Download - 外文讲义5
![Page 1: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/1.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Nutritional iron defici
ency anemia
![Page 2: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/2.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Iron Deficiency a Global Problem
58 % of pregnant women in developing countries are
anaemic
31% of children under 5 in developing countries are also anaemic
![Page 3: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/3.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
As iron deficiency chiefly influences the synthesis of heme, the production of Hb is decreased, and the red cells become microcyte and hypochromic.
this anemia is also named nutritional microcytic anemia.
Definition
![Page 4: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/4.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
The Hemoglobin Molecule
α
β
![Page 5: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/5.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Protoporphyrin + iron heme
+
globin
IDA hemeglobin
MechanismMechanism
![Page 6: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/6.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Iron source Dietary iron is important source, such as meat,
fish, liver, yolk, bean…
Recycled From the breakdown of red cells,
80 % iron is reutilized to produce Hb
Iron metabolism
![Page 7: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/7.jpg)
Iron cycleIron cycle
Fe
Fe
FeFeFe Ferritin
Hemosiderinslow
Fe
Fe
Fe FeFe
Fe
Fe Fe
Fe
Ferritin Ferritin
Tra
nsfe
rrin
Rec
epto
r
RBC PRECURSOR
CIRCULATING RBCs
Fe Fe
TRANSFERRIN
MONONUCLEARPHAGOCYTES
![Page 8: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/8.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
The iron content : young adult male is about 50mg/kg female average 35mg/kg newborn about 60-90mg/kg 2/3 functional - being used
1/3 stored
Iron metabolism
![Page 9: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/9.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Iron distribution 65-70% of total body iron content is used to the composition of Hb Smaller amounts of iron are found in myoglobin , enzymes
Iron metabolism
![Page 10: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/10.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Storage (30%)
two forms
ferritin
hemosiderinwhich are located primarily in the
liver, spleen and bone marrow
Hemosiderin is an insoluble iron aggre
gate derived from ferritin
Iron metabolism
![Page 11: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/11.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Storage of iron
Tissues with higher requirement for iron
( bone marrow, liver) contain more transferrin receptors.
Once in tissues, iron is stored as ferritin & hemosiderin compounds, which are present in the liver & bone marrow.
The amount of iron in the storage compartment depends on iron balance (positive or negative).
Ferritin level reflects amount of stored iron in the body & is important in assessing ID.
![Page 12: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/12.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Plasma
Fe
16%
65%
4%
15%
![Page 13: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/13.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
two forms of dietary iron:
heme meat, fish, and poultry
nonheme Flours, cereals, and grain
Iron absorption
Iron metabolism
![Page 14: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/14.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
IronHeme iron is part of hemoglobin and myoglobin and is obtained from meat of all types.
– About 20%-25% absorbed
Non-heme iron is found in leafy green vegetables, legumes, and meat, and is absorbed at about half (or less) the rate of heme iron. Non-heme iron can also leach out of iron cookware into food.
![Page 15: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/15.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Iron: Heme vs. Nonheme
Copyright 2005 Wadsworth Group, a division of Thomson LearningCopyright 2005 Wadsworth Group, a division of Thomson Learning
10-17%
![Page 16: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/16.jpg)
Food
Gastrointestinal tract
Fe3+
Phosphates,oxalates (-) (+) ascorbic acid, meat
Fe2+
intestinal mucosa
Fe3+
Fe3+ + apoferritin blood
Fe3+ +transferrin
Ferritin bone marrow liver spleen
(storage) heme Fe3+ +apoferritin ferritin
hemoglobin Hemosiderin (storage)
Iron absorption
![Page 17: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/17.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Iron in
the Body
![Page 18: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/18.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
iron absorption is influenced body’s iron stores the type of iron in the diet other dietary factors that either help or hinder iron absorption enhanced by Vitamin C meat diminished by phosphates, oxalates, and tannic acidThe greatest influence on ironabsorption is the amount stored in your body.
Iron absorption
![Page 19: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/19.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Iron Absorption
Copyright 2005 Wadsworth Group, a division of Thomson LearningCopyright 2005 Wadsworth Group, a division of Thomson Learning
![Page 20: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/20.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
insufficient iron stores
insufficient iron intake
rapid growth and development
failure of iron absorption
iron loss
Etiology
![Page 21: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/21.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
In newborn, the body contains about 0.2-0.5g of iron.
