《儿科学教学课件：Approach to Childhood Anemia》由会员分享，可在线阅读，更多相关《儿科学教学课件：Approach to Childhood Anemia（42页珍藏版）》请在装配图网上搜索。
1、Approach to Childhood Anemia Important to Remember on AnemiaAnemia is a clinical sign of disease.It is not a single disease by itself.Need to look for the underlying cause!Will we ignore a fever with out investigation?Drug Administration depends on the cause.extramedullary hematopoiesis extramedulla
2、ry hematopoiesis Sites of erythropoiesis:extramedullary hematopoiesis Sites of erythropoiesis:extramedullary hematopoiesis Morphology of normal red blood cellsNormal red blood cell(erythrocyte)is small,round,and biconcaveMean corpuscular volume,MCV 80-94 flMean corpuscular hemoglobin,MCH 28-32 pgMea
3、n corpuscular hemoglobin concentration,MCHC 32-38%How to work up an anemic patient?History:age,duration,diet,complaintPE:jaundice,hepatomegaly,thrillCBC:MCV,MCH,MCHCRet&RPI(Reticulocyte production index):RPI=Ret(%)(Patient Hct)/(Normal Hct)/2Peripheral smear examination 1yr old boy:Hb 7.8 g/dL;retic
4、ulocyte count 4.2%;MCV 60.4fl,MCH 24.6 pg/L,MCHC 30.5%.RPI?1st step:Anemia?MeasurementNormalRangeRBC count5 million/mm34.0 5.7Hemoglobin(Hb)15 g/dL12 17Hematocrit(Hct)45%38 50A x 3=B x 3=C-This is the rule of thumb Normal childrenThe change of RBC and Hb birth 10d 23m 12y(age)6 5 4 3 2 1(180)(150)(1
5、20)(90)(60)(30)Hb RBC6 5 4 3 2 1 AgeHb(g/L)At birth1451-4 m904-6 m1006 m-6 y1106-14 y120The Diagnostic CriteriaThe Diagnostic Criteria2nd step:Reticulocyte production index=?3rd step:Size of RBC?Iron deficiency(IDA)ThalassemiasLead poisonSideroblastic AnemiaChronic infectionsBone marrow disorder:Apl
6、astic anemiaTumor infiltrationMDSMegaloblastic anemia:Vit B 12Folic acidDifferentiation of microcytic anemiaIDAThalassemiasSideroblastic AnemiaChronic diseaseserum ironN,serum ferritinN,Hb electrophoresisNHbF/HbA2NNhemolysisimmunenon-immuneCoombs(+)Coombs(-)AIHA allogenicRPI2ABO,Rhtransfusion4th ste
7、p:immune-related?Primary Secondarynon-immune hemolysismicroangiopathicmembrane defects(Hereditary spherocytosis)DIC/TTP/HUSmechanical heart valve congenitalPosterioritysnake venomsUnstable hemoglobins(Thalassemias)Enzyme deficiencies(G-6-PD)DiagnosisEvaluationHemoglobinopathyHb electrophoresisMembra
8、ne disorderOsmotic fragility,MorphologyEnzyme deficienciesPK/G6PD screen,reduction of methemoglobinAutoimmuneCoombs test MicroangiopathicMorphology,History,BUN/CrPNHHam test,flow cytometryDifferentiation of Hemolytic anemiaLast but not least-HemorrhagePeptic ulcerHiatus herniaMeckel diverticulumInte
9、stinal duplicationParasitic infectionPulmonary hemorrhage idiopathic pulmonary hemosiderosisApproach to anemia Case study An eight months old girl referred to the clinic due to progressing pale for 2 months.The patient had no fever,no rash,no cough,no vomiting,no diarrhea,no sleepiness,and no cramp.
10、She took no medication.Since onset,her appetite is good,and both her spiritedness and physical energy are normal.Defecation and urination are normal.Past history：No history of sever disease,operation,trauma and allergy to drugs(foods).Personal history：G1P1,35 weeks premature infant,natural birth,the
11、 birth weight is 2.5 kilograms,no asphyxiation at birth,breast feeding,normal development,history of preventive i m m u n i z a t i o n i s n o r m a l.Family history：her parents are in good healthy.No consanguineous marriage.No family history of hepatitis,TB and other infectious diseases.No history
12、 of hemorrhagic disorders and anemia.Physical examination:Alert,in good spirits.T 36.4C,P 124 times/min，R 26，BP 84/63mmHg，W 12.5KG，H 67cmAnemic pale facies,skin and mucosa look pale.The skin and sclera are not stained yellow.Superficial lymph nodes are not enlarged.Heart and lungs show no abnormalit
13、ies.Abdomen is flat and soft.Liver is not reached.Spleen is just palpated under the left rib edge.No cyanosis.No pigmentation.No skin eruption.Extremities:no articular swelling,no rash or lesions,free movements of all limbs.Physiological reflexes are existent without any pathological ones.Laboratory
14、 examination:Complete blood count:WBC 9.7109/L,L62.4%,N32.2%;RBC 2.81012/L,Hb 65g/L,MCV 59.7fl,MCH 18.1pg,MCHC 30%,Ret 2.3%,CRP:75%）Coombs test：negativeBone marrow:Granulocytic proliferation is reduced(32.5%),majority metamyelocyte and band granulocyte,morphology is normal.Erythroid hyperplasia(40.5
15、%),majority in median and late immature stage,variability of red cell size,fragmented cytoplasm with poor hemoglobinization Iron staining:intracellular 3%(normal 15%),extracellular(-)(normal+-+)Final diagnosis Nutritional iron deficiency anemia The probable cause of iron deficiency for this patient?
16、The etiological factors of iron deficiencyStored iron deficiency at birthInadequate dietRapidly growthMalabsorptionExcessive loss of blood non-immune hemolysisnon-immune hemolysisHiatus hernia&Meckel diverticulumIdiopathic Pulmonary HemosiderosisIPHRecurrent hemoptysisMicrocytic hypochromic anemiaChest CT scan:ground glass Lung biopsyHemosiderin cellsHemosiderin cells at diagnosis(A)after 1 month of steroid treatment(B).ground glass,ground glass,pathy shadowpathy shadowHemosiderin cellsHemosiderin cells
儿科学教学课件：Approach to Childhood Anemia
