邹善华-缺铁性贫血

Laboratory findings
Bone marrow：
1.Erythroid hyperplastia(mide to moderate),
polychromatic and ortho-chromatic normoblast
make the majority
2. cytoplasma less mature than cell nucleus 3.Intracellular and extracellular iron stain of bone marrow (-)
Iron source and absorption
2.Nonheme iron： Fe3＋→stomach acid，VitC →Fe2+
3.Contains:10-15mg/d;10% absorbed
4.Absorption portions：duodenum and upper part of jejunum 5. Absorption rate
Clinical manifestations
Enzyme activity ↓: nervous system: agitation,excitation,restlessness, headache skin and mucosa: dry skin,shedding hair, koilonychia atrophic glossitis angular cheilitis Immunity ↓:infection Pica ：like eating clay,lime and coal, crude rice ,etc. Dysphagia (Plummer-Vinson syndrome)
Laboratory findings
Peripheral blood:
1.HB↓
2.Microcytic hypochromic anemia： MCV< 80fl, MCH< 26pg, MCHC<32% 3.Red blood cell distribution width (RDW) ↑ 4.Reticulocyte count：normal or mild increase
Iron metabolism :
Iron source and absorption
1.Heme iron： hemoglobin
stomach acid,prolease
heme
heme oxygenase
protoporphyrin iron Its absorption is not influenced by food ingrediant
Etiology and mechanism
digestion tract hemorrhage：peptic ulcer ，can( hemorrhage )
ancylostomiasis ，varices， acute gastritis，hemorrhoids recurrent rhinorrhagia excessive menses
Iron recycle and excretion
Recycle
Excretion 0.5-1.5mg/d epithelial cell of intestinal tract bile urinary tract skin sweating
Etiology and mechanism
rapid growing infants, adolacent relative Insufficient uptake absolute pregnant and lactating female inadequate nutrition ,dietary bias postgastrectomy anacidity frequent vomit chronic diarrhea
Laboratory findings
Biochemistry study: 1.SI↓<8.95μ mol/L(500μ g/L) , TIBC ↑> 64.44 μ mol/L (3600μ g/L), Transferrin saturation ↓< 15%,
2. Ferritin↓ <12g/L，high sensitivity and specificity 3. Free protoporphyrin↑
Iron-Deficiency Anemia
Zhongshan Hospital ,Fudan University Zou Shanhua
Definition
Absent iron-store
hemoglobin synthesis↓ A microcytic and hypochromic anemia The most common nutritional anemia
Iron distribution and storage
Normal iron content Male：50mg/kg weight Female：35mg/kg weight Iron distribution 66.7% --- hemoglobin 3.3% --- myoglobin 29.7% --- ferritin and hemosiderin < 1% --- enzymes , transferrin and ferritin in blood plasma Form of storage:ferritin and hemosiderin
diagnosis
Stages: prelatent iron-deficiency,
latent iron-deficiency, iron-deficiency anemia
Procedure:
1.anemia 2.iron-deficiency 3.cause of iron-deficency
Prevention
Iron transportation
Fe2+ → Fe3+ → ferritin Fe3+→transferrin→receptor (erythroblast) → mitochondria protoporphyrin heme ferritin Total iron-binding capacity(TIBC) Serum iron (SI) Transferrin saturation :SI/TIBC×100%＝33%~35% Tansferrin receptor
Clinical manifestations
Oxygen deficiency of organs：
symptom：dizzy，fatige，palpitation， short of breath，tinnitus physical finding： paleness, ankle edema cardiac murmur
Differential diagnosis
Hemoglobinopathy and thalassemia Anemia of chronic disease Sideroblastic anemia
Treatment
Causal treatment Ferrotherapy
Treatment
Oral iron：ferrous sulfate，ferrous fumarate, ferrous gluconate, ferrous succinate, etc. ＋ VitC effect：in 1 week：Ret↑ in 2 weeks：HB↑ in 2 months：normal peripheral blood, maintenace therapy for 3-6months ineffective：insufficient dose，malabsorption， iron loss> iron intake， medicine of poor quality，wrong diagnosis
Treatment
Parenteral iron：iron dextran Suitable for：intolerance,malabsorption,severe gastrointestinal disease,late phase of pregnance
Dose:
total amount(mg)＝[150-patient`s Hb(g/L) ]×weight(kg)×0.33
Point:
1.Causes and clinical findings of iron deficiency 2.Peripheral blood：microcytic hypochromic anemia 3.Bone marrow iron stain 4.Ferritin 5.Iron diagnostic therapy:Ret increase