小儿营养性贫血(NUTRITIONAL-ANEMIA).ppt

1 NUTRITIONAL ANEMIA 2 New words Nutritional 营养的 Megaloblastic巨幼细胞 Hamorrhage出血 Irritability激惹 Lethargy嗜睡 Fatigue疲乏 Anorexia厌食 Appetite食欲 Microcytic小细胞的 Hypochromic低色素的 Thalassemia海洋性贫血 Ferrous sulfate硫酸亚铁 Hookworm钩虫 Epistaxis鼻出血 Reticulocyte 网织红细胞 3 Nutritional anemia Megaloblastic anemia vitamin B12 deficiency folic acid deficiency Iron deficiency anemia iron deficiency 4 Iron defeciency anemia Introduction Cause of Iron deficiency anemia Clinical features Laboratory findings Diagnosis Defferential diagnosis Treatment 5 Iron Deficiency Anemia,IDA Incidence of IDA:10-70%(WHO)40%(6m-6y，China)6 IDA is the most common cause of anemia in childhood.It usually results from inadequate dietary intake rather than loss of iron through hemorrhage.7 Iron in milk Both of breast and cows milk are low in iron Iron is better absorbed from breast milk(50%)compared to cows milk(10%)Formula milks are fortified with iron(4%)8 Dietary sources of iron 9 Dietary sources of iron Red meat Fortified breakfast cereals Dark green vegetables Black bread about 10-15%iron of dietary is absorbed 10 Iron requirements The fetus absorbs iron from the mother across the placenta.Term infants have adequate reserve for the first 4 months of life.Preterm infants have limited iron stores and because of their higher rate of growth,their iron reserves were used up by 8 weeks of age.Adolescents also need more iron because of 1.Growth spurt 2.Dietary deficiency 3.Menstrual blood loss 11 Reference nutrient intake of iron are:6 months:4 mg/day 12 months:8 mg/day Adult male:9 mg/day Adult female:15 mg/day 12（一）（一）the decrease of iron stores low birthweight preterm infants hemorrhage Causes of iron deificiency 13 Causes of iron deificiency （二）（二）Nutritional deficiency is common in certain at-risk groups preterm infants require iron supplements from 6-8 weeks.Term infants will develop iron deficiency after 4 months if 1.mixed feeding is unduly delayed 2.unmodified cows milk is introduced early.It is common in the first two years of age 14 Causes of iron deificiency(三）三）Malabsorption may be complicated by iron deficiency The children usually company with another malnutrition.15 Causes of iron deificiency(四）四）Blood loss is a less common cause in children,but may occur with:Menstruation Hookworm infection Repeated venesection in babies Meckels diverticulum Recurrent epistaxis It is the important cause of IDA in older children 16 Clinical features Mild iron deficiency anemia is asymptomatic More severe may be irritability Lethargy Fatigue anorexia 17 Signs:pallor of the skin and mucous membranes.Hb70g/L,tachycardia and cardiac dilation occur,and systolic murmurs are often present IDA in infancy and early children is associated with developmental delay and poor growth Clinical features 18 Laboratory findings 19 Serum iron(SI)62.7 umol/L Serum Ferritin(SF)0.9 umol/L Laboratory findings 20 IDAIDA外周血涂片红细胞形态外周血涂片红细胞形态 Laboratory findings 21 Iron deficiency anemia:low power view of peripheral blood film 22 Microcytic and hypochromic anemia.MCHC 30%,MCV 80fl,MCH 27pg The children with the clinical features of IDA and the cause of iron deficiency SI 10.7umol/L Transferin saturation 0.9umol/L Serum Ferritin(SF)20%50 10 20200 Iron stores 34+0 14+Transferrin receptor N or N HbF N N 25 Thalassemia minor IDA Thalassemia minor SI N or T IBC N HbF and A2 N Differential diagnosis 26 27 Treatment Management will depend on The severity of the anemia The cause of the iron deficiency The ability of the patient to tolerate medicinal iron preparations 28 Treatment Oral iron preparations tablet(iron content)Elixir(iron content)Ferrous sulfate 325(65)300/5ml(60)Ferrous gluconate 325(38)300/5ml(35)Ferrous fumarate 325(107)100/5ml(33)Polysaccharide-iron 150(150)100/5ml(100)29 Treatment Oral administration of simple ferrous provides inexpensive and satisfactory therapy Ferrous sulfate is 20%elemental iron by weight.A daily total of ferrous sulfate is 4-6 mg/kg of elemental iron in three divided doses provides 30 Serum Irom 7AM 12N 12MN 7PM Figure.Oral iron absoption.When medicinal iron is given 3 times a day,each dose raises the SI for several hours.A fourth dose at bedtime can help sustain the SI during nighttime hours.31 Treatment Blood transfusion is indicated only when the anemia is very severe Its not necessary to attempt rapid correction of severe anemia by transfusion The children with hemoglobin values less than 40g/L should be given only 2-3ml/Kg of RBCs 32 Responses to Iron Therapy in IDA Time After Iron Administration Response 1224 hr Replacement of intracellular iron enzymes;decreased irritability;increased Appetite 36-48 hr Initial bone marrow response;erythroid hyperplasia 48-72 hr Reticulocytosis,peaking at 57 days 4-30 days Increase in hemoglobin level 1-3 mo Repletion of stores 33 The case 8 years old boy from countryside Diagnosis is IDA and Hookworm infection(Hb=65g/L)Three weeks late after treatment with Ferrous sulfate:Hb=70g/L 34 婴儿期缺铁性贫血最常见的原因是婴儿期缺铁性贫血最常见的原因是 A胎儿