兒童貧血(全英文)-wenkub

　

【正文】 0100806040 1 d 5 d 10d 2 m 3 m 7y 12y第十五頁(yè)，共九十四頁(yè)。 Physiological haemolysis ? erythropoiesis abruptly ceases with onset of respiration at birth, when the arterial oxygen saturation rises toward 95%. levels of erythropoietin (EPO) are low. ? EPO has a decreased halflife and an increased volume of distribution in newborns. A shortened survival of the fetal RBC also contributes to the development of physiologic anemia. ? the sizable expansion of blood volume that acpanies rapid weight gain during the first 3 mo of life adds to the need for increased RBC production. 第十一頁(yè)，共九十四頁(yè)。 Embryo stage myelohaematopoiesis：6mons Haematogenesis function emphasis，make various kinds of blood cells， unique hematogenic an after birth. 第七頁(yè)，共九十四頁(yè)。 haematogenesis of children hematopoiesis produced blood extramedullary before birth and postnatal mesoblast hepatic medullary 315w 6w6ms 3ms 第四頁(yè)，共九十四頁(yè)。Anemia in childhood (小兒貧血 ) 第一頁(yè)，共九十四頁(yè)。 Embryo stage ? Mesoblastic haematogenesis： 3ws begin，8ws weaken, 1215ws disappears。 第八頁(yè)，共九十四頁(yè)。 blood characteristics – ages ? red blood cells(RBC) and Hb Physiological haemolysis and anemia ? write blood cells(WBC) and classification 46 cross ? Platelets 150250 109/L ? blood volume 810% 第十二頁(yè)，共九十四頁(yè)。 Reticulocyte 第十六頁(yè)，共九十四頁(yè)。 White blood cell(WBC) ? Lymphocyte is about 60% and granulocyte is about 35% subsequently . ? They are equal at 4~6 years. ? After 7 years white cell classification in infants is similar to that in adult. 第二十頁(yè)，共九十四頁(yè)。 Anemia Defination : Anemia is defined as a reduction of the red blood cell volume or hemoglobin concentration below the range of values occurring in healthy persons. Anemia is an absolute 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)。 Morphology ?anemia with microcytosis and hypochromia ?Anemia with macrocytosis ?Anemia with normalcytosis Anemia 第二十八頁(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)。 nutritional anemia with microcytosis and hypochromia Definition nutritional iron deficiency anemia (IDA) Hb、 most mon 、 624ms、 special prevention 第三十六頁(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)。 Three stage of iron deficiency Deficiency of iron progresses in stages ? iron depletion(ID): tissue iron stores are deleted, under normal condition, this correlates directly with decrease in the ferritin lever, reticulocyte percentage decreases. ? Iron deficient erythropoiesis(IDE): loss of circulating iron. Low serum iron less than 30ug/dl, low transferring saturation and/or elevated total iron binding capacity. 第四十四頁(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)。 Bone marrow iron stain： ferrugination grains in the erythocytes. Normal bone marrow iron stain正常骨髓鐵染色 IDA iron stain鐵缺乏骨髓鐵染色 第五十二頁(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)。 ?Oral administration of simple ferrous salts ? ferrous sulfate(硫酸亞鐵 ) ? ferrous gluconate〔 葡萄糖酸亞鐵 〕 ? ferrous fumarate ? polysaccharide iron ?Dosage: 46mg/kg elemental iron per day Oral iron preparation 第六十頁(yè)，共九十四頁(yè)。 Blood Transfusion With a severe anemia,