Newborn term infants 75 mg/kg A preponderance of iron hemoglobin (75%) first 2-3 months hemoglobin concentration (iron is reclaimed and stored)
adult has 5g
Insufficient iron stores
Etiology
![Page 22: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/22.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
![Page 23: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/23.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
premature
low birth weight
twins
infant with perinatal blood loss
Insufficient iron stores
the premature or low birth weight infant
64 mg/kg
Etiology
![Page 24: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/24.jpg)
Iron balance during the first year of life
Full-term infant Premature infant
Birth 1 year Birth 1 year
Weight(kg) 3.3 10.5 1.5 9.5
Blood hemoglobin(g/dl) 20.0 12.3 20.0 12.3
Blood volume(ml) 290 800 135 720
Total hemoglobin(g) 58 98 27 89
Hemoglobin iron(mg) 198 335 90 300
Storage tissue iron(mg) 60 73 27 67
Total body iron(mg) 258 408 117 367
Net positive iron balance 0.4 0.7
(mg/day)
![Page 25: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/25.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
A diet containing 8-15mg of iron is necessary
for optimal nutrition
(approximately 10% is absorbed)
the normal daily excretion of iron < 1mg/d
Insufficient iron intake
Etiology
![Page 26: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/26.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
1mg/kg/day to a maximum of 15mg/day
is required in a normal full-term infant
2mg/kg/day to a maximum of 15mg/day
is required in Premature infants
Etiology
![Page 27: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/27.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Insufficient iron intake
Poor sources of iron The diet (during the period of infancy) milk (cow’s or human’s) contain little iron poverty Malabsorption syndrome loss of appetite
Etiology
![Page 28: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/28.jpg)
Iron content of infant foods Food iron(mg) unit
Milk 0.5-1.5 liter
Eggs 1.2 each
Cereal,fortified 3.0-5.0 ounce
Vegetables (strained)
yellow 0.1-0.3 ounce
green 0.3-0.4 ounce
Meats (strained)
Beef,lamb,beef liver 0.4-2.0 ounce
Pork, liver ,bacon 6.6 ounce
Fruits (strained) 0.2-0.4 ounce
![Page 29: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/29.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Rapid growth and development
The age of 6 months to 2 yrs is a period of rapid growth and development, correspondingly the infant’s blood volume must be proportionately expanded, the requirement of iron also increased
Etiology
![Page 30: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/30.jpg)
Iron balance during the first year of life
Full-term infant Premature infant
Birth 1 year Birth 1 year
Weight(kg) 3.3 10.5 1.5 9.5
Blood hemoglobin(g/dl) 20.0 12.3 20.0 12.3
Blood volume(ml) 290 800 135 720
Total hemoglobin(g) 58 98 27 89
Hemoglobin iron(mg) 198 335 90 300
Storage tissue iron(mg) 60 73 27 67
Total body iron(mg) 258 408 117 367
Net positive iron balance 0.4 0.7
(mg/day)
![Page 31: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/31.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
failure of iron absorption
Food collocation is not reasonable
Chronic diarrhea
Etiology
![Page 32: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/32.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Iron loss infant during the first 2 months iron loss > iron absorption from the diet intolerance cow’s milk syndrome of sensitivity to cow’s milk 0.7 ml of blood in stool is lost each day (induced by a heat-labile protein in whole cow’s milk)
Etiology
![Page 33: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/33.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Iron loss occult bleeding (Chronic iron deficiency anemia) lesion of the gastrointestinal tract peptic ulcer meckels diverticulum polyp hemangioma hookworm infection
Etiology
![Page 34: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/34.jpg)
Infants at high risk for iron deficiency Increased iron needs
Low birth weight
High growth rate
Chronic hypoxia
Low hemoglobin after birth
Blood loss
Perinatal bleeding
Dietary factors
Early cow milk intake
Early solid food intake
Low vitamin C intake
Low meat intake
Breast-feeding for more than 6 months without iron supplements
Low socioeconomic status
![Page 35: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/35.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Causes of Iron Deficiency
Inadequate Stores (Birth)
Inadequate Intake
Increased Requirements
Increased Loss
Infancy Common Common Common Rare
Childhood Rare Moderate Moderate Moderate
Adulthood Rare Rare None Common
![Page 36: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/36.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
iron depletion (store)
iron deficiency erythropoiesis
iron deficiency anemia
Clinical manifestation
![Page 37: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/37.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Predisposing age
6 months
3 years
Clinical manifestation
![Page 38: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/38.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
General manifestation Pallor the most common symptom palpebral conjunctivas mucous membranes of the oral cavity, the nails, palms, the rest of the skin also become pale. Dyspnea on exertion failure to thrive listlessness irritability fatigue dizziness vertigo
The nails clubbing and koilo’nychia.
