最新小儿营养性贫血(NUTRITIONAL-ANEMIA)课件PPT.ppt 89页

'小儿营养性贫血(NUTRITIONAL-ANEMIA) NewwordsNutritional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Ferroussulfate硫酸亚铁Hookworm钩虫Epistaxis鼻出血Reticulocyte网织红细胞2 NutritionalanemiaMegaloblasticanemiavitaminB12deficiencyfolicaciddeficiencyIrondeficiencyanemiairondeficiency3 IroninmilkBothofbreastandcow`smilkarelowinironIronisbetterabsorbedfrombreastmilk(50%)comparedtocow`smilk(10%)Formulamilksarefortifiedwithiron(4%)7 Dietarysourcesofiron8 DietarysourcesofironRedmeatFortifiedbreakfastcerealsDarkgreenvegetablesBlackbreadabout10-15%ironofdietaryisabsorbed9 IronrequirementsThefetusabsorbsironfromthemotheracrosstheplacenta.Terminfantshaveadequatereserveforthefirst4monthsoflife.Preterminfantshavelimitedironstoresandbecauseoftheirhigherrateofgrowth,theirironreserveswereusedupby8weeksofage.Adolescentsalsoneedmoreironbecauseof1.Growthspurt2.Dietarydeficiency3.Menstrualbloodloss10 Referencenutrientintakeofironare:6months:4mg/day12months:8mg/dayAdultmale:9mg/dayAdultfemale:15mg/day11 （一）thedecreaseofironstoreslowbirthweightpreterminfantshemorrhageCausesofirondeificiency12 Causesofirondeificiency（二）Nutritionaldeficiencyiscommonincertainat-riskgroupspreterminfantsrequireironsupplementsfrom6-8weeks.Terminfantswilldevelopirondeficiencyafter4monthsif1.mixedfeedingisundulydelayed2.unmodifiedcow`smilkisintroducedearly.Itiscommoninthefirsttwoyearsofage13 Causesofirondeificiency(三）MalabsorptionmaybecomplicatedbyirondeficiencyThechildrenusuallycompanywithanothermalnutrition.14 Causesofirondeificiency(四）Bloodlossisalesscommoncauseinchildren,butmayoccurwith:MenstruationHookworminfectionRepeatedvenesectioninbabiesMeckel`sdiverticulumRecurrentepistaxisItistheimportantcauseofIDAinolderchildren15 ClinicalfeaturesMildirondeficiencyanemiaisasymptomaticMoreseveremaybeirritabilityLethargyFatigueanorexia16 Signs:palloroftheskinandmucousmembranes.Hb<70g/L,tachycardiaandcardiacdilationoccur,andsystolicmurmursareoftenpresentIDAininfancyandearlychildrenisassociatedwithdevelopmentaldelayandpoorgrowthClinicalfeatures17 Laboratoryfindings18 Serumiron(SI)<10.7umol/LTatalironbindingcapacity(TIBC)>62.7umol/LSerumFerritin(SF)<16ug/LFreeerythrocyteprotoporphyrin(FEP)>0.9umol/LLaboratoryfindings19 IDA外周血涂片红细胞形态Laboratoryfindings20 Irondeficiencyanemia:lowpowerviewofperipheralbloodfilm21 ①Microcyticandhypochromicanemia.MCHC<30%,MCV<80fl,MCH<27pg②ThechildrenwiththeclinicalfeaturesofIDAandthecauseofirondeficiency③SI<10.7umol/L④Transferinsaturation<15%⑤Ironstoresdecreaseinbonemarrow⑥Freeerythrocyteprotoporphyrin(FEP)>0.9umol/L⑦SerumFerritin(SF)<16ug/L⑧Goodresponsetoirontherapy①+twoof②~⑧isnecessaryforthediagnosisdiagnosis22 