单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,1,缺铁性贫血,Iron Deficiency,Anemia(IDA),河北医科大学第二医院,血液内科,邢丽娜,1 缺铁性贫血 Iron Deficiency Anemi,2,内容,CONTENTS,?,简介,INDUCTION,?,铁代谢,IRON METABOLISM,?,流行病学,EPIDEMIOLOGY,?,发病机制,ETIOLOGY/PATHOGENESIS,?,临床表现,MANIFESTATIONS,?,实验室检查,LABORATORY FINDINGS,?,诊断和鉴别诊断,DIAGNOSIS&DIFFERENTIAL,?,治疗和预防,PREVENTION&TREATMENT,2 内容 CONTENTS?简介INDUCTION?铁,3,简介,INTRODUCTION,定义,Definition,由于机体对铁是摄入不足，而导致体内储存铁耗尽，继而红细胞内铁,缺乏，最终导致贫血。,?,The anemia caused by insufficient iron uptake,in which the,iron storage and hemoglobin synthesis decreased.,铁缺乏症的三个阶段,There are three stages in iron dificiency,?,储存铁耗竭,Iron deletion,（,ID),?,红细胞内铁缺乏,Iron deficient erythropoiesis,（,IDE),?,缺铁性贫血,Iron deficiency anemia,（,IDA),3 简介 INTRODUCTION 定义Definition,4,铁代谢,IRON METABOLISM,铁总量,CONTENTS,New born 75mg/kg,Children35-70mg/kg,Adults,?,M 50mg/kg,?,F 35mg/kg,?,铁分布,CMOPARTMENT,?,血红蛋白,Hemoglobin 64%,?,储存铁,Storage iron 30%,?,铁蛋白,Ferritin,?,含铁血黄素,hemosiderin,?,肌红蛋白,Myloglobin 3%,?,含铁酶,Enzyme iron 0.4%,?,血清铁,Serum iron 0.4%,4 铁代谢 IRON METABOLISM 铁总量CONTE,5,铁的储存和利用,Iron stores and utilizing,Liver,Spleen,Marrow,RBC,iron,Food,iron,SI,Fe,Fe,heme+globin,Hb,Fe,Fe,marrow,5 铁的储存和利用Iron stores and utili,6,铁代谢,IRON METABOLISM,?,铁的需要和排泄,Requirement and excretion,demand,需要,excretion,排泄,Infants 1mg/d,Children 0.5mg/d,Young,nonpregnant women 2 mg/d,Pregnant women 3 mg/d,Men and postmenopausal women 1mg/d 0.5-1mg/d,6 铁代谢 IRON METABOLISM?铁的需要和排泄,7,Which people need more iron,？,哪些群体对铁的需要量多？,儿童,children,妊,娠,妇,女,哺,乳,母,亲,pregnancy,lactation,7 Which people need more iron？,8,?,铁来源,Iron sources,?,血红蛋白内铁,Hemoglobin iron,?,食物中铁,Dietary iron,?,铁通过胃肠道吸收，主要在十二指肠和空肠上段,?,duodenum,priximal jejunum,铁代谢,IRON METABOLISM,8?铁来源 Iron sources?血红蛋,9,食物中的铁,Dietary iron,含铁高的食物,High in iron,Red meat/liver/kidney,一般含铁食物,Average iron,Beans/fortified cereals/dark green,vegetables/dried fruit/nuts and seeds,含铁少的食物,Poor in iron,milk,铁代谢,IRON METABOLISM,9 食物中的铁 Dietary iron 含铁高的食物 H,10,?,铁的吸收,Iron absorption,一般吸收,General absorption,1-20%,?,肉类,Meat/fish/chicken,10-25%,?,谷物蔬菜,Cereals/vegetables,1%,?,母乳,/,牛奶,Breast/cows,milk,50%/10%,铁代谢,IRON METABOLISM,10?