Clinical manifestation
![Page 39: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/39.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
![Page 40: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/40.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Manifestation of extramedullary hematopoiesis
hepatosplenomegaly
lymphonodes enlarged
Clinical manifestation
![Page 41: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/41.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Others Gastrointestinal symptom: Anorexia, dysphagia, pica
Cardiovascular symptom:
A systolic murmur Tachycardia cardiomegaly
congestive cardiac failure
There is an increased incidence of infections
tuberculosis chest gastrointestinal infections
Nervous system: Irritability , decreased attentiveness
shorter attention span, associated with behavioural
and intellectual deficiencies.
Clinical manifestation
![Page 42: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/42.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Behavioural Change
Lack of energy , irritability, poor concentration
Nervous system
Of course these are common problems
associated with children that may not
always becaused by iron deficiency
Clinical manifestation
![Page 43: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/43.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Learning Difficulties
Learning difficulties can be present in anemic children, and there is some evidence to suggest that intellectual and physical development may not always be completely reversed when the child’s iron status has been corrected.
Nervous system
Clinical manifestation
![Page 44: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/44.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
red cells microcytic and hypochromic.
Laboratory findings
![Page 45: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/45.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
![Page 46: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/46.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Iron Deficiency Anemia:
![Page 47: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/47.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Iron Deficiency Anemia
![Page 48: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/48.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
• Both size and color are normal in these blood cells
• Blood cells in iron-deficiency anemia are small and pale because they contain less hemoglobin
![Page 49: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/49.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
IDA
![Page 50: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/50.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Mean corpuscular volume (MCV)<80fl
Mean corpuscular hemoglobin (MCH) <26pg
Mean corpuscular hemoglobin concentration
(MCHC)<31%
Red blood cell indices
Laboratory findings
![Page 51: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/51.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
The reticulocyte count may be normal /slight decrease Nucleated red cells may be present White cells and platelets may normal. severe cases may slightly decreased
Laboratory findings
![Page 52: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/52.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Serum irons below 9-10.7 umol/L
( normal range is 12.8-31.3)
Serum ferritin less than 12ug/l
The total iron-binding capacity(TIBC)
more than 62.7 umol/L
Free erythrocyte protoporphyrin (FEP)
more than 0.9umol/L
Laboratory findings
![Page 53: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/53.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
![Page 54: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/54.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Bone marrow : erythroid hyperplasia granulocyte normal megakaryocytes normal < 2 years little or no iron in the form of hemosiderin Stool routine
Laboratory findings
![Page 55: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/55.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
The highest incidence age 6m-3yrs A history of inadequate intake of iron History of chronic malabsorption or infections The clinical manifestation The peripheral blood smear microcytic and hypochromic red cells A good hematopoietic respons after 3-7 days of adminstration of iron. then the red cells and Hb other laboratory examinations : bone marrow serum iron or serum ferritin
Diagnosis
![Page 56: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/56.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Anemia of infection
Protein of malnutrition
Thalassemia acquired hemolytic anemia
Pyridoxine deficiency
Sideroblastic anemia
lead poisoning
Differential Diagnosis
![Page 57: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/57.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Thalassemia
Disorders of Globin chain synthesis
• Imbalance between alpha and beta chain synthesis
• Results in hypochromic/microcytic anemia
Alpha Thal: Alpha gene deletions
Beta Thal: Many different point mutations
Genetics of Thalassemia
![Page 58: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/58.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
b-Thalassemia
HbA2
![Page 59: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/59.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Mentzer Index
MCV/RBC
– > 13.5 suggestive of iron deficiency< 11.5 suggestive of thalassemia
![Page 60: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/60.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
• Microcytic, hypochromic form• Inherited defect of heme synthesis enzyme• High serum and tissue iron levels• Buildup of immature sideroblasts — hence the name
Sideroblastic AnemiaSideroblastic Anemia
![Page 61: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/61.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
![Page 62: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/62.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Lead Poisoning
• A very serious but preventable health problem
• Nearly 1 million U.S. children under age 6 have elevated blood lead levels
• Even children who seem healthy may have high levels of lead in their blood
![Page 63: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/63.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Major Source of Lead Poisoning
• Dust and chips from lead-based paint
– Children may eat dust that accumulates on hands, toys, furniture, floor, window sills, porches
– Children may inhale dust or fumes if paint is heated (automobile end gas)
![Page 64: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/64.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
lead≥10ug/dl
![Page 65: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/65.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Encourage breast feeding for infantuse an iron-fortified infant formulasSupplement with high in iron foodAdequate nursing care and prevention of infectious diseases and diarrheaCooking with an iron-pot to replace the aluminum-pot.
