【正文】 solute decrease in hematocrit , hemoglobin concentration, or the RBC count. Anemia is not a diagnosis, but a sign of underlying disease. 第二十四頁(yè)，共九十四頁(yè)。 Symptoms of anemia ? Asymptomatic: particularly if the anemia develops over a long time. ? General manifestation: pallor of the skin and mucous membranes, lethargy, malnutrition, growth retardation. ? liver, spleen and lymph nodes expansion. ? Digestion system: anorexia, nausea and constipation. 第三十二頁(yè)，共九十四頁(yè)。 Iron metabolism Iron characteristics: ? The fetus absorbs iron from the mother across the placenta. ? Term infants have adequate reserves for the first 4 months of life. ? Preterm infants have limited iron stores and because of their higher rate of growth, they outstrip their reserves by 8 weeks of age. 第四十頁(yè)，共九十四頁(yè)。 clinical manifestation ? Main signs may be pallor of the skin and mucous membranes. ? Severe anemia may cause congestive cardiac failure. ? IDA in infancy and early childhood is associated with developmental delay and poor growth. 第四十八頁(yè)，共九十四頁(yè)。 Iron metabolisms ? Serum ferritin (SF) (血清鐵蛋白 ) ? Free erythrocyte protoporphyrin(FEP) ? Serum iron, total iron binding capacity ? Iron in bone marrow 第五十六頁(yè)，共九十四頁(yè)。 Blood Transfusion With a severe anemia, immediate red blood cell transfusion may advisable, especially in cardiac failure or severe infection, but volume and speed of transfusion must be controlled well. We may transfuse, severely anemia children should be given only 23ml/kg of packed cells at any one time. If there is evidence of frank congestive failure, a modified exchange transfusion using freshpacked RBCs should be considered. 第六十四頁(yè)，共九十四頁(yè)。 ? Patients develop a demyelinating lesion of neurons of the spinal column and cerebral cortex. ? This condition results in paresthesias of the hands and feet, unsteadiness of gait, and eventually memory loss and personality changes. ? There is retard of intellective and physical development. Trembling of Extremities or head, hypertension of muscle, tendon reflex reinforcement, positive Babinski39。 Diagnosis ? first consider history + clinical manifestation[Marked symptoms and signs of central nervous system.( it supports defiency of vitamin B12.)] + .blood smear ? decide marrow + metabolism(To distinguish the deficiency of folic acid with the deficiency of vitamin B12.) ? maybe see treatment with medicine 第七十九頁(yè)，共九十四頁(yè)。 In the macroblastic anemia produced by deficiency of vitamin B12, the symptoms and signs include those of anemia and neuropathy. Patients develop a demyelinating lesion of neurons of the spinal column and cerebral cortex. This condition results in paresthesias(感覺(jué)異常 ) of the hands and feet, unsteadiness of gait, and eventually memory loss and personality〔 智力 〕 changes. There is retard of intellective and physical development. Trembling〔 震顫 〕 of Extremities or head, hypertension of muscle, tendon reflex reinforcement, positive Babinski39。 內(nèi)容總結(jié) Anemia in childhood (小兒貧血 )。 2. Diagnosis。 第八十八頁(yè)，共九十四頁(yè)。 Vitamin B12 preparation ? Vit B12 preparation to treat vit B12 deficiency. Not to use folic acid preparation in patients with vitB12 deficiency only. ? Intramuscular administration of vit B12 mg， QW or 100μg， BiW， usually with reticulocytosis in 24 days, unless there is concurrent inflammatory disease. ? If there is evidence of neurologic involvement, 1 mg should be injected intramuscularly daily for at least 2 wk. ? Maintenance therapy is necessary throughout a patient’s life； monthly intramuscular administration of 1 mg of vit B12 is sufficient. 第八十一頁(yè)，共九十四頁(yè)。 Clinical manifestation 1. General features: puffiness, poor nutrition, hair yellowed, mild edema, petechia (plt↓), mucocutaneous hemorrhage. 2. feature of anemia: lethargy, extramedullary 3. neurology psychology: irritability, vertigo. 4. digestive symptoms : anorexia, nausea, diarrhea. 第七十三頁(yè)，共九十四頁(yè)。 Prevention 4 points— ? mother milk ? feeding specter ? food with iron – ? preterm infant 第六十六頁(yè)，共九十四頁(yè)。 diagnosis ? first consider history + clinical manifestation + blood smear ? Decide diagnosisbone marrow + iron metabolism ? May be see treatment with iron (The bone marrow is hypercellular, with erythroid hyperplasia, the normoblasts may have scanty, and th