NUTRITIONAL

IRONDEFICIENCYANEMIAJieYu

MD.ProfessorTheDepartmentofPediatricsHematology/Oncology,Children’sHospital營養(yǎng)性貧血-英文CONTENTSINDUCTIONIRONMETABOLISMETIOLOGY/PATHOGENESISMANIFESTATIONSLABORATORYFINDINGSDIAGNOSIS&DIFFERENTIALPREVENTION&TREATMENT營養(yǎng)性貧血-英文INTRODUCTIONDefinition/describingTheanemiacausedbyinsufficientdietaryironuptake,inwhichtheironstorageandhemoglobinsynthesisdecreased.HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL營養(yǎng)性貧血-英文Clinicalcharacteristics

ironstores

serumiron

hemoglobinconcentration,hypochromicmicrocyticanemia,goodresponsetoirontherapy.6moto3yrs.Incidence

INTRODUCTIONHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL營養(yǎng)性貧血-英文IRONMETABOLISMCONTENTSNewborn75mg/kgChildren35-70mg/kgAdultsM50mg/kgF35mg/kgCMOPARTMENTHemoglobin64%Storageiron30%ferritinhemosiderinMyloglobin3%Enzymeiron0.4%Serumiron0.4%HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL營養(yǎng)性貧血-英文IronsourcesHemoglobinironDietaryironHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALIRONMETABOLISM營養(yǎng)性貧血-英文DietaryironHighinironRedmeat/liverkidney/oilyfishAverageironBeans/fortifiedcereals/darkgreenvegetables/driedfruit/nutsandseedsPoorinironmilkHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALIRONMETABOLISM營養(yǎng)性貧血-英文Ironabsorption

generalabsorption 1-20%Meat/fish/chicken 10-25%Cereals/vegetables 1%Breast/cow’smilk 50%/10%HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALIRONMETABOLISM營養(yǎng)性貧血-英文ABSORPTION&TRANSPORT

Hemoglobiniron nonhemoglobiniron

gastricjuice

proteinase

proteolytic HCl

heme ferric

hemolytic

ferricreductase

*VitC

ferrous

duodenum

upperjujenumferric

mucosalcells

transferrin*

circulation

GItract

liver/spleen

marrow

(fig2)HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL營養(yǎng)性貧血-英文FerritinFeTfRtransferritinFeFeIRONMETABOLISMMucouscells營養(yǎng)性貧血-英文IRONMETABOLISMIronstoresandutilizing

LiverSpleenMarrowRBCironFoodironSIFeFeheme+globin(fig2)HbFeFemarrowHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL營養(yǎng)性貧血-英文IRONMETABOLISMRequirementandexcretion

demand

excretion

adults 1mg/d 1mg/d1mg/d 4mo-3yr 1mg//kg(15ug/kg/d) premature 2mg/kgHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL營養(yǎng)性貧血-英文HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL

ETIOLOGY&PATHOGENESISETIOLOGYPoorironstoresPoordietaryintakeofiron*

OverdevelopChronicbleeding營養(yǎng)性貧血-英文PoorironstoresPrematurebirthMultiplebirth/LowweightbirthCordbloodMotherironreserveoverdevelopPoordietaryintakeofiron*BloodlossandirondepletionHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL

ETIOLOGY&PATHOGENESIS營養(yǎng)性貧血-英文PoorironstoresPoordietaryintakeofiron*MilkandcerealsFactorsinfluencingabsorptionDiarrheaandinfectionOverdevelopBloodlossandirondepletionHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL

ETIOLOGY&PATHOGENESIS營養(yǎng)性貧血-英文

ETIOLOGY&PATHOGENESISPoorironstoresPoordietaryintakeofiron*Overdevelop3-5mo/1yrPrematurebirthPubertyChronicbleedingHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL營養(yǎng)性貧血-英文

ETIOLOGY&PATHOGENESISPoorironstoresoverdevelopPoordietaryintakeofiron*ChronicbleedingCow’smilkHookworminfectionMenstruatingOthers:HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL營養(yǎng)性貧血-英文Pathogenesisiron

