low red blood cells
Introduction
Introduction Low red blood cells are clinical manifestations of iron deficiency anemia in children. Iron deficiency anemia refers to the imbalance between the body's demand and supply of iron, resulting in the reduction of the amount of iron depleted red blood cells and the amount of hemoglobin stored in the body to a certain extent, followed by anemia caused by iron deficiency in the red blood cells. Iron deficiency anemia is the most common anemia. In the most vigorous growth period, if the iron stored in the body is used up and the iron content in the diet is not enough, the absorption of iron by the digestive tract is insufficient to supplement the blood volume and the increase of red blood cells, and anemia can occur.
Cause
Cause
1. The relationship between the body iron content and anemia at the time of birth:
Normal newborns have a blood volume of approximately 85 ml/kg and hemoglobin of approximately 190 g/L. More than 75% of total iron in the neonatal period is stored in hemoglobin, and about 15% to 20% is stored in the reticuloendothelial system. The amount of synthetic myoglobin is small. The iron in the enzyme is only a few milligrams. Therefore, the content of iron in the newborn is mainly determined by the blood volume and the concentration of hemoglobin. Blood volume is proportional to body weight. Inverted to a 3.3kg newborn compared with a 1.5kg premature infant, the total iron content in the body is 120mg. Normal newborns have an iron content of about 70 mg/dl. The amount of iron in premature and low birth weight children is directly proportional to their body weight. The iron released by physiological hemolysis after birth is stored in reticuloendothelial cells, plus the application of storing iron enough to double the body weight after birth. Therefore, the lower the birth weight, the less the total amount of iron in the body, and the greater the possibility of anemia. In addition, fetal transfusion of the placenta to the mother, or a fetus in a twin fetus to another fetus, as well as placental vascular rupture and biliary ligation during childbirth (lattice ligation delay, the newborn can get 75ml of blood or 40mg Iron) may affect the iron content of the newborn. There is iron deficiency anemia in the mother during pregnancy, and there is no positive relationship with the anemia of the baby, because the placenta can transport the iron in the mother with low serum iron content to the fetal body with high serum concentration, regardless of whether the mother is iron or not, or The quality of the diet, after inputting isotopically labeled iron, about 10% of the iron enters the fetus. Therefore, at birth, regardless of whether the mother has anemia, the concentration of hemoglobin, serum ferritin and serum iron in the newborn is not significantly different, and is not proportional to the mother's hemoglobin. Even if the mother is suffering from or is suffering from anemia, the serum ferritin of the baby can still be within the normal range.
2. The relationship between growth rate and anemia:
Children grow rapidly and blood volume increases rapidly. Normal infants gain 1 time weight when they reach 5 months. Premature infants increase more quickly, and can increase by 6 times at 1 year of age. If the primary blood protein is 19g/dl. It will be reduced to about 11g/dl by 4.5 to 5 months. At this time, only the stored iron can be used for maintenance, and there is no need to add iron to the food. But premature babies are different and their needs are much higher than normal babies. A normal baby gains 1 time and maintains hemoglobin at 11 g/dl. The iron stored in the body is sufficient. Therefore, before the weight gain is doubled, if there is obvious iron deficiency anemia, it is generally not caused by iron deficiency in the diet, and other reasons must be sought.
3, diet iron deficiency:
Infants are dominated by dairy foods, which have extremely low levels of iron. The content of breast milk is related to the mother's diet, and the iron content is generally 1.5 mg/L. Cow 0.5 ~ 1.0mg / L, less goat milk. The absorption rate of iron in milk is about 2% to 10%, and the absorption rate of iron in human milk is higher than that in milk (the iron absorption rate in human milk can be increased to 50% when iron is deficient). Infants within 6 months after birth can maintain hemoglobin and stored iron in the normal range if they have enough breast milk to feed. Therefore, when breastfeeding is not possible, the formula of fortified iron should be fed, and the complementary food should be added in time. Otherwise, after the weight gain is doubled, the stored iron and the end can cause anemia. Anemia can also occur in breastfed infants after 6 months without the addition of complementary foods. According to the etiology of 39 cases of small cell anemia in Beijing Children's Hospital, 65% were artificially fed, and some breast-feeders did not add complementary food in time. Larger children suffer from anemia due to poor eating habits, refusal to eat, partial eclipse or poor nutritional supply.
