贫血的处理原则.doc

貧血的診察 男人 女人 紅血球數 (red blood cells) ＜4.5 ＜4.0 (×106 per mL) 血色素 (Hemoglobin; gm/dl) ＜14 ＜12 血球容積比(Hematocrit) ＜41 ＜37 貧血 MCV ＜80 80-100 ＞100 Figure 2. Figure 3. Figure 4. Microcytic anemia Normocytic anemia Macrocytic anemia Iron def. Anemia(RBC↓, Cirrhosis of liver Hemorrhage ferritin↓,SI↓,TIBC↑) Acute bleeding Hemolysis Chronic diseases Chr. renal insuff. Folic deficiency Sideroblastic anemia Hypothyroidism Vit.B12 deficiency Lead poisoning Addisson`s disease Thalassemia(RBC↑) RA，SLE Chronic inflammation Hemolytic anemia(hepatoglobin↓,LDH↑, indirect bilirubin↑,Coombs’test +) Bone marrow disorders Figure 1. 貧血的診察原則以MCV值來鑑別貧血的可能原因,history taking 也是很重要;需看morphology, reticulocyte,或排除leukemia時請送 CBC-H Microcytic and/or hypochromic anemia Serum iron Decreased Normal Increased Hemoglobin electrophoresis Bone marrow sideroblastic Fe Thalassemia increased Hemoglobinopathies Sideroblastic anemia Ferritin Increased Decreased Iron Chronic Congenita