（参考翻译）05.3Iron Deficiency Anemia-Li Wang.pptVIP

Bone marrow Serum Iron concentration (血清铁) The amount of iron binding with transferrin in the serum Total Iron Binding Capacity （总铁结合力） The total amount of transferrin which can combine with iron Transferrin saturation （转铁蛋白饱和度） 血清铁/总铁结合力 X100% Transferrin receptor concentration Ferritin concentration （铁蛋白） Iron Metabolism ： Diagnosis Anemia Hb 120 g/L (M); 110 g/L (F) Low MCV、MCH、MCHC (baseline) Evidence of Iron deficiency Iron stain in BM Iron metabolism Etiology diagnosis Gastroscopy Colonoscopy Gynaecological examination Answer to Q2: Blood Routine BM aspiration Ferritin concentration Gastroscopy Differential Diagnosis microcytosis, hipochromia 小细胞低色素性贫血 Sideroblastic Anemia (铁粒幼细胞性贫血) Thalassemia (地中海贫血) Chronic diseased anemia (慢性病性贫血) Atransferrinemia (转铁蛋白缺乏症) Case presentation Mr. Zhang had: Blood routine BM smear 骨髓涂片 Stool occult blood test 粪便隐血试验 ‘negative’ Gastrosocpy ‘chronic gastritis’ Q3: What is the diagnosis? Q4: How to treat it? ‘IDA’ Treatment Etiology management is essential: Removal of etiological factors Start with oral supplementation 补充 Avoiding taking iron with antacids 抗酸药 or antibiotics Improvement should be seen in a month reticulocytes（网织红细胞） Reticulocytes ORAL SUPPLEMENTATION 200 mg of iron daily 1 hour before meal (e.g. 100 mg twice daily) How long 14 days + (Hg required level – Hg current level) x 4 half of the dose – 6-9 months to restore iron reserve Absorption is enhanced: vit C, meat, orange juice, fish is inhibited: cereals 谷类, tea, milk PARENTERAL IRON SUBSTITUTION 肠外铁替代（？） Bad oral iron tolerance (nausea, diarrhoea) Necessity of quick management (CHD 冠心病, CHF 充血性心力衰竭) 50 - 100 mg daily I.v only in hospital (risk of anaphylactic shock 过敏性休克) I.m in outpatient department 门诊部