儿科学之小儿贫血PPT推荐.ppt

儿科学之小儿贫血PPT推荐.ppt

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Anemiainchildhood（小儿贫血小儿贫血）Dept.ofpediatrics李圭华李圭华第十五章TeachingpurposeTounderstandfeaturesofhematopoiesisandbloodinchildren.Tocomprehendclinicalfeatures,diagnosisandtherapyofanemia.Tounderstandthedefinition,gradedivisionandclassificationofanemiainchildren.Tomasteretiology,pathogenosis,diagnosis,therapyandpreventionofnutritionalirondeficiencyanemiaandnutritionalmegaloblasticanemia.FeaturesofhematopoiesisinchildrenHematopoiesisinfetalperiod（胎儿期造血）胎儿期造血）Developmentalhematopoiesisoccursinthreeanatomicstagesmesoblastic（中胚层）,hepatic（肝）,andmyeloid（骨髓）.Fig.HematopoiesisinfetalperiodyolksacliverspleenBonemarrowlymphnodeFeaturesofhematopoiesisinchildrenHematopoiesisafterbirthHematopoesisinbonemarrowExtramedullaryhemopoiesis（骨髓外造血）HematopoesisinbonemarrowYellowbonemarrow（黄骨髓）cancomebacktoredbonemarrow（红骨髓）whenhematopoeticneedincreases.Yellowbonemarrowisdeficiencyinchildren,especiallyininfantandtoddlerperiod.Whenhematopoieticdemandincreases,liver,spleenandlymphnodescomebacktotheStatustoproducebloodcells,hepatomegaly（肝肿大）andsplenomegaly（脾肿大）appears,andmaybethereareimmatureerythrocytesandgranulocytesincirculatingblood.Extramedullaryhemopoiesisisthespecificphenomenaonlyappearingininfantandtoddler.Extramedullaryhemopoiesis（髓外造血）FeaturesofbloodinchildrenErythrocyteandhemoglobin7654321012h10d3m6m1yRBC（1012/L）YearsHemoglobinAtbirth1yr2yrLeucocytecountWBC109/L9h10d1y8y123%2040608005d5yDifferentialcountofWBC（白细胞分类计数）Lymphocyte淋巴细胞Granulocyte粒细胞MorphologicalclassificationofanemiaTypesMCV（fl）MCH（pg）MCHC（%）Normal809428323238macrocytic（大细胞性）大细胞性）94323238normocytic（正细胞性）正细胞性）809428323238microcytic（小细胞性）小细胞性）80283238hypochromicmicrocytic（小细胞低色素性）小细胞低色素性）802832BloodroutineHypochromicmicrocyticMacrocyticNormocytic（HbRBC）（HbRBC）（Hb=RBC）IDA（缺铁性贫血）缺铁性贫血）megaloblasticacutebleedingThalassemiaVitB12hemolyticanemiasideroblasticanemiafolicacidaplasticanemiaChronicinfectionmostofsecondaryanemiaAgeHbconcentration（g/L）28d14514mon9046mon1006mon6y110614y120nThecriterionofanemia.Nutritionalirondeficiencyanemia（IDA）营养性缺铁性贫血营养性缺铁性贫血Zhou,male,10monthsold.Palenessinfaceandlipsfor4mons.Hisfacialexpressionbecamemoreandmorepalesince6monthsofage.Withoutfeverandbleeding.Hewasprematurebirthat33weeksofgestationalageandfedwithMothersmilkonly.Case1PE:

@#@Pallor.nojaundiceandhemorrhagicspotsinskinandsclera;@#@Bilateralsubmandibularlymphnodesare0.80.8cm.Breathsoundsinlungsaredistinct;@#@therearenorhonchiandmoistrale.HR100/min.ThereisII/VIsystolicmurmurinprecordialregion.Theliverandspleenenlargeto4cmand3cmbelowlowercostamarginrespectively.Case1BloodroutinetestWBC4.0109/LLym2.4（60%）109/LGran1.6（40%）109/LRBC2.181012/LHb47g/LMCV70.4flMCH22.4pgMCHC176g/LRDW23.7%RC0.026Plt194109/LquestionsDoananemiaexist?

@#@Whichkindofanemiadoesitbelong?

@#@answerHypochromicmicrocyticanemia（小小细细胞低色素性胞低色素性贫贫血）血）questionsWhatisthecauseofanemiainthecaseabove?

@#@answerThecauseofanemiainthecaseaboveisdeficiencyofironbecauseheisprematureandisfedwithMothersmilkonly.etiologyTheetiologicalfactorsofnutritionalirondeficiencyanemia:

@#@vStoredirondeficiencyatbirth.vInadequatediet.vRapidlygrowth.vMalabsorption.vExcessivelossofiron.questionsNextexaminations?

@#@SmearofBloodnormalThepatientBonemarrowBonemarrowexaminationThebonemarrowishypercellular,witherythroidhyperplasia（过度增生）.Thenormoblasts（幼红细胞）mayhavescanty,fragmentedcytoplasmwithpoorhemoglobinization.Leukocytesandmegakaryocytesarenormal.HemosidenincannotbedemonstratedinmarrowspecimensbyPrussianbluestaining.questionsHowdoirondeficiencycauseanemia?

@#@questionsPathogenesisofnutritionalirondeficiencyanemia.铁缺乏铁缺乏贮存铁贮存铁血清铁血清铁血红蛋白铁血红蛋白铁酶铁酶铁红细胞内合成红细胞内合成含铁酶含铁酶细胞分裂不受影响细胞分裂不受影响铁依赖酶铁依赖酶，RBC正常或正常或某些细胞功能紊乱，如某些细胞功能紊乱，如生物氧化、细胞呼吸生物氧化、细胞呼吸小细胞低色素性贫血小细胞低色素性贫血神经递质分解与合成等神经递质分解与合成等血液系统症状血液系统症状非血液系统症状非血液系统症状一般贫血表现一般贫血表现行为发育异常行为发育异常髓外造血表现髓外造血表现皮肤粘膜损害皮肤粘膜损害心血管系统症状心血管系统症状细胞免疫功能细胞免疫功能缺铁性贫血发病机理缺铁性贫血发病机理IronstudyIronstudyIDIDEIDA*serumferritin（SF）IronstoreFEP（红细胞游离原卟啉）NsideroblastsNSerumironNNorTherapygoodnursingremovalofetiologicalfactorstreatmentwithironpreparationOraladministrationofsimpleferroussaltsferroussulfateferrousgluconateferrorsfumaratepolysaccharideironDosage:

@#@4-6mg/kgelementalironperdayOralironpreparationAdministrationtheironpriortomealsAdministrationascorbicacidwithironpreparation.Therapeuticcourse:

@#@withdrawalofironpreparation6-8weeksafterhemoglobinrecovertonormallevelorwhenSFandFEPisnormal.OralironpreparationParenteralironTobeadministeredonlyforgastrointestinalmalabsorptionorsevereintolerancepreventseffectiveoralirontherapy.ReticulocytosisTransfusionPreventionNutritionalMegaloblasticAnemia（营