diagnosisDeterminationofthecauseofIDAismostimportantfordiagnosis23 DifferentialdiagnosisthalassamieIDAchronicinflammationSINorTIBCNPercentsaturtion>20%<10%10~20%Ferritin(ug/L)>50<1020~200Ironstores3~4+01~4+TransferrinreceptorNorNHbFNN24 ThalassemiaminorIDAThalassemiaminorSI↓Nor↑TIBC↑NHbFandA2N↑Differentialdiagnosis25 26 TreatmentManagementwilldependonTheseverityoftheanemiaThecauseoftheirondeficiencyTheabilityofthepatienttotoleratemedicinalironpreparations27 TreatmentOralironpreparationstablet(ironcontent)Elixir(ironcontent)Ferroussulfate325(65)300/5ml(60)Ferrousgluconate325(38)300/5ml(35)Ferrousfumarate325(107)100/5ml(33)Polysaccharide-iron150(150)100/5ml(100)28 TreatmentOraladministrationofsimpleferrousprovidesinexpensiveandsatisfactorytherapyFerroussulfateis20%elementalironbyweight.Adailytotalofferroussulfateis4-6mg/kgofelementalironinthreedivideddosesprovides29 SerumIrom7AM12N12MN7PMFigure.Oralironabsoption.Whenmedicinalironisgiven3timesaday,eachdoseraisestheSIforseveralhours.AfourthdoseatbedtimecanhelpsustaintheSIduringnighttimehours.30 TreatmentBloodtransfusionisindicatedonlywhentheanemiaisverysevereIt`snotnecessarytoattemptrapidcorrectionofsevereanemiabytransfusionThechildrenwithhemoglobinvalueslessthan40g/Lshouldbegivenonly2-3ml/KgofRBCs31 ResponsestoIronTherapyinIDATimeAfterIronAdministrationResponse12–24hrReplacementofintracellularironenzymes;decreasedirritability;increasedAppetite36-48hrInitialbonemarrowresponse;erythroidhyperplasia48-72hrReticulocytosis,peakingat5–7days4-30daysIncreaseinhemoglobinlevel1-3moRepletionofstores32 Thecase8yearsoldboyfromcountrysideDiagnosisisIDAandHookworminfection(Hb=65g/L)ThreeweekslateaftertreatmentwithFerroussulfate:Hb=70g/L33 婴儿期缺铁性贫血最常见的原因是A胎儿期储铁不足B饮食中铁的缺乏C出血下列哪项是鉴别缺铁性贫血与海洋性贫血的重要依据A临床表现B细胞形态CHbF和HbA2检查缺铁性贫血铁剂治疗后，最先改善的是A食欲B网织红细胞CHb量34 病例10个月男孩面色苍白两个月，不发烧，不咳嗽，无皮肤黏膜出血，无血便及肉眼血尿，大小便正常。出生史：第一胎，第一产，孕36周早产喂养史：生后母乳喂养至今，6个月开始添加辅食。平素食欲较差。体检：皮肤黏膜苍黄，肝右肋下2CM，脾左肋下2CM实验室检查：35 项目结果参考值红细胞(RBC)2.683.5-5.0×1012/L血红蛋白(HGB)67110-150g/LMCV6282-92flMCH2227-31pgMCHC280320-360g/LRET4.5%血小板(PLT)275100-300×109/L白细胞(WBC)10.24.0-10×109/L36 肝功能：GPT39U，GOT40U，TB，DB正常红细胞脆性降低，HbF56%37 THANKS38 大家好 你 将 看 到 我的 自我介绍 自我介绍 自我介绍 自我介绍 我叫 XXx XX 这 是 我 第一次 第一次 做 快闪 快闪 快闪 快闪 快闪 快闪 快闪 快闪 类型的ppt 我喜欢和大家玩 我们来玩一个小游戏 小游戏 小游戏 你的眼睛受得了 受得了 这种 刺激 刺激 吗？ 累死狗！ 还在吗 如果觉得此模板不错 请点个赞 赞 不喜欢的话 那就 点一个踩吧 谢谢！'