实验诊断学(英文版)第三章.ppt

genetic disorders, disorders of immunity, neoplasia, infectious diseases, nutritional disease, and environmental disorders. The result of the majority of these disease processes is anemia. It is important, however, to understand both classification schemes and how they relate, as evaluation of the anemic patient requires a thorough and careful history, physical examination, laboratory investigation, and examination of the peripheral blood smear. IRON-DEFICIENCY ANEMIA If one excludes the clinically silent thalassemia syndromes, iron deficiency is the primary cause of anemia worldwide. To understand the multiple causes of iron deficiency and the consequent biochemical changes that are used clinically as aids in establishing a diagnosis of iron-deficiency anemia Iron Metabolism Iron is supplied exogenously through the diet in two forms: heme iron and nonheme iron. Heme iron is derived from hemoglobin, myoglobin, or other heme proteins in foods of animal origin. The absorption of iron is regulated at the level of the mucosal cell, and hence, the tight balance of iron is controlled (Fig.3-1).Under normal circumstances, 5% to 10% of ingested iron is absorbed; in stance of iron deficiency, absorption may increase several fold. Exactly how this process occurs and how it is controlled remain unclear. Fig.3-1 Fe lost with sloughed cell Laboratory Findings Serum Chemistry The appearance of a microcytic hypochromic anemia is actually a finding late in the course of iron deficiency. Decreased iron stores, reflected by decreased serum ferritin, are found early in the course of iron deficiency, as stored iron is liberated to transferrin to maintain adequate delivery of iron to the developing erythroblast. Blood Early in the course of iron deficiency, the anemia appears normocytic and normochromic. As heme synthesis is impaired, hypochromic erythrocytes become evident. Microcytosis usually develops in tandem. Consequently, the MCV, mean corpuscul