nutritional anemia
Introduction
Introduction to nutritional anemia Nutritional anemia refers to a disease in which the body's blood is essential for the production of blood, such as iron, folic acid, and vitamin D, which are relatively or absolutely reduced, resulting in the formation of hemoglobin or insufficient red blood cell production, resulting in low hematopoietic function. Frequently, infants and young children aged 6 months to 2 years, pregnant or lactating women, and patients with poor absorption of nutrients caused by diseases such as the gastrointestinal tract. Modern medicine divides the disease into small cell anemia and large cell anemia. The former is also called iron deficiency anemia, mostly in infants from 6 months to 1 year old; the latter is also called megaloblastic anemia, which occurs mostly in children under 2 years of age, mainly due to vitamin D2 and folic acid in children's diet. Insufficient content, or insufficient amount of intestinal bacterial synthesis, causes a deficiency in the maturation of red blood cells. The onset of the disease is relatively slow, and the lighter ones are pale or pale yellow of the skin, mucous membranes, and are more pronounced in the lips, gums, eyelids, and nails. Severe anemia can be seen dizziness, general malaise, irritability, loss of appetite, etc., children often accompanied by malnutrition. Some also appear to eat clods, cinders, wall mud and so on. Excessive anemia can lead to growth and development disorders. basic knowledge Sickness ratio: 0.0001% Susceptible people: mostly occur in children under 2 years old Mode of infection: non-infectious Complications: angular cheilitis
Cause
Causes of nutritional anemia
Iron deficiency anemia (30%):
1. The demand for iron is increased and the intake is insufficient: in fast-growing infants, children, menorrhagia, pregnant women or lactating women, the demand for iron increases, and if the diet is lacking, it is easy to cause iron anemia.
2, iron malabsorption: iron deficiency anemia due to iron absorption disorders are relatively rare.
3, blood loss: blood loss, especially chronic blood loss, is the most common and most important cause of iron deficiency anemia. Gastrointestinal hemorrhage such as ulcer disease, cancer, hookworm disease, esophageal varices bleeding, hemorrhoids bleeding, sinusitis after taking salicylate and other diseases that can cause chronic bleeding, women with menorrhagia and hemolytic anemia Iron lutein or hemoglobinuria can cause iron deficiency anemia.
The occurrence of iron deficiency anemia is gradually formed over a long period of time. During the iron depletion period, the stored iron is depleted and the serum ferritin is reduced. There is no anemia at this time, and if the iron deficiency is further aggravated. Storage iron is depleted, serum ferritin and serum iron are decreased, total iron binding capacity is increased, and iron deficiency anemia occurs.
Megaloblastic anemia (30%):
1. Insufficient intake: Vitamin B12 is mainly found in animal foods, with more liver, kidney and meat, and less milk. Folic acid is rich in fresh green leafy vegetables, liver and kidney. The main requirement for vitamin B12 is ~3g per day for adults and ~1g per day for infants. The physiological requirement of folic acid is 75g per day for adults. Infants are ~20g daily. If you do not add food supplements in time, or long-term partial eclipse in older children, it is prone to vitamin B12 or folic acid deficiency.
2, absorption and utilization disorders: small intestine resection in chronic diarrhea, localized ileitis, intestinal tuberculosis, etc. can affect the absorption of vitamin B12 and folic acid, liver disease, acute infection, gastric acid reduction or vitamin C deficiency, can affect vitamin B12 and The metabolism or utilization of folic acid.
3, the need for increased: immature children, newborns and infancy growth and development. The amount of hematopoietic material needs to increase relatively, such as insufficient intake, it is easy to lack. When the infection is repeated, the consumption of vitamin B12 folate is increased, so that the amount of demand is increased and it is easy to cause deficiency.
4, congenital insufficient storage: the fetus can pass the placenta, get vitamin B12 folic acid stored in the liver, such as pregnant women suffering from vitamin B12 or folic acid deficiency, the newborns are less stored, prone to lack.
Prevention
Nutritional anemia prevention
1. Anemia is best not to drink tea. Drinking more tea will only aggravate the symptoms of anemia. Because the iron in the food enters the digestive tract in the form of trivalent colloidal iron hydroxide. Through the action of gastric juice, high-priced iron can be absorbed into low-cost iron. However, tea contains citric acid, which tends to form insoluble iron citrate after drinking, thereby hindering the absorption of iron. Secondly, milk and some drugs that neutralize stomach acid can hinder the absorption of iron, so try not to eat it with iron-containing foods.
2, first of all should emphasize the prevention and treatment of the cause of anemia, due to anemia caused by chronic blood loss, should correct the cause of bleeding.
3, active prevention and treatment of parasitic diseases, especially hookworm disease, for menstruation or maternal and pregnant women should use iron fortified foods or iron supplements.
4, for infants and premature infants should be added intensive food in a timely manner, reasonable feeding.
5. In the production workers exposed to harmful substances, labor protection should be strengthened. Do not abuse drugs in daily life and strictly control the indications.
Complication
Nutritional anemia complications Complications
Iron deficiency is a common complication of this disease, especially in the effective treatment process, due to increased hematopoietic levels, increased iron consumption and "mixed anemia."