4, a small amount of blood loss for a long time:
The iron stored in normal people is 30% of the total iron volume of the human body. If the acute blood loss does not exceed 1/3 of the total blood volume, it can be quickly recovered without additional iron supplementation, and no anemia will occur. Long-term chronic blood loss, 4ml per blood loss, is about equal to 1.6mg of iron loss, although the daily blood loss is not much, but the iron consumption has more than 1 times the normal, it can cause anemia. Because of the rapid growth of infants under 1 year old, the stored iron is used to supplement the expansion of blood volume, so that a small amount of chronic blood loss can also lead to anemia. In recent years, it has been found that chronic intestinal blood loss can occur in children fed a large amount (>1 L) of uncooked fresh milk, and antibodies against heat-labile proteins in fresh milk can be found in the blood of such children. It is also believed that intestinal blood loss is related to the amount of fresh boiled milk that is not boiled. For infants aged 2 to 12 months, if the total amount of fresh milk is not more than 1L per day (preferably not more than 750ml) or application of evaporated milk The blood loss can be reduced. Common chronic blood loss can also be caused by gastrointestinal malformations, phlegm, polyps, ulcer disease, esophageal varices, hookworm disease, epistaxis, thrombocytopenic purpura, pulmonary hemosiderosis and teenage menstruation.
5. Other reasons:
Long-term diarrhea and vomiting, enteritis, fatty phlegm, etc., can affect the absorption of nutrients. In acute and chronic infections, the child's loss of appetite, poor absorption of the gastrointestinal tract, can also cause iron deficiency anemia.
Examine
an examination
Related inspection
Blood routine hemoglobin serum ferritin serum iron blood biochemistry six tests
Iron deficiency anemia is a common nutritional deficiency in children. It occurs in infants from 6 months to 3 years old. It can cause irritability, poor mentality, lack of activity, fatigue, loss of appetite, lips, conjunctiva, nail beds and The palms are pale and other symptoms. A macrophage proliferative disorder with immune dysfunction, representing a group of diseases with different pathogens, characterized by fever, hepatosplenomegaly, and complete blood cell reduction. Hemoglobin and red blood cell values are low in blood tests, and biochemical tests such as serum ferritin and serum iron can be diagnosed.
Diagnosis
Differential diagnosis
1. Red blood cell life shortening: Heavy thalassemia is a homozygote of 0 or + thalassemia or a double heterozygote of 0 and + thalassemia, due to complete or almost complete inhibition of -strand formation, resulting in reduced -chain HbA synthesis. Or disappear, and the excess chain binds to the chain to become HbF (a22), which causes a significant increase in HbF. Due to the high oxygen affinity of HbF, the patient's tissue is hypoxic. Excess a-chain is deposited in the red blood cells and red blood cells, and the a-chain inclusion bodies are attached to the red blood cell membrane to become stiff, and are mostly destroyed in the bone marrow to cause "ineffective hematopoiesis". Some of the red blood cells containing inclusion bodies mature and are released into the peripheral blood, but they are easily destroyed when they pass through the microcirculation; this inclusion body also affects the permeability of the red blood cell membrane, resulting in shortened life of red blood cells.
2, red blood cell syndrome: hemophagocytic syndrome (HPS) also known as hemophagocytic lymphohistiocytosis, also known as hemophagocytic reticulosis (hemophagocytic reticulosis), first in 1979 by Risdall et al report. It is a multi-organ, multi-system involving, and progressively aggravated macrophage proliferative disease with immune disorders, representing a group of diseases with different pathogens, characterized by fever, hepatosplenomegaly, and complete blood cell reduction.
