英文班贫血总论-赵维莅.pptVIP

Anemia- General aspects Department of Hematology Rui Jin Hospital Anemia Most important Related to many diseases Diagnosed properly Treated properly What is anemia? A reduction below normal in the - concentration of hemoglobin - red blood cells in the blood - hematocrit （红细胞比容） The blood hemoglobin concentration often preferred - accuracy and reproducibility - value most indicative of the patho-physiologic consequences of anemia Conditions associated with a significant disproportion between the hematocrit and RBC? Spurious anemia (假性贫血) - relative increase in plasma volume hydremia of pregnancy overhydration in oliguric renal failure or congestive heart failure chronic diseases and hypoalbuminemia congestive splenomegaly recumbency (斜卧) Regulation of erythropoiesis How many are produced? 25 billion /24 hours The entering cells are reticulocytes which should be 1% of the total population of circulating erythrocytes Erythrocytes last 120 days and are destroyed by the spleen Red cell production should equal red cell destruction Anemia: Etiologies Production defects Blood loss Blood destruction RBC loss without RBC Destruction Hemorrhage - Due to trauma - Due to disorders: e.g. cancer, ulcers, tuberculosis, and irritable bowel syndrome (including ulcerative colitis and Crohn’s disease) Menstrual flow Gynecological disorders (e.g. endometriosis) Pregnancy, especially at gestation Parasitism - Hookworms RBC Destruction Intrinsic Abnormalities Thalassemia G6PD Sickle Cell Anemia Hereditary Spherocytosis Extrinsic Abnormalities Infections Malaria (Plasmodiumm species) Mycoplasma (支原体） Disseminated Intravascular Coagulation Lead poisoning 贫血的病理生理(pathophysiology of anemia) ●RBC的主要功能是输送氧气 ●正常血液一克Hb能携带1.34ml氧 ●贫血的病理生理基础是血液携氧能力减低，组织缺氧 ●机体对缺氧进行代偿和适应机制如下 贫血的病理生理 心脏搏出量增加 贫血患者因RBC减少，血液粘度减低和选择性的周围血管扩张，周围血管阻力减低 心率加速，循环速度加快 为防止对机体供氧量减少，心脏排血量增加 贫血的病理生理 增加组织的灌注 ：贫血时血液供应重新分配，供血减少区域为皮肤组织和肾脏，故皮肤苍白，对缺氧敏感的心肌、脑和肌肉供血量增加 肺的代偿机能 ：贫血时呼吸加快、加深、呼吸增强，但这并不能得到更多的