1、缺铁性贫血幻灯11/5/20221缺铁性贫血幻灯11/5/20222缺铁性贫血幻灯11/5/20223缺铁性贫血幻灯11/5/20224缺铁性贫血幻灯11/5/20225缺铁性贫血幻灯11/5/20226缺铁性贫血幻灯11/5/20227缺铁性贫血幻灯11/5/20228组织铁组织铁（10%）血清铁血清铁 0.5%）贮存铁贮存铁20%）胆汁、尿、粪、汗胆汁、尿、粪、汗 骨髓幼红、骨髓幼红、(10%)网织红细胞网织红细胞血红蛋白血红蛋白(60%)缺铁性贫血幻灯11/5/20229铁铁 减减 少少血清铁减少血清铁减少细胞内铁减少细胞内铁减少组织内铁减少组织内铁减少缺铁性贫血幻灯11/5/20221
2、0缺铁性贫血幻灯11/5/202211缺铁性贫血幻灯11/5/202212缺铁性贫血幻灯11/5/202213缺铁性贫血幻灯11/5/202214缺铁性贫血幻灯11/5/202215缺铁性贫血幻灯11/5/202216缺铁性贫血幻灯11/5/202217缺铁性贫血幻灯11/5/202218缺铁性贫血幻灯11/5/202219缺铁性贫血幻灯11/5/202220缺铁性贫血幻灯11/5/202221缺铁性贫血幻灯11/5/202222缺铁性贫血幻灯11/5/202223缺铁性贫血幻灯11/5/202224缺铁性贫血幻灯11/5/202225减低：缺铁贫缺铁贫增高：溶贫、溶贫、AA、铁粒幼贫、铁粒幼
3、贫缺铁性贫血幻灯11/5/202226减低或正常：减低或正常：溶贫、继发患者溶贫、继发患者增加：增加：缺铁贫、红细胞增多症缺铁贫、红细胞增多症缺铁性贫血幻灯11/5/202227减低：减低：缺铁贫缺铁贫15%缺铁性贫血幻灯11/5/202228减低：减低：缺铁贫血早期、失血。缺铁贫血早期、失血。SF下降只发生下降只发生于铁缺乏症，单纯缺铁贫在于铁缺乏症，单纯缺铁贫在1020 ug/L以下；以下；而伴有慢性感染、活动性肝炎、恶性肿瘤、组而伴有慢性感染、活动性肝炎、恶性肿瘤、组织坏死，甲状腺机能亢进，织坏死，甲状腺机能亢进，SF正常或增高。正常或增高。增高：增高：感染、继发性贫血。感染、继发性贫血
4、。缺铁性贫血幻灯11/5/202229缺铁性贫血幻灯11/5/202230缺铁性贫血幻灯11/5/202231缺铁性贫血幻灯11/5/202232缺铁性贫血幻灯11/5/202233缺铁性贫血幻灯11/5/202234缺铁性贫血幻灯11/5/202235缺铁性贫血幻灯11/5/202236缺铁性贫血幻灯11/5/202237缺铁性贫血幻灯11/5/202238缺铁性贫血幻灯11/5/202239缺铁性贫血幻灯11/5/202240缺铁性贫血幻灯11/5/202241缺铁性贫血幻灯11/5/202242缺铁性贫血幻灯11/5/202243缺铁性贫血幻灯11/5/202244缺铁性贫血幻灯11/5
5、/202245缺铁性贫血幻灯11/5/202246A 60-year-old pharmacist had black stools over a two-day period one week prior to admission.She had been taking estron and pro gesterone for three months ending two months prior to admission because she was worried about osteoporosis.A brief episode of vaginal bleeding ended
6、 this practice.However,replaced estrogen and progesterone therapy with synthroid“to feel better”.Admission labs:RBC histogram as show(MCV obviously normal).Serum Fe decreased,IBC normal,ferritin markedly decreased,stools guaiac positive.Case 缺铁性贫血幻灯11/5/202247View of patient red cells from admitting
7、 smear.Note minimal anisocytosis(x200)缺铁性贫血幻灯11/5/202248Patient red cells and admitting histogram/hemogram combined.Note normal RDW.(x500)缺铁性贫血幻灯11/5/202249DIAGNOSIS:blood loss anemia with very early iron deficiency.Iron deficiency has not yet resulted in low MCV.Further,the RDW,though an early indi
8、cator of emerging anisocytosis,has not yet entered the abnormal range.But for the fact that the admitting serum ferritin was sharply decreased,a diagnosis of iron deficiency could not have been made,as a low serum iron could equally well have indicated anemia of chronic disease.(x500)缺铁性贫血幻灯11/5/202
9、250Case 2Blood smear from 72-year-old man with anemia of unknown etiology.Lab:Hb 68.0g/L,MCV 65.0fl,RDW 19.3 percent.Retic count 1.4 percent.DIAGNOSIS:iron deficiency anemia.Field reflects the severity of the anemia.Anisocytosis is mildly increased.Hypochromasia is moderate.Poikilocytosis is relativ
10、ely minor.(x200)缺铁性贫血幻灯11/5/202251Two cells at center show mild and moderate hypochromasia.(x500)缺铁性贫血幻灯11/5/202252铁蛋白铁蛋白含铁血黄素含铁血黄素缺铁期缺铁期缺铁性红细胞生成期缺铁性红细胞生成期缺铁性贫血期缺铁性贫血期缺铁性贫血幻灯11/5/202253缺铁性贫血幻灯11/5/202254缺铁性贫血幻灯11/5/202255SITIBCTSSFFEP骨髓铁染色骨髓铁染色下降下降增加增加减低减低减低减低增加增加内铁减低，外铁消失内铁减低，外铁消失 缺铁性贫血幻灯11/5/202256缺铁性贫血幻灯11/5/202257