Symptom
Symptoms of nutritional anemia Common symptoms Lip pale pale pale appetite, lack of energy, irritability, dry skin, dizziness, eclipse, inattention
Iron deficiency anemia
I. Symptoms caused by epithelial tissue damage: The decrease of intracellular iron-containing enzyme is the main cause of epithelial changes.
1, angular cheilitis and glossitis: about 10-70% of patients have angular keratitis, smooth tongue and tongue nipple atrophy, especially in the elderly.
2, esophageal fistula.
3, atrophic gastritis and gastric acid deficiency.
4, skin and nail changes: dry skin, keratinization and atrophy, hair easy to fold and fall off; nails are not smooth, flat nails, anti-A and gray armor.
Second, the nervous system symptoms:
About 15-30% of patients show neuropathic pain (mainly headache), paresthesia, severe cases may have increased intracranial pressure and papilledema. 5-50% of patients have mental and behavioral abnormalities, such as inattention, irritability, mental retardation and ecstasy. The reason is that iron deficiency not only affects the oxidative metabolism and nerve conduction of brain tissue, but also leads to a decrease in the activity of mitochondrial monoamine oxidase associated with behavior.
Third, splenomegaly: the reason is related to the shortening of red blood cell life.
Megaloblastic anemia
1, anemia performance
Mild or moderate anemia is the majority, with a yellowish face and fatigue. Due to anemia, it causes hematopoietic reaction outside the bone marrow, and it has a three-line reduction phenomenon, so it is often accompanied by swelling of the liver, spleen and lymph nodes.
2, neurological symptoms
The expression is sluggish, drowsiness, slow response to the outside world, less crying or crying, mental development and backwardness of movement, or even backwards. If you have already recognized people, will climb, etc., you will not be sick afterwards, and there are still uncoordinated and Involuntary movements, limbs, head, tongue and even whole body tremor, increased muscle tone, hyperreflexia, positive sputum, shallow reflexes disappeared, and even convulsions.
3, digestive symptoms
Loss of appetite, glossitis, sublingual ulcers, diarrhea, etc.
Examine
Nutritional anemia check
Iron deficiency anemia
1, blood:
Early or mild iron deficiency can be free of anemia or only mild anemia. Late or severe iron deficiency has typical small cell hypopigmentation anemia. The extent to which hematocrit and hemoglobin concentrations are reduced by the extent to which red blood cell counts are reduced.
2, bone marrow:
The bone marrow hyperplasia is active, the proportion of red blood is reduced, and the red blood cell system is obviously active. The proportion of young and middle red blood cells is increased, the volume is slightly smaller than that of normal young and middle red blood cells, the edges are not neat, the cytoplasm is less, the staining is blue, and the nuclear condensation is like the late red blood cells, indicating that the cytoplasm is behind development in the nucleus, granulocytes and megakaryocytes. The number and morphology of the cells were normal.
3. Bone marrow iron staining.
4. Serum ferritin.
5. Serum iron.
Megaloblastic anemia
First, the blood image
It is a large cell positive anemia, MCV>94m3, MCN>32pg, and MCNC is 32-36%. There are fewer red blood cells, the central light-stained area is not obvious, the staining is deep, the light size is uneven, occasionally the young red blood cells, the polychromatic and eosinophilic red blood cells can be seen, and the Haoqiu body and Kappo can also be seen. ring.
The number of white blood cells is slightly lower, the granulocyte diameter is increased, the nuclear lobes are excessive (nuclear right shift), and the lobes can be more than 5, which often appear before the red blood cell changes, so it is important for early diagnosis, and the platelet count is generally Reduced, its shape is larger.
Second, the bone marrow image
The bone marrow hyperplasia is active, mainly erythrocyte proliferation, and the ratio of granules and red is normal or inverted. The red blood cell line is large in volume, the nuclear chromatin is loose, the nucleus develops behind the cytoplasm, and the early red blood cells can appear hemoglobin early, indicating that the old nucleus is old. This phenomenon of enlarged cells, large nuclei, and loose chromatin is called giant juvenile change. According to its maturity, it is divided into four stages: Juyuan, Juhong, Juzhong, and Juvenile. The total number of juvenile red blood cells in each period can reach 30-50%. In the granulocyte system, juvenile and rod-shaped granulocytes can also be seen as giant changes.
Excessive nuclear lobes appear in megakaryocytes, with large platelets and loose particles.
Third, blood biochemical examination
1, serum vitamin B12 content determination, the normal value of 200-800pg / ml. For example, <100pg/ml suggests vitamin B12 deficiency.
2, serum folic acid content determination, the normal value of 5-6ng / ml. <3 ng/ml suggests a deficiency in folic acid.
Diagnosis
Diagnosis and identification of nutritional anemia
1. Have a history of malnutrition, rickets and acute and chronic infections.
2, the skin and mucous membranes gradually pale or yellow, hair thin yellow and sparse, often accompanied by anorexia, fatigue, lack of energy, sluggish expression, slow response and other symptoms.
3, the number of red blood cells decreased, hemoglobin <100g / L in 3 months, <110g / L in March ~ 6 years old, <120g / L in 6 ~ 14 years old is anemia. Reduced serum iron or decreased serum vitamin B12 or folate levels.
4, bone marrow like nucleated cell proliferation, red blood cell line increased.
5, iron and vitamin B12 or folic acid treatment is effective.
