1、1Iron Deficiency AnemiaIron Deficiency Anemia (IDA) (IDA)Dr. Liu Chonghai2 Iron-deficiency anemia affected about 1.48 billion people in 2015. A lack of dietary iron is estimated to cause approximately half of all anemia cases globally. Women and young children are most commonly affected. In 2015 ane
2、mia due to iron deficiency resulted in about 54,000 deaths down from 213,000 deaths in 1990.3Disability-adjusted life year for iron-deficiency anemia per 100,000 inhabitants in 2004.4Metabolism of Iron Metabolism of Iron A. Iron distribution in the body 5A. Iron distribution in the bodyA. Iron distr
3、ibution in the body6B. The source of ironB. The source of iron Endogenous old RBC (2/3) Exogenous through food (1/10mg/d) Animal foods with high iron content and high heme iron, the absorption rate of 10-25% Iron of vegetable food is non-heme iron, the absorption rate of 1.7-7.9%7C. Physiological re
4、quirement of iron:C. Physiological requirement of iron: 1mg 1.5mg/kg/d (15yr) Premature 2mg/kg/d89Index of iron nutritionIndex of iron nutrition10TIBC and iron saturation in IDATIBC and iron saturation in IDA11Etiology of iron deficiencyEtiology of iron deficiency 1. Insufficient iron store: prematu
5、re, severe maternal iron deficiency, intra-uterus transfusion etc. 2. Insufficient intake: food with insufficient iron, e.g. fed with milk, flour or rice flour only etc. 3. Absorptive problems: chronic diarrhea, steatorrhea 4. Growth demand: young infants, premature baby, adolescent children, girls
6、after menarche etc. 5. Blood loss: chronic gastrointestinal bleeding caused by peptic ulcer, hook worm, multiple polyps, angioma, diverticuloritis or inflammative enteropathy, or acute blood loss with injury or epitaxisetc.123 stages Iron depletion, ID: Iron deficient erythropoiesis, IDE Iron defici
7、ency anemia, IDA13Impact on body health by IDImpact on body health by ID 1. Hematopoieticsystem: gradual anemiaStages Ferritin Serum iron, SI Hb ID Low N NIDE L L NIDA L L L 14Impact on body health by ID (continued)Impact on body health by ID (continued) 2. GI system: absorptive disorders; 3. Circul
8、ative system: cardiac contractivity decrease, heart enlargement, murmur and heart failure; 4. Neuroschycological system: insomnia, attention absent (aprosexia), apathy; 5. Immune system: compromised immunity, susceptible to infection; 6. Skin and hair system: dryness of skin, sparse and brittle hair
9、s,loss of polish, fragile nails, koilonychia;15Clinical ManifestationClinical Manifestation Age:6 months 3yrs General: anemic pale, positional hypotension; GI system: diarrhea, dyspepsia, nausea, vomiting Hematopoietic System: hepatosplenomegaly (extramedullary hematopoiesis) Circulatory system: tac
10、hycardia, murmurs and heart enlargement; Immune system: infection; Neuropsycological system: pica, apathy;16Lab testsLab tests-Blood smear:Blood smear:17Microcytic and hypochromic RBCMicrocytic and hypochromic RBC18BM smearBM smear： Cellularity: hypercellularity; Iron stain: compromised both interce
11、llular and intracellular iron stains. Developing nucleated erythrocytes: delayed cytoplasmicdevelopment;192021Indices of iron nutritionIndices of iron nutrition SI (serum iron) Fn (Ferritin) TIBC (total iron binding capacity) FEP (free erythrocyticprotopophrin)22 1、IDA: is a gradual process which ca
12、n be divided into 3 stages, ie, ID stage, IDE stage and IDA stage. 2、Ferritin is the most sensitive marker for IDA; 3、Once Hbhas been recovered to normal level, iron agents should be used continuesllyfor another 2 months. 23Diagnosis and differential diagnosisDiagnosis and differential diagnosis Dia
13、gnosis: History clinical manifestation lab tests Differential diagnosis:(Hypochromic and microcytic anemias) thalassemia, lead poisoning, chronic infection etc.24TreatmentTreatment1.Looking for etiology and modify feeding formula;2. Medications: iron agents for Oral: ferrous gluconate, ferrous sulfa
14、te; for Inj: Ferrous dextran; dosage: 3-6mg elemental iron/kg/day, 3 divided doses Responses: reticulocyte 2-3d ,5-7d to peak, 2-3wks to normal. Hb 1-2wks , 3-4wks correction anemia. Caution: continue to give iron for 4-6 months(India) 6-8 wks(China) after Hb becomes normal.25Blood TransfusionBlood
15、Transfusion when it is necessary. 1. severe anemia with congestive cardiac failure 2. with severe infection 3. need surgeryHb 60g/L, NO.26PreventionPrevention 1. Health propaganda and councilling; 2. Adequate diet for pregnant mothers; 3. Correct feeding for baby; 4. Treatment of diseases: GI disord
16、ers, parasitesetc.27Megaloblastic AnemiaMegaloblastic Anemia28DefinationDefination: : Nutritional VitB12 or folic acid deficiency anemia was defined as the deficiency in either VitB12 or Folic acid.29 In India, 6.8% children had folate deficiency, 32% showed vinB12 deficiency and combined deficiency
17、 China-rare30Metabolism of VitB12 and Folic acidMetabolism of VitB12 and Folic acidFolic acid:Food: rich in green vegetible, lack in sheep milk;Absorptive site: at upper portion of jejunum;Vitamin B12:Food: rich in animal food;Absorptive site: terminus of ileum; Absorption helping factor: internal f
18、actor.31EtiologyEtiologyDecreased intake （vegetarian-VB12, goat milkFolic acid );Increasing demands;Impaired absorption (celiac disease, intestinal parasites)Disease impacts;Congenital defects:1、congenital FA absorptive defects; 2、Juvenile pernicious anemia;3、congenital transcobalamin defects。32Clin
19、calClincal Manifestations ManifestationsAge: peak at 6 mon 2 yrs;Anemia: soil color of skin, edema, petechae;GI system problems: dyspepsia, nausea, etc.Circulatory system: tachycardia, murmur, heart failure etc.Neurosphycological system: mental retardation, Ataxia, clonus with VitB12 defective.33Lab
20、 testsLab testsBlood smear: RBC morphology: macrocytic normochromic WBC morphology: neutrophil: large cell with hyper-fragmented nucleus Plt: enlarged size, reduced number34HyperfragmentedneutrophilHyperfragmentedneutrophil35MegloblasticMegloblastic anemia CBC anemia CBC36BM smear:BM smear: Cellular
21、ity:hypercellularitywith bigger size of the RBCs; Morphology:imbalance development of cytoplasma: nucleus; WBC morphology:enlarged WBC with hyperfragmented; Megakaryocyte/plt:normal or decreased.3738Determination of FA and Vitamin B12: FA: 3 ug/L B12： 100ng/L39Diagnosis and Differential DiagnosisDia
22、gnosis and Differential Diagnosis Diagnosis: causes; histories and lab tests results; pay attention to congenital factors; Differential diagnosis:1. Spherocytosis;2. Erythroleukemia(M6)3. Congenital dysplasiaof brain development.404142ManagementsManagements 1.General managements: eliminate causes an
23、d appropriate feeding; 2. Specific treatment: FA reagent(5-15mg/d+VitC 300mg) and VitB12 reagents 3. Transfusion: multiple transfusion if necessary.43PreventionPrevention 1.Appropriate feeding; 2.Avoid singular diet; 3.Avoid feeding with sheep milk only. 4.Patients with ileum resectedneeds supplement of vitB12.44