+protoporphyrin

IDA

heme+globinshemoglobin

HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGY&PATHOGENESIS營養(yǎng)性貧血-英文PathogenesisHypochromic/microcyticanemiaID.IrondeficiencyIDE.IrondeficiencyerythropoiesisIDA.IrondeficiencyanemiaEnzymesImmunefunctionSkin/mucosalHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALETIOLOGY&PATHOGENESIS營養(yǎng)性貧血-英文FeaturesAgeTheonsetoftheIDAThedegreeofanemiaHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALCLINICALMANIFESTATIONS營養(yǎng)性貧血-英文PallorExtramedullaryhematopoiesisMild/SevereconditionDigestivesystemCardiacfunctionNeurology/intellectualImmunefunctionHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALCLINICALMANIFESTATIONS營養(yǎng)性貧血-英文IDA:microcytic/hypochromic+SI↓Peripheralblood：HemoglobinlevelRBCMCV<80fl, MCH<26ug,MCHC<0.31BonemarrowErythroidhyperplasiaStainableiron

HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALLABORATORYFINDINGS營養(yǎng)性貧血-英文IDA:hypochromic/microtyticanemia+SI↓SI：<9-10.7umol/L(12.8-31.3umol/L) or<50-60ug/dl(75-175ug/dl）TIBC：>62.7umol/L(>350ug/dl)TS：<15%（30-50%）IDE:SF↓,FEP↑（>0.9umol/Lor>50ug/dl)ID：SF

<12ug/L/marrowironHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALLABORATORYFINDINGS營養(yǎng)性貧血-英文HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL

NormalIDIDEIDAMarrowiron+

++

0SF(ug%)100

60

10-20FEP

SITIBCTS

HbMCVMCH

營養(yǎng)性貧血-英文HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL營養(yǎng)性貧血-英文DiagnosisImpression：age,feeding,PBLDiagnosis：biochemicalchangeProvenbytherapyHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALDIAGNOSIS&DIFFERENTIAL營養(yǎng)性貧血-英文DifferentialChronic&inflammatorydiseasesThalassemiaPulmonaryhemosiderosisSiderblasticanemiaMagaloblasticanemiaHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALDIAGNOSIS&DIFFERENTIAL營養(yǎng)性貧血-英文MegaloblasticAnemiaSimilaraspectstoIDAAgeAnemiabyinadequatedietaryintakeHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL營養(yǎng)性貧血-英文MegaloblasticAnemiaHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALPathogenesisVitamin12↓Folicacid↓FolicacidreductaseDNASynthesis↓

TetrahydrofolicacidNucleotide營養(yǎng)性貧血-英文MegaloblasticAnemiaManifestation&DifferentialPaleandpuffyNeurologicalinvolvementLabfindingsMacrocyticnormochromicanemiaNeutropeniawith/thrombocytopeniaMarrowfilm:megaloblasticformsofnucleatedRBCSerumVitB12and/orfolicacidHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL營養(yǎng)性貧血-英文營養(yǎng)性貧血-英文營養(yǎng)性貧血-英文MegaloblasticAnemiaTREATMENTGeneralcareDrugtherapyVitaminB12：25-100ug/次，2-3times/w，weeksortoHbnormal；Onehighdose：500ug

imFolicacid：5-10mg,tid,2-3w，

EffectOtherdrug：VitaminC；B6；ironinrecovery

TransfusionHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL營養(yǎng)性貧血-英文

TREATMENTGeneralcareEradicatethecauses*Irontherapy*transfusionHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL營養(yǎng)性貧血-英文IrontherapyElementaliron：4-6mg/kg/dOralmedicationTypesAdministrationBetweenmealsVitaminCCourse

HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL

TREATMENT營養(yǎng)性貧血-英文FerrousSalts4mg/kg/dFerroussulfate（20%）20mg/kg/dferrousfumarate(30%）13mg/kg/dFerrousgluconate（11%）40mg/kg/dHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALTable:Ferroussaltsanttheironcontents營養(yǎng)性貧血-英文IrontherapyInfusionironindicationtypes：HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL

TREATMENT營養(yǎng)性貧血-英文

IRONTHERAPYRESPONSE（fromNelson）timeresponse12-24hrReplacementofironenzymes,subjectiveimprovement36-48hrInitialmarrowresponse:erythroidhyperplasia48-72hrReticulocytespeaking5-74-30daysHemoglobinlevel

1-3moReplenishofstoresHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL營養(yǎng)性貧血-英文TREATMENTTransfusion

IndicationsSevereanemiaInfectionPre-operationComponent：redbloodcellsVolume：Hb<30g/L,3-5ml/kg Hb30-60g/L,5-10ml/kgAttentionsHEMATOLOGY/ONCOLOGY,CHILDRE