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 anemia du
2、e 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 distribution i
3、n 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 requirement of iron:C
4、.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:premature,severe maternal iron
5、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 after menarche etc.5.Blood loss:chronic g
6、astrointestinal 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 deficiency anemia,IDA13Impact on body health by IDImpact o
7、n 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.Circulative system:cardiac contractivity decrease,heart enlargement,m
8、urmur 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 hairs,loss of polish,fragile nails,koilonychia;15Clinical ManifestationClinical Mani
9、festation Age:6 months 3yrs General:anemic pale,positional hypotension;GI system:diarrhea,dyspepsia,nausea,vomiting Hematopoietic System:hepatosplenomegaly(extramedullary hematopoiesis)Circulatory system:tachycardia,murmurs and heart enlargement;Immune system:infection;Neuropsycological system:pica,
10、apathy;16Lab testsLab tests-Blood smear:Blood smear:17Microcytic and hypochromic RBCMicrocytic and hypochromic RBC18BM smearBM smear：Cellularity:hypercellularity;Iron stain:compromised both intercellular and intracellular iron stains.Developing nucleated erythrocytes:delayed cytoplasmicdevelopment;1
11、92021Indices 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 can be divided into 3 stages,ie,ID stage,IDE stage and IDA stage.2、Ferritin is the most sensitive marker for IDA;3、
12、Once Hbhas been recovered to normal level,iron agents should be used continuesllyfor another 2 months.23Diagnosis and differential diagnosisDiagnosis and differential diagnosis Diagnosis:History clinical manifestation lab tests Differential diagnosis:(Hypochromic and microcytic anemias)thalassemia,l
13、ead poisoning,chronic infection etc.24TreatmentTreatment1.Looking for etiology and modify feeding formula;2.Medications:iron agents for Oral:ferrous gluconate,ferrous sulfate;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
14、 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 Transfusion when it is necessary.1.severe anemia with congestive cardiac failure 2.with severe infection 3.need surgeryHb 60g/L,NO.26Preventio
15、nPrevention 1.Health propaganda and councilling;2.Adequate diet for pregnant mothers;3.Correct feeding for baby;4.Treatment of diseases:GI disorders,parasitesetc.27Megaloblastic AnemiaMegaloblastic Anemia28DefinationDefination:Nutritional VitB12 or folic acid deficiency anemia was defined as the def
16、iciency in either VitB12 or Folic acid.29 In India,6.8%children had folate deficiency,32%showed vinB12 deficiency and combined deficiency 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 up
17、per portion of jejunum;Vitamin B12:Food:rich in animal food;Absorptive site:terminus of ileum;Absorption helping factor:internal factor.31EtiologyEtiologyDecreased intake（vegetarian-VB12,goat milkFolic acid);Increasing demands;Impaired absorption(celiac disease,intestinal parasites)Disease impacts;C
18、ongenital defects:1、congenital FA absorptive defects;2、Juvenile pernicious anemia;3、congenital transcobalamin defects。32ClincalClincal Manifestations ManifestationsAge:peak at 6 mon 2 yrs;Anemia:soil color of skin,edema,petechae;GI system problems:dyspepsia,nausea,etc.Circulatory system:tachycardia,
19、murmur,heart failure etc.Neurosphycological system:mental retardation,Ataxia,clonus with VitB12 defective.33Lab testsLab testsBlood smear:RBC morphology:macrocytic normochromic WBC morphology:neutrophil:large cell with hyper-fragmented nucleus Plt:enlarged size,reduced number34Hyperfragmentedneutrop
20、hilHyperfragmentedneutrophil35MegloblasticMegloblastic anemia CBC anemia CBC36BM smear:BM smear:Cellularity:hypercellularitywith bigger size of the RBCs;Morphology:imbalance development of cytoplasma:nucleus;WBC morphology:enlarged WBC with hyperfragmented;Megakaryocyte/plt:normal or decreased.3738D
21、etermination of FA and Vitamin B12:FA:3 ug/L B12：100ng/L39Diagnosis and Differential DiagnosisDiagnosis 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
22、 brain development.404142ManagementsManagements 1.General managements:eliminate causes and 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
