Anemia Def. Besi Ida_44

7/29/2019 Anemia Def. Besi Ida_44

1/21

Meu FK-UISU - 2011Topik: 1.Hematologi

2.Urogenital

3. OncologiMinggu III.

02 - 07 April 2011Prof .dr.Hi. Rafita Ramayati SpA(K),Prof. dr. H. Rusdidjas SpA(K),dr. Hj. Oke Rina Ramayani SpA

3/14/2013 1

file: First_1/ 1 Meu FK-UISU - 2011


2/21

Meu FK-UISU (Blok Hemato-Urogenital & Oncologi,Minggu ke III 02 07 Maret 2011

Pokok Bahasan : Anemia DefisiensiSub Pokok Bahasan:

ANEMI DEF. BESI pada ANAK.

Rusdidjas, Rafita Ramayati, Oke Rina

Ramayani


3/21

Kuliah

Selasa 03-05-2011Pukul 07.30 08.20


4/21

Morphological classification of anemias

microcytic, hypochromic anemia

(decreased MCV) [ mean corpuscular vol.]

normocytic, normochromic anemia

(normal MCV)

macrocytic, normochromic anemia

(increased MCV)

ANEMIA DEF. BESIIron Deffiisiency Anemia [IDA]


5/21

Etiological classification of anemias

Caused by blood loss

[Kehilangan Darah / perdarahan]

Caused by disturbed RBC production

[Gangg. produksi RBC ok kurang bahan baku,mis. Besi, Protein, Folic acid, Vit B12 dll.]

Caused by increased RBC destruction

[Peningkatan pemecahan RBC]

Aplastic Anemia [ Fabrik RBC tidak berfungsi]


6/21

Issues, which help in diagnosing anemia

[Isu utk membantu DIAGNOSIS Anemia]

Presence of symptoms and signs (the patientshistory and physical examination) typical for aparticular type of anemia

[Gejala, Anamnesis, Fisis Diag. dan Type Anemia]A morphological type of anemia

[Type Morphologi RBC]

75% of all hospital anemias are caused by iron deficiency anemia (IDA) anemia of chronic disorders (ACD).


7/21


8/21

MICROCYTIC anemia

Blood smear microcytosis (MCV


9/21

MICROCYTIC anemia

CAUSES - failure of Hb synthesis [GAGAL SYNTESIS]

1. IDA - iron deficiency (iron deficiency anaemia)

2. ACD - anemia of chronic disorders

block in iron metabolism

3.T - thalassaemia and other hemoglobinopathies or a failure of globin synthesisas

4.SA - sideroblastic anemia failure of protoporphyrin and hem synthesis


10/21

5. LTA - lead toxicity anemia(Keracunan Timah hitam)

lead inhibits both the hem and globinsynthesis

6. LIDLatent Iron Deficiency -

precedes the anemialow serum iron (SI)Low serum ferritinelevated TIBC (transferrin)without anemia (normal Hbconcentration)!!!(TIBC Total Iron Bnding Capacity)


11/21

Differentiation between anemias

on the basis of iron metabolism and RDW

[RED CELL DISTRIBTUION WITH]

Serum Fe TIBC Ferritin

Marrow

hemosiderin

Sideroblasts

RDW

Normal

values

M 80-160 g%

F 50-150 g%

250-410 g% 20-150 ng% 30-50% 11.5-

14.5%

IDA Absent

ACD or normal Normal or Normal or N

T normal or normal or Normal or N

SA or normal ringed

sideroblasts


12/21

Iron deficiency anemia (IDA)most common hematologic disorder [ Kelainan Hematol.yg sering]

usually due to chronic blood loss [Kehilangan drh kronik]Symptoms anemia itself

damage to the epithelial tissues [Keruskan jaringan endothel]

pallor of the mucous membranes (clinically recognised if Hb concentration

is less than about 9,0g%)ridged and brittle nails

stomatitis

cracking at the corners of the mouth

glossitis with loss of filiform papillaee (in severe cases)

blood smear microcytic, hypochromic red cells

abnormal shape of RBC (pencil or cigar-shaped poikilocytosis)

target cells (occasionally)


13/21

Typical blood count for a patient with IDA

Hb 7.1 g%

RBC 4.0 x 106

PCV 24%

MCV 62 flMCH 17.8 pg

Reticulocytes 0.8 %

WBC 8.4 x 10

3

(differential normal)PLT 510 x 103

RDW >15%


14/21

Blood and bone marrow smears in IDA

Blood smear

Anisocytosis

Poikilocytosis

Target cells

annulocytes

Bone marrow smear

E:G as 1:1 1:2

Held up differentiation

of RBC onpolychromatofilicerythroblasts stage

Decreased level ofsideroblasts


15/21

Iron metabolism parameters

Serum iron

Total Iron Binding Capacity (TIBC)

Serum ferritinSideroblasts


16/21

Possible causes of IDA

increased blood loss hemorrhage

(menorrhagia, chronic gastrointestinal blood

loss)increased requirements

pregnancy, children (growth)

poor dietary intakemalabsorption


17/21

Treatment:

Nutritional Counseling

1.Maintain breast feeding at least 6 months, if possibl

2.Use an iron-fortified (6-12 mg/l) infant formula until

1 year of age (formula is preferred to whole cows milk).Restrict milk to 1 pint/day

3.Use iron-fortified cereal from 6 months to 1 year

4.Use evaporated milk or soy-based formula when irondeficiency is caused by hypersensitivity to cows milk


18/21

5.Provide suplemental iron for low birth weight infant

a. Infants 1.5 2.0 Kg : 2mg/kg/day suplemental ironb. Infants 1.0 -1.5 Kg : 3mg/kg/day suplemental iron

c. Infants < 1.0 Kg : 4mg/kg/day suplemental iron

6.Facilitators of iron absorption such vit.C-rich food, meat, fish,& poultry should be included in the diet, & inhibitors of

iron absorption such as tea, phosphate, & phytates common

in vegetarian diets should be eliminated


19/21

Oral Iron Medication

1.Product: ferrous iron (e.g, ferrous gluconate, ferrous ascorbate,

ferrous lactate, ferrous succinate, ferrous fumarate,

ferrous glycine sulafate) is effective.

2. Dose: 1.5 2.0 mg/kg elemental iron three times daily.

Older children : ferous sulfate (0.2g) or ferrous gluconate (0.3 g)given three times daily to provide 100-200 mg elemental iron

3. Duration: 6 8 weeks after Hb level is restored to normal


20/21

Parenteral Therapy

Iron-dextran complex I.M (Imferon )

Indications:

1. Noncompliance with oral administration of iron

2. Severe bowel disease

(e.g inflammatory bowel disease) ;

use of oral iron might aggravate

the underlying disease of the gut


21/21

TKS

Documents

Anemia Def. Besi Ida_44