Physiological anemia in children
Introduction
Introduction Pediatric physiologic anemia: With the establishment of spontaneous breathing after birth, blood oxygen content increases, erythropoietin decreases, bone marrow hematopoietic function temporarily decreases, and reticulocytes decrease. Fetal red blood cells have a short life span and more damage (physiological hemolysis), combined with rapid growth of the baby, rapid increase in circulating blood volume, etc., red blood cell count and hemoglobin volume gradually decrease, to 2-3 months (early premature infants) The number of red blood cells fell to 3.0×10/12/L, the amount of hemoglobin dropped to about 100g/L, and mild anemia appeared, which was called ''physiological anemia''.
Cause
Cause
The fetus is relatively hypoxic in the uterus, and the oxygen saturation is about 45%. Hypoxia increases the synthesis of erythropoietin (a hormone that promotes bone marrow hematopoiesis) in the body, so the number of red blood cells and hemoglobin is higher, at birth. The number of red blood cells is about 5.0 to 7.0×1012/L, and the hemoglobin is about 150-220 g/L. The hemoglobin of physiological anemia gradually declines one week after birth, and does not stop until after the eighth week. The hemoglobin drops to about 100 g/L at 2 to 3 months. The number of red blood cells decreased to 3.0×1012/L. The physiological anemia in premature infants appeared early and heavier. Hemoglobin decreased to 70-90 g/L at 3-6 weeks after birth. The causes of physiological anemia are:
1. After the birth of the child, lung respiration was established. The oxygen saturation increased from 45% in the fetal period to 95%. The increase in blood oxygen saturation doubled the erythropoietin and decreased the hematopoietic function of the bone marrow. This is the most important. the reason.
2. The life span of fetal red blood cells is shorter than that of red blood cells produced after birth (the life of fetal red blood cells is about 45-70 days, and the average life span of red blood cells produced after birth is 120 days). The fetal red blood cells are gradually destroyed after birth.
3, 3 months after birth is the fastest stage of weight gain, blood volume increased a lot, red blood cells were diluted.
Examine
an examination
Related inspection
Erythropoietin neonatal hemolysis screening urinary biliary tract sputum erythrocyte alkaline spot color red blood cell count
Hemoglobin gradually decreases within 1 week after birth, and usually stops after 8 weeks. Hemoglobin can be reduced to 90-110g/L after 2-3 months of birth. The state of transient anemia caused by such normal physiological changes is called physiological anemia. During the process of hemoglobin decline, the body "indicates" that the bone marrow gradually enhances hematopoietic capacity. Generally, hemoglobin rises to a normal level in the first half of the year, reaching 120-160 g/L.
Before the birth of the fetus, the mother will give him or her a special gift - hematopoietic material stored in the fetus, which will ensure the hematopoietic needs of the fetus at least 3 months after birth. Although every baby has physiological anemia after birth, in general, hemoglobin in newborns is less than 90g/L, but hemoglobin can be reduced by 70-90g/L in 3-6 weeks after birth. This is due to the fact that premature infants receive less hematopoietic material from their mothers, plus the reason that premature infants grow faster than full-term infants, blood fluid volume increases more, and red blood cell concentrations dilute more.
Physiological anemia is a normal phenomenon that occurs during the growth and development of infants, so there is no need for treatment. However, it should be noted that the food to be fed must be rich in hematopoietic substances. For example, try to breastfeed and give formulas of a certain age. For premature infants, foods containing vitamin E, folic acid and iron should be added in time to benefit. Recovery of the body's hematopoietic function.
Diagnosis
Differential diagnosis
1. "iron deficiency anemia": iron deficiency affects the anemia caused by hemoglobin synthesis, seen in malnutrition, large amount of small-term bleeding and hookworm disease, as long as women are more likely to suffer from iron deficiency anemia, this is Because women have a fixed loss of blood every month during their physiological period. Therefore, on average, about 20% of women and 50% of pregnant women have anemia. If the anemia is not very serious, you don't have to eat all kinds of supplements. You can change the symptoms of anemia by adjusting your diet. For example, first of all, pay attention to diet, and balance the intake of iron-rich foods such as liver, egg yolk, and cereals. If the iron ingested in the diet is insufficient or the iron deficiency is serious, iron supplements should be added immediately. Vitamin C can help the absorption of iron, but also help to make hemoglobin, so the intake of vitamin C should be sufficient. Second, eat a variety of fresh vegetables. Many vegetables are rich in iron. Such as black fungus, seaweed, hairy vegetables, leeks, black sesame seeds, lotus root powder and so on.
2. "Bleeding anemia": caused by acute massive bleeding (such as gastric and duodenal ulcer disease, rupture of esophageal varices or trauma).
3. "Hemolysis anemia": anemia caused by excessive destruction of red blood cells, but less common, often accompanied by jaundice, known as "hemolytic jaundice."
4. "Giant erythrocyte anemia": lack of red blood cell maturation caused by anemia, lack of folate or vitamin B12 caused by megaloblastic anemia, more common in infants and pregnant women long-term malnutrition, megaloblastic anemia refers to the presence of bone marrow A type of anemia of a large number of mega-cells. In fact, megaloblasts are immature red blood cells in various stages that are abnormal in morphology and function. The formation of this megaloblastic cell is the result of defects in DNA synthesis, and the development and maturation of the nucleus lags behind the cytoplasm of hemoglobin. A variety of tissue cells in the body are affected by defects in DNA synthesis, but hematopoietic tissues are most severe, especially erythroid cells. Both granulocyte and megakaryocytes also have morphological changes and a decrease in the number of mature cells. The megaloblasts include immature red blood cells at different developmental stages of protoplasts, early megaloblasts, medium megaloblasts, and megaloblasts. These megaloblasts are larger than the corresponding normal young red blood cells, and the proportion of the nucleus is slightly higher than normal. After Wright staining, the cytoplasm of the original megaloblasts is dark blue, without particles, and there is a lightly colored circle around the nucleus. The nucleus is round and dyed purple. The most prominent feature is that the chromatin is granular and separated from each other. The partition is relatively translucent, and sometimes there are small pieces of chromatin separated from each other around the core to form a so-called "clock face" state; the nucleolus is large and blue. As the cells mature, the chromatin retains its granular structure and is difficult to form deep-stained condensed masses. Sometimes megaloblastic cells are less anemia, and the morphology of megaloblasts is often less typical, called megaloblasts. The vast majority of megaloblastic anemia is caused by folic acid and vitamin B12 deficiency, but there are a few exceptions, such as megaloblastic proliferation caused by antimetabolites, erythroleukemia and red blood disease, and iron granulocyte anemia. Increased yolk cells, hereditary whey and