11、on ? + protoporphyrin IDA ? heme + globins hemoglobin?,,,,,,發(fā)病機制PATHOGENESIS,13,病因和發(fā)病機制ETIOLOGY & PATHOGENESIS,病因學 ETIOLOGY鐵儲存減少 Poor iron stores鐵攝入減少 Poor dietary intake of

12、 iron 鐵需要增加 Overdevelop慢性失血鐵丟失Chronic bleeding,14,對血液系統(tǒng)的影響：Hypochromic / microcytic anemiaID. Iron deficiencyIDE. Iron deficiency erythropoiesisIDA. Iron deficiency anemia組織代謝的影響：Enzymes activity decrease酶的活性下降，

13、影響精神，行為，體力，生長發(fā)育遲緩對免疫系統(tǒng)的影響Immune function 下降對皮膚粘膜的改變Skin/mucosal,發(fā)病機制PATHOGENESIS,15,特點 Features 年齡 Age發(fā)病過程 The onset of the IDA貧血程度The degree of anemia,臨床表現(xiàn)CLINICAL MANIFESTATIONS,16,一般改變General可以發(fā)生在任何年齡，在六個月到兩歲的兒童

14、中很常見Any age; commonly found in age 6 mths ~ 2 yrs髓外造血Extramedullary hematopoiesisMild/ Severe condition 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)CLINIC

15、AL 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，眼結膜Pallor : esp. lips, buccal and palpebral mucosa ，反甲 Koilonychia (spoon-shaped nails）粘膜潰瘍糜爛 rough ，ulcer，erosion鏡面舌 mirror surfac

16、e 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 hear

17、t心力衰竭 Even heart failure,19,臨床表現(xiàn)CLINICAL MANIFESTATIONS,消化系統(tǒng) Digestive system口角炎 Angular stomatitis舌炎 Glossitis唇炎 Angular cheilitis 異食癖 Pagophagia or pica,20,臨床表現(xiàn)CLINICAL MANIFESTATIO

18、NS,神經(jīng)系統(tǒng)癥狀 CNS manifestations: 易激動 Irritability嬰幼兒的學習能力下降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 development

19、血液系統(tǒng) Hemopoietic systemEnlargement 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,

20、 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: hypochromic /microcytic anemia+ SI↓SI：

21、62.7umol/L (>350ug/dl) TS： 0.9umol/L or> 50ug/dl)ID： SF < 12ug/L / marrow ironAcronyms and Abbreviations 血清鐵 SI：serum iron；總鐵結合力TIBC：total iron binding capacity；轉鐵蛋白飽和度 TS：transferrin saturation,實驗室檢

22、查LABORATORY FINDINGS,23,實驗室檢查Laboratory findings,Normal,Patient,24,,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 & DIFFERENT

23、IAL,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 Thalassemia鐵粒幼細胞性貧血Siderblastic anemia,,鑒別診斷 DIFFERENTIAL

24、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鐵缺如prussian blue iron stain：negative,,,鐵缺性貧血IDA

25、,29,有家族史，有溶血表現(xiàn)，脾腫大，黃疸 Faimly 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?！?2.海洋性貧血 Thalassemia,鑒別診斷DIFFERENT

26、IAL-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 DIFFERENTIAL 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 Erad

27、icate 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多糖鐵復合物poly

28、saccharide-iron complex 150mg 2/d服用：兩餐直接，加維生素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 dextranumIndicat

29、ion：severe gastrointestinal reaction Oral medication duodenum–priximal 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IRON THERAPY RESPONSE,36,治療 TREATMENT,輸血指征 Tr

30、ansfusion Indications 重度貧血Severe anemia感染 Infection 擬行手術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,預防PREVENTION,保健教育 Educati

31、on孕期婦女 For pregnant women母乳喂養(yǎng)/牛奶 Breast milk/cow’s 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,促鐵吸收因素Positive factors 維生素C/胃酸/氨基酸Ascorbic acid/ ga