儿科学之小儿贫血.ppt

Teaching purpose To understand features of hematopoiesis and blood in children. To comprehend clinical features, diagnosis and therapy of anemia. To understand the definition, grade division and classification of anemia in children. To master etiology, pathogenosis, diagnosis, therapy and prevention of nutritional iron deficiency anemia and nutritional megaloblastic anemia. Features of hematopoiesis in children Hematopoiesis in fetal period（胎儿期造血） Developmental hematopoiesis occurs in three anatomic stages—mesoblastic（中胚层）, hepatic（肝）, and myeloid（骨髓）. Features of hematopoiesis in children Hematopoiesis after birth Hematopoesis in bone marrow Extramedullary hemopoiesis 　　（骨髓外造血） Hematopoesis in bone marrow Yellow bone marrow（黄骨髓） can come back to red bone marrow（红骨髓） when hematopoetic need increases . Yellow bone marrow is deficiency in children, especially in infant and toddler period. When hematopoietic demand increases, liver, spleen and lymph nodes come back to the Status to produce blood cells, hepatomegaly（肝肿大） and splenomegaly（脾肿大） appears, and maybe there are immature erythrocytes and granulocytes in circulating blood. Extramedullary hemopoiesis is the specific phenomena only appearing in infant and toddler. Erythrocyte and hemoglobin Morphological classification of anemia Bone marrow examination The bone marrow is hypercellular, with erythroid hyperplasia（过度增生）. The normoblasts(幼红细胞) may have scanty, fragmented cytoplasm with poor hemoglobinization. Leukocytes and megakaryocytes are normal. Hemosidenin cannot be demonstrated in marrow specimens by Prussian blue staining. ? Iron study Nutritional Megaloblastic Anemia（营养性巨幼细胞性贫血） Folic acid and vitamin B12 deficiency are primary causes of megaloblastic anemia. Case 2. Zhou, male, 8 month old.　pallor for 2 mo . progressive drowsiness and go asleep for 20 hr pre day. He can not smile and to raise his head, which can be done before. He was fed with Mothers milk