Prevention
![Page 66: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/66.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Iron Rich Foods
• Meats beef, pork, lamb, liver, and other organ
meats
• poultry chicken, duck, turkey
• fish – shellfish mussels, and oysters, sardines
• Dark green, leafy vegetables broccoli, kale, turnip greens, and collards Kidney beans, pumpkin seeds, wheat germ, sunflower seeds, lentils, walnuts, parsley, almonds, oats
• Eat more vitamin C
![Page 67: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/67.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Iron Content Of Some Common Foods Food Quantity Milligrams Of Iron
Lean beef 100 grams 4.1
Chicken Breast 100 grams 0.6
Fish 100 grams 0.4
1 medium egg 60 gram 0.8
Baked beans 1/2 cup 1.9
Lentils 1/2 cup 2.5
Wholemeal 1 slice 0.7
Boiled spinach 1/2 cup 2.2
Broccoli 1/2 cup 0.7
Iron fortified baby cereal 15 grams 7.5
![Page 68: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/68.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
General therapy
Removal of etiological factors
Treatment with iron preparation
Blood transfusions
Treatment
![Page 69: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/69.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Oral preparation of iron
It is convenient to give iron in the form of
an oral preparation
a doses of 4-6mg/kg/day of elemental
iron
Treatment
![Page 70: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/70.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Which iron form to use?
The major factors governing the choice of iron compound include:
Bioavailability Organoleptic problems Cost Safety
Ideally we should go for a safe, cheap, highly bioavailable iron, which causes no organoleptic side-effects
![Page 71: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/71.jpg)
Dose of oral iron preparation
Kind of iron infant children elemental iron
Dose/day in 1g
Ferrous sulfate 0.15-0.3g 0.3-0.6g 200mg
Ferrous fumarate 0.1-0.2g 0.2-0.4g 330mg
Ferrous gluconate 0.3-0.6g 0.6-1.2g 115mg
(Ferrous salts are absorbed better than ferric salts)
therapy is generally continual 2-3 months after
restoration of the Hb to normal.
![Page 72: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/72.jpg)
Failure to respond to oral iron:
the following reasons should be considered
Failure or irregular administration of oral iron; administration
verifiable by change in stool color to gray-black
Inadequate iron dose
Ineffective iron preparation
Persistent or unrecognized blood loss, with the patient losing iron as fast as it is replaced.
Incorrect diagnosis
Coexistent disease that interferes with absorption or utilization of iron (infection , hepatic or renal disease …)
Impaired GI absorption (e.g. concurrent administration of large amounts of antacids, which bind iron, as treatment of peptic ulcer)
![Page 73: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/73.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Parenteral iron therapy indicated in children showing
intolerance to oral iron
reduced iron absorption
persistent blood loss
their parents are unreliable
Treatment
![Page 74: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/74.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
The requirement of iron dextran milligrams is calculated as fellows:
Total doses (mg)
(elemental iron)
· kg: body weight
· 12.5 is the normal Hb in infant
· 3.4 is elemental iron(mg) in 1 gram of Hb
· 1.2 means an additional iron supplement of 20%
for serum iron.
75 x kg x (12.5-Hb) x 3.4 x 1.2100
Treatment
![Page 75: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/75.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Iron dextran complex intramuscular
ampoule containing 100mg elemental
iron in 2ml.
administer daily, on alternate days,
biweekly.
Treatment
![Page 76: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/76.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
The good response reticulocyte
48 ~ 72h
a peak during the 5th to 7th days
falls the normal level after 2-3 weeks
Treatment
![Page 77: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/77.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
. Iron supplementation should be continued for a minimum of 3 months, not only to correct the hemoglobin but also to replenish the iron stores.
Treatment
![Page 78: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/78.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Therapeutic effect observationResponse to iron supplements
Time reaction
12-24 hr Enzyme activity improve
36-48 hr Bone marrow reaction; hyperplasia
48-72 hr Reticulocyte, 5-7d peak
4-30 days Hemoglobin
1-3 mo Replenish iron stores
![Page 79: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/79.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Blood transfusion are rarely indicated in iron deficiency anemia, except for severe cases (Hb<60g/l).
Treatment
![Page 80: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/80.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
• Blood transfusion– indication : sever anemia complicated cardia
insufficiency or infection– Ingredient: concentrated RBC/
suspension of RBC – amount : Hb <30g/L, 3-5ml/kg;
Hb 30-60g/L, 5-10ml/kg
Treatment
![Page 81: 外文讲义5](https://reader034.vdocuments.mx/reader034/viewer/2022051817/54785110b4af9f65248b45cf/html5/thumbnails/81.jpg)
Mosby items and derived items © 2005, 2001 by Mosby, Inc.
Iron deficiency anemia definition Iron’s storageIron’s absorptionIron deficiency anemia’s etiologyThe first good response to iron medication Therapy time
QUESTIONS