【正文】 1. Classification。s sign may appear. 第八十七頁，共九十四頁。 Treatment feeding rid of etiology 3. medicine vit B12 ,folic acid 第八十頁，共九十四頁。s sign may appear. 第七十二頁，共九十四頁。 Iron therapy Notice : 3 points iron in danger : 1224h(irritability ↓ ,appetite ↑ ) 3648h(erythroid hyperplasia ) 4872h(reticulocytosis↑ )57ds(peaking ) 23ws to reticulocytes : 68ws 第六十五頁，共九十四頁。 Iron metabolisms Iron study ID IDE IDA Serum ferritin (SF) ↓ ↓↓ ↓↓ Iron store ↓ ↓ ↓ ↓ ↓ Red blood cell protoporphyrin (FEP) N ↑ ↑ ↑ Percent sideroblasts N ↓ ↓ ↓ Serum iron N N / ↓ ↓ ↓ 第五十七頁，共九十四頁。 laboratory test smear marrow metabolism 第四十九頁，共九十四頁。 Iron metabolism Iron characteristics: At birth, because of “physiological haemolysis〞 , much iron is released to plasma and little iron is absorbed from food, During the second stage (about 2 months old), hematopoiesis is increased and more iron is absorbed from food, so iron deficiency is rare in this stage. After 4months, development increase, iron in food is deficient and iron stores exhaust, so most iron deficiency anemia occurs in 6 months to 2 years or 3 years old child. 第四十一頁，共九十四頁。 Symptoms of anemia ? Cardiovascular and respiratory system: tachycardias, increased artery pressure, wheeze and increased pulse. severe anemia may cause heart expansion and congestive cardiac failure. ? Nerver system: vertigo, tinnitus, irritability, and disorders of attention. 第三十三頁，共九十四頁。 The criteria of anemia Age Hb concentration 28 days 145 g/L 1～ 4 months 90 g/L 4～ 6 months 100g/L 6 months～ 6 years 110g/L 6～ 14 years 120g/L 第二十五頁，共九十四頁。 Reticulocyte ? Reticulocyte is in the first 3 days. ? Reticulocyte decreases to after 47 days. ? Reticulocyte rises to in 46 weeks. ? Reticulocyte is equal to an adult’s after 5 months. 第十七頁，共九十四頁。 Haematopoiesis postnatal ? marrow： ? extramedullary： when requirement of haemopoiesis increase， liver、 spleen、 lymphadenectasis，hepatomegaly and splenomegaly, in circulating blood immature erythrocytes and granulocytes . 第九頁，共九十四頁。 第二頁，共九十四頁。 Embryo stage spleen： 12ws begin erythrocyte, granule , lymphocyte Haematogenesis of lymphatic an ? gland:8ws nodes:11ws 第六頁，共九十四頁。 Red blood cell (RBC) The wide range of hemoglobin concentration is accounted for by: ? Variation in how rapidly the umbilical cord is clamped. ? An infant’s position after delivery. If cord clamping is delayed and the baby is held lower than placenta, both hemoglobin and blood volume are increased by a placental transfusion. 第十四頁，共九十四頁。 Platelet count Normal value for the platelet count are about 150~250 109/L and vary little with age. 第二十二頁，共九十四頁。 Causes blood :acute chronic 2. hemolysis Intrinsic membrane hereditary spherocytosis Glycolysis pyruvate kinase hemoglobin sickle cell,unstable Hb oxidation G6PD extrinsic : immune, infection, DIC 第三十頁，共九十四頁。 Iron metabolism Iron absorption: ? The primary regulator of iron homeostasis is intestinal iron absorption. ? Iron absorption takes place primarily in the duodenum by the enterocytes at the tip of the intestinal villa. ? Iron must pass though the apical and the then the basolateral membranes of these cells to reach the circulation. 第三十八頁，共九十四頁。 clinical manifestation ? 1. general manifestation: mild iron deficiency is Asymptomatic , pallor of the skin and mucous mebranes are most evident and lethargy, malnutrition, growth retardation. ? 2. liver spleen and lymph nodes enlarge ? 3. digestion system: anorexia〔 食欲差 〕 , nausea〔 惡心 〕 , constipation〔 便秘 〕 . diarrhea ? 第四十六頁，共九十四頁。 Blood count in iron deficiency HB 75g/L 120g/L RBC 1012/L 1012/L MCV 64fl 86fl MCHC 32pg reticulocyte % % WBC 109/L 109/L proportion normal normal platelet 254109/L 257109/L 第五十四頁，共九十四頁。 Parenteral iron preparation To be administered only for gastrointestinal malabsorption or severe intolerance prevents effective oral iron therapy. 第六十二頁，共九十四頁。 Pathogenesis ? folic acid folic acid with 4 hydrate vitamin B12