【正文】 e development of cytoplasm falls behind one of nucleus. leukocytes and megakaryocytes are normal.) 第五十八頁(yè)，共九十四頁(yè)。 Inequality of size of erythrocytes， small cell， Central olistherozone obviously 第五十頁(yè)，共九十四頁(yè)。 causes iron stores: preterm infant, twin iron deficiency and development increased iron requirement absorb abnormal amount of iron loss: hookworm infestation, repeated venesection, Meckel’s diverticulum, recurrent epistaxis(反復(fù)鼻出血 ). 第四十二頁(yè)，共九十四頁(yè)。 2. Diagnosis History –positive manifestation –laboratory tests Blood smear BM Hb ananysis Growth development nutrition nails fairs liver spleen and lymph notes 5 points: age, course, symptoms, feeding, past medical history ,family history Morphology of RBC, reticulocyte count, WBC, platelet count, bone marrow cell smear, HB ,special examination 第三十四頁(yè)，共九十四頁(yè)。 Anemia ? 1. Classification ? 1〕 degree : mild moderate severe Very severe ? 2〕 Morphology of RBC ? 3〕 Causes: lost blood , hemolytic , deficiency of forming Hb and RBC 第二十六頁(yè)，共九十四頁(yè)。 White blood cell(WBC) ? The normal number of WBC is higher in infancy and early childhood than later in life. ? WBC count is 15 109～ 20 109 at birth. ? After 6～ 12 hours, it rise to 21 109～ 28 109 and then begins to decrease to 12 109 by 1 week. ? WBC count maintains about 10 109 at infant period and approach adult’s WBC count level by 8 years. 第十八頁(yè)，共九十四頁(yè)。 Physiological haemolysis Normal newborns have higher hemoglobin(HB) and hematocrit levels and a shortened survival period of the fetal RBCs contributes to the development of physiologic anemia. 第十頁(yè)，共九十四頁(yè)。 Disease of hematopoietic system infantile anemia 〔 1〕 nutritional iron deficiency anemia(IDA) 〔 2〕 nutritional megaloblastic anemia Primary/immunity thrombocytopenia Purpura(ITP) Leukemia 第三頁(yè)，共九十四頁(yè)。 ? liver： 8ws begin， 6months gradually weaken ,erythroblast、 granular cell and megakaryocyte. 第五頁(yè)，共九十四頁(yè)。 Red blood cell (RBC) ? Term newborns have a red cell mass that is higher than at any other time of life. ? an appropriate condition for the low oxygen environment of intrauterine life. ? The RBC count is 1012～ 1012, hemoglobin concentration is about 150～ 220g/L at birth. ? The RBC and hemoglobin concentration in preterm infants are slightly lower than those in term infants. 第十三頁(yè)，共九十四頁(yè)。 46 Days Granulocyte Lymphocyte 46 years Change of proportion in Lymphocyte and Granulocyte 第二十一頁(yè)，共九十四頁(yè)。 More anemia MCV MCH MCHC Normal 8094 2832 3238 Microhypochromia 80 28 32 Macrocytosis 94 32 3238 microcytosis 80 28 3238 mean corpuscular volume(MCV), means corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration(MCHC) 第二十九頁(yè)，共九十四頁(yè)。 Iron metabolism ? Iron content and distribution: 2/3 of the iron is present in HB and 1/3 in tissue and transport form. Content of elemental iron (mg/kg) Adult females 40 Adult males 50 newborn 75 第三十七頁(yè)，共九十四頁(yè)。 Three stage of iron deficiency ? iron deficiency anemia (IDA): iron deficiency following depletion of both marrow store and circulating iron. ID IDE IDA 第四十五頁(yè)，共九十四頁(yè)。 laboratory test ? The decrease of HB concentration is more than the decrease of red cells count. ? Blood smear reveals the more feature of microcyte and hypochromia. MCV＜ 80fl, MCH＜ 26pg, MCHC＜ . ? Reticulocyte is normal or slightly decreases. ? WBC and platelets are normal. . 第五十三頁(yè)，共九十四頁(yè)。 ? Administration the iron prior to meals /between to meals. ?Administration ascorbic acid with iron preparation. ?Therapeutic course: withdrawal of iron preparation 68 weeks after hemoglobin recover to normal level or when SF(Serum ferritin) and FEP(Free erythrocyte protoporphyrin) is normal. Oral iron preparation 第六十一頁(yè)，共九十四頁(yè)。 Causes ? intake ? abnormal ? interactions ? increased 第六十九頁(yè)，共九十四頁(yè)。 Hypercellular , Megaloblastic changes, hypersegmentation 第七十六頁(yè)，共九十四頁(yè)。 IDA megaloblastic anemia Blood smear microhypochromia macrocytosis Bone marrow cytoplasm falls behind nucleus Megaloblastic changes Iron metabolism abnormal N VtB12/ folic acid N ↓ 第八十四頁(yè)，共九十四頁(yè)。 第九十一頁(yè)，共九十四頁(yè)。