湘雅儿科精品课件-Anemia in childhood

Features of hematopoiesis in children Hematopoiesis in period（胎儿期造血） （胎儿期造血） fetal
Developmental hematopoiesis occurs in three anatomic stages—mesoblastic （中胚层）, hepatic（肝）, and myeloid （骨髓）.
红细胞内Ｈｂ合成↓↓ 红细胞内Ｈｂ合成 Ｈｂ合成 细胞分裂不受影响
Ｈｂ↓↓， 正常或↓ Ｈｂ ，RBC正常或 某些细胞功能紊乱，如 正常或 某些细胞功能紊乱， 生物氧化、 生物氧化、细胞呼吸 小细胞低色素性贫血 神经递质分解与合成等 血液系统症状 非血液系统症状 一般贫血表现 行为发育异常 髓外造血表现 皮肤粘膜损害 细胞免疫功能↓ 心血管系统症状 细胞免疫功能 缺铁性贫血发病机理
questions Do an anemia exist?
Which kind of anemia does it belong?
answer
Hypochromic
microcytic anemia
(小细胞低色素性贫血） 小细胞低色素性贫血） 小细胞低色素性贫血
questions
What
is
the
etiology
The etiological factors of nutritional iron deficiency anemia:
Stored iron deficiency at birth. Inadequate diet. Rapidly growth. Malabsorption. Excessive loss of iron.
Leucocyte count
3 2 1
WBC×109/L ×
9h
10d
1y
8y
80 60 40 20 0
%
Lymphocyte 淋巴细胞
Granulocyte 粒细胞
5d
5y
Differential count of WBC
(白细胞分类计数)
Morphological classification of anemia
questions
How do iron deficiency cause anemia?
questions
Pathogenesis
of
nutritional
iron
deficiency anemia .Fra bibliotek贮存铁
铁缺乏 血红蛋白铁↓ 血清铁 血红蛋白铁 含铁酶↓ 含铁酶 铁依赖酶↓ 铁依赖酶
酶铁↓ 酶铁
megaloblastic Vit B12↓↓ folic acid ↓
acute bleeding hemolytic anemia aplastic anemia most of secondary anemia
The criterion of anemia.
Age < 28 d 1～4 mon 4～6 mon 6 mon～6 y 6～14 y
Extramedullary hemopoiesis（髓外造血）
When hematopoietic demand increases, liver, spleen and lymph nodes come back to the Status to produce blood cells, hepatomegaly （ 肝 肿 大 ） and splenomegaly （ 脾 肿 大 ） appears, and maybe there are immature erythrocytes and granulocytes in circulating blood. Extramedullary hemopoiesis is the specific phenomena only appearing in infant and toddler.
good nursing removal factors treatment preparation of etiological with iron
Oral iron preparation
Oral administration of simple ferrous salts ferrous sulfate ferrous gluconate ferrors fumarate polysaccharide iron Dosage: 4-6mg/kg iron per day elemental
（骨髓外造血）
Hematopoesis in bone marrow
Yellow bone marrow（黄骨髓） can come back to red bone marrow（红骨髓） when hematopoetic need increases . Yellow bone marrow is deficiency in children, especially in infant and toddler period.
Oral iron preparation
Administration the iron prior to meals Administration ascorbic acid with iron preparation. Therapeutic course: withdrawal of iron preparation 6-8 weeks after hemoglobin recover to normal level or when SF and FEP is normal.
Iron study
Iron study *serum ferritin(SF) Iron store FEP(红细胞游离原卟啉） sideroblasts Serum iron ID ↓ ↓ N N N IDE ↓↓ ↓↓ ↑ ↓ N or↓ IDA ↓↓ ↓↓ ↑↑ ↓↓ ↓↓
Therapy
第十五章
Anemia in childhood
(小儿贫血 小儿贫血) 小儿贫血
Wuqing Wan Dept. of pediatrics
中南大学儿科学教研室
Teaching purpose
To understand features of hematopoiesis and blood in children. To comprehend clinical features, diagnosis and therapy of anemia. To understand the definition, grade division and classification of anemia in children. To master etiology, pathogenosis, diagnosis, therapy and prevention of nutritional iron deficiency anemia and nutritional megaloblastic anemia.
Features of blood in children
Erythrocyte and hemoglobin
7 6 5 4 3 2 1 0 12h 10d 3m 6m Years 1y
RBC(× 1012/L) ×
Hemoglobin At birth 1 yr
HbF HbA HbA2
2 yr
cause
of
anemia in the case above?
answer The cause of anemia in the case above is deficiency of iron because he is premature and is fed with Mother's milk only.
yolk sac liver Bone marrow
spleen
lymph node
Fig.Hematopoiesis in fetal period
Features of hematopoiesis in children
Hematopoiesis after birth
Hematopoesis in bone marrow Extramedullary hemopoiesis
Blood routine test
WBC Lym Gran RBC Hb MCV MCH MCHC RDW RC Plt 4.0 2.4(60%) 1.6(40%) 2.18 47 70.4 22.4 176 23.7 0.026 194 109/L 109/L 109/L 1012/L g/L fl pg g/L % 109/L
Types Normal macrocytic （大细胞性） 大细胞性） normocytic （正细胞性） 正细胞性） microcytic （小细胞性） 小细胞性） MCV （fl） ） 80～94 ～ >94 80～94 ～ <80 MCH (pg) 28～32 ～ >32 28～32 ～ <28 <28 MCHC (%) 32～38 ～ 32～38 ～ 32～38 ～ 32～38 ～ <32
Hb concentration (g/L)
< 145 < 90 < 100 < 110 < 120
Nutritional iron deficiency anemia (IDA)
营养性缺铁性贫血
Case 1
Zhou, male, 10 months old. Paleness in face and lips for 4 mons. His facial expression became more and more pale since 6 months of age. Without fever and bleeding. He was premature birth at 33 weeks of gestational age and fed with Mother's milk only.