内科学营养性贫血(英文).ppt

Anaphylaxis- rarely Hypoesthesia – decrease sensation to painful stimuli * * * * * * * Enterohepatic recirculation: Reabsorption from the small intestine of many of the compounds secreted in bile. * THF (tetrahydrofolate) dTMPs (deoxythymidylate monophosphate) * THF (tetrahydrofolate) dTMPs (deoxythymidylate monophosphate) * Inadequate intake: malnutrition, elderly, alcoholics, poverty Decreased absorption: celiac disease, Crohn’s disease, alcoholism Hyperutilization: pregnancy, childhood growth spurts, hemolytic anemia, malignancies, Crohn’s or rheumatoid arthritis, exfoliative skin diseases, long-term dialysis * Methotrexate irreversibly binds to dihydrofolate reductase and inhibits formation of reduced folates Sulfasalazine, cholestyramine – interferes with folate absorption P450-enzyme-inducing AEDs such as phenytoin, phenobarbital, primidone can inactivate folate Alcohol depletes body stores of folic acid by interfering with enterohepatic recirculation * * * * Aleve is the trade name for Over-the-Counter naproxen (NSAID) Ranitidine is a H2 antagonist that decreases stomach acid production * Laboratory Signs Association with iron-deficiency anemia (IDA): Hct and Hgb may be normal early on, but these lab values will fall as anemia progresses Reticulocyte count may be normal or may be low Serum iron may be low, but that is not diagnostic of IDA Elevated TIBC (total iron binding capacity) Decreased serum ferritin * Other symptoms of IDA Cheilosis Decreased resistance to infections Difficulty with thermoregulation Decreased saliva production * Other sources of iron Diet: poultry, raisins, eggs, fish, legumes, potatoes, rice, orange juice Dietary enhancers of absorption: vitamin C, fructose CLINICAL PEARL: Vitamin C increases iron absorption, but most iron/vitamin C combination products do not contain enough vitamin C to be beneficial * If dietary iron is low and insufficient to sustain erythropoiesis, the body will used stored iron until it is d