内科学英文课件：Iron-Deficiency-Anemia.ppt

内科学英文课件：Iron-Deficiency-Anemia.ppt

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IronDeficiencyAnemia,Irondeficiencyanemiaisasignofdisease,isnotinitselfacompletediagnosisIronstoreisinadequatefortheneedsofnormalerthropoiesisAnemiaoccursatalatestage,IronMetabolism1.Ironinnormalindividuals,IronMetabolism,2.RequirementofIronAdultmanbodyironcontent5055mg/kgAdultwomanis3540mg/kgMaleandpostmenopausalwomen-0.5-1mg/dayMenstruatingwomen-1.5mg/dayDuringpregnancy-atleast2.5mg/dayDuringgrowth-requirementincrease,IronMetabolism,3.Obtainedofiron-fromfoodsAdultdiet-6mgiron/1000Cal.or10-20mg/day（only5-10%absorbed）Absorbedrateincreasedbodyironstoresaredepleted,erythropoiesisacceleratedAbsorbedratedecreasedironoverload,erythroidhypoplasia,IronMetabolism,4.TransportofIronAbsorptionportion-duodenum,uppersmallintestineAbsorbedbytwodifferentpathways-Ironinheme-ironinferrousandferricironsalts（affectedbygastricacidity,dietarycomponents）BoundbyplasmatransferrinTransporttoBMforHbsynthesis,IronMetabolism,5InternalironcycleNatureredcellsincirculationfor120daysIngestedbymacrophagesIronstoreinmacrophagesasferritin（smallportion）Returntotheplasmaboundtotransferrin,IronMetabolism,6.LossofIron（intactcellscontainingiron）Maleandfemale1mg/day（stool0.5mg,urine0.5mg）Menstratingwomen2mg/day,CauseofIronDeficiency,InsufficientironinthedietImpairedabsorptionIsafrequentcomplicationofpostgastricoperationIncreasedrequirementRapidlygrowingtissuesironrequirmentrelativelygreat（infancy,childhood,adolescence）4.LossofbloodGastrointestinalbleeding-mostcommoncause（Thefirstsignofthegastrointestinaltractcancer）,IrondeficiencyAnemia,EtiologiesChronicbloodlossPregnancyDietarydeficiencyMalabsorptionChroniclowgradehemolysis（asinPNH）,Threestagesofirondeficiency,（Accordingtotheirondepletionprogression）StageI-PrelatentirondeficiencyReticuloendothelialironstore（RES）decreasedWithoutreducedserumironlevelsIncreasedintherateofironabsorption,Threestagesofirondeficiency,StageII-LatentirondeficiencyIronstoresexhaustedHemoglobinlevelremainsnormalBiochemicalabnomalitiesinironmetabolism（increasedinfreeRBCprotoporphyrin,reducedplasmaironlevel）,Threestagesofirondeficiency,StageIII-IrondeficiencyerythropoiesisRedcellproductionislimitedHemoglobinconcentrationbelowthenormalIron-enzymesreachabnormallevels（cytochromes）Transferrinsaturationratefallsbelow16%Anemiadeveloped,Stageofirondeficiency,ClinicalManifestations:

IncludeunderlingdiseasesmanifestationsMildtomoderateasymptomaticDefectivestructuresymptomaticDefectiveepithelialtissuesymptomaticNailbrittle,fragile,spoon-shapedTongue,mouthatrophy,soreness,burningHypopharynx,stomach-gastritis,ClinicalManifestations:

Pica:

habitualingestionofunusualsubstances（earth,clay-geophagia,starch-amylophagia,ice-pagophagia,others-match,rice,chalk,candle,flower）AtrophictonguePlummer-vinsonsyndrome:

Difficultyinswallowingsolidfoods,alittleforliquids,LaboratoryFindings,IrondeficiencyAnemia,HypoproliferativeMicrocytic（MCV80）HypochromicReticulocytecountisLOWSerumironisLOWFerritinisLOWTransferrinsaturationisLOWTIBCisHIGH,PlasmaandMarrowIron,Treatment,AnearlysignofaseriousillnessTreatmentofunderlingdiseaseIronadministeredorallysafest,leastexpensiveAbsorptionstomachemptycompletelyWithmealdecreaseby4050%IronadministeredintramuscularlyContinuetreatmentfor36monthsrepletionofironstores,OralIronTherapy,Failuretorespondtoirongivenorally:

IncorrectdiagnosisComplicationillnessFailureofpatienttotakeprescribedmedicationInadequateprescription（doseorform）ContinuingironlossMelabsorptionofIron,ParenteralIronTherapy,IsunabletotolerateirongivenorallyRepeatedlyfailstoheedinstructionsLosesironataratetoorapidHasadisorderofthegastrointestinaltractTotaldose-formula,THANKS,