【正文】 thesias 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。s sign may appear. 第七十二頁，共九十四頁。 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，共九十四頁。 Laboratory tests smear marrow biochemistry tests 4. others 第七十四頁，共九十四頁。 variation in BRC shape and size, macrocytosis , reticulocyte count is low , nucleated RBCs and megaloblastic morphology are often seen , thrombocytopenia 第七十五頁，共九十四頁。 Hypercellular , Megaloblastic changes, hypersegmentation 第七十六頁，共九十四頁。 Laboratory tests ? Blood routine examination: macrocytic anemia, the decrease of red cell count is more than the decrease of HB. MCV＞ 94fl, MCH＞ 32pg. Rreticulocyte is decrease. WBC and platelets are also decreased. ? Bone marrow: increased basophilic normoblast and polychromatic normoblastic. Granulocytic system and megakaryocyte system : normal/less than normal. 第七十七頁，共九十四頁。 Laboratory tests ? Vitamine B12: normal serum vitamin B12 levels range from 200800ng/L, B12＜ 12ng/L reveals B12 deficiency. ? Folate : normal serum folate levels range from 56ug/L, folate ＜ 3ug/L reveals deficiency. ? others :LDH : serum lactic dehydrogenase(LDH) is increase 第七十八頁，共九十四頁。 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，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。 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，共九十四頁。 Folic acid preparation . Folic acid may be administered orally in a dose of 15 mg/24 hr. If the specific diagnosis is in doubt, 125 mg/24 hr of folate may be used for a week as a diagnostic test. vitamine C will help absorption of folate. 第八十二頁，共九十四頁。 IDA megaloblastic anemia age 6m2y 6m2y Cause iron ↓ VtB12/folic acid↓ Clinical manifestation pallor puffiness extramedullary ↑ ↑ Nervous system slight striking 第八十三頁，共九十四頁。 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，共九十四頁。 第八十五頁，共九十四頁。 In this case, macrocytic anemia is caused by deficiency of vitamin B12. Why? 第八十六頁，共九十四頁。 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。s sign may appear. 第八十七頁，共九十四頁。 第八十八頁，共九十四頁。 第八十九頁，共九十四頁。 Final diagnosis Diagnosis 第九十頁，共九十四頁。 第九十一頁，共九十四頁。 Treatment Therapy 第九十二頁，共九十四頁。 第九十三頁，共九十四頁。 內(nèi)容總結(jié) Anemia in childhood (小兒貧血 )。 1. Classification。 2. Diagnosis。 4872h(reticulocytosis↑)57ds(peaking )。Thank you 第九十四頁，共九十四頁。