铁的吸收 Iron absorption 一般,11,铁的吸收和转运,ABSORPTION&TRANSPORT,11 铁的吸收和转运 ABSORPTION&TRANSP,12,?,Pathogenesis,iron,?,+,protoporphyrin,IDA,?,heme,+,globins,hemoglobin,?,发病机制,PATHOGENESIS,12?Pathogenesis iron?,13,病因和发病机制,ETIOLOGY&PATHOGENESIS,?,病因学,ETIOLOGY,?,铁储存减少,Poor iron stores,?,铁摄入减少,Poor dietary intake of iron,?,铁需要增加,Overdevelop,?,慢性失血铁丢失,Chronic bleeding,13 病因和发病机制 ETIOLOGY&PATHOGE,14,对血液系统的影响：,?,Hypochromic/microcytic anemia,?,ID.Iron deficiency,?,IDE.Iron deficiency erythropoiesis,?,IDA.Iron deficiency anemia,?,组织代谢的影响：,Enzymes activity decrease,酶的活性下降，影响精神，行为，体力，生长发育,迟缓,?,对免疫系统的影响,Immune function,下降,?,对皮肤粘膜的改变,Skin/mucosal,发病机制,PATHOGENESIS,14 对血液系统的影响：?Hypochromic/mi,15,?,特点,Features,?,年龄,Age,?,发病过程,The onset of the IDA,?,贫血程度,The degree of anemia,临床表现,CLINICAL MANIFESTATIONS,15?特点 Features?年龄 Age?发病过程,16,?,一般改变,General,?,可以发生在任何年龄，在六个月到两岁的儿童中很常见,Any age;commonly found in age 6 mths 2,yrs,?,髓外造血,Extramedullary hematopoiesis,?,Mild/Severe condition,?,消化系统,Digestive system,?,心血管系统,Cardiac function,?,神经系统,Nervous/intellectual,?,免疫系统,Immune function,临床表现,CLINICAL MANIFESTATIONS,16?一般改变General?可以发生在任何年龄，在六个,17,临床表现,CLINICAL MANIFESTATIONS,对皮肤粘膜的改变,Skin/mucosal,苍白：特别是嘴唇，颊粘膜，眼结膜,Pallor:esp.lips,buccal and palpebral mucosa,，,反甲,Koilonychia(spoon-shaped nails,）,粘膜溃疡糜烂,rough,，,ulcer,，,erosion,镜面舌,mirror surface tongue,(smooth,red tongue),17 临床表现CLINICAL MANIFESTATIONS,18,?,呼吸和循环系统,Respiratory&,cardiovascular system,?,心悸,Palpitation,?,呼吸困难,Dyspnea,?,呼吸急促,Tachypnea,?,心动过速,Tachycardia,?,血压升高,Increased artery blood pressure,?,心脏扩大,Enlargement of heart,?,心力衰竭,Even heart failure,18?呼吸和循环系统 Respiratory&c,19,临床表现,CLINICAL MANIFESTATIONS,?,消化,系统,Digestive system,?,口角炎,Angular stomatitis,?,舌炎,Glossitis,?,唇炎,Angular cheilitis,?,异食癖,Pagophagia or pica,?,19 临床表现CLINICAL MANIFESTATIONS,20,临床表现,CLINICAL MANIFESTATIONS,?,神经系统症状,CNS manifestations:,?,易激动,Irritability,?,婴幼儿的学习能力下降,decreasing learning ability of,infant,?,注意力不集中,Loss of concentration,?,感觉麻木,Paresthesia,?,耳鸣,Tinnitus,?,虚弱乏力,Fainting or feeling faint,?,发育迟缓,Slow development,?,血液系统,Hemopoietic system,?,Enlargement of liver and spleen,20 临床表现CLINICAL MANIFESTATIONS,21,?,IDA:,小细胞低色素性贫血,+,血清铁,?,microcytic/hypochromic+SI,?,外周血,Peripheral blood,：,?,血红蛋白,Hemoglobin level,?,红细胞,RBC MCV 80fl,MCH 26ug,MCHC 0.31,?,骨髓,Bone marrow,?,红系增生活跃,Erythroid hyperplasia,?,铁染色减少,Stainable iron,?,实验室检查,LABORATORY FEATURES,21?IDA:小细胞低色素性贫血+血清铁?,22,?,IDA:,hypochromic/microcytic anemia+,SI,?,SI,：,9-10.7umol/L(12.8-31.3umol/L),or 62.7umol/L(350ug/dl),?,TS,：,0.9umol/L or 50ug/dl),?,ID,：,SF,12ug/L/,marrow iron,Acronyms and Abbreviations,?,血清铁,SI,：,serum iron,；,总铁结合力,TIBC,：,total iron binding capacity,；,?,转铁蛋白饱和度,TS,：,transferrin saturation,实验室检查,LABORATORY FINDINGS,22?IDA:hypochromic/microcyt,23,实验室检查,Laboratory findings,Normal,Patient,23 实验室检查Laboratory findings No,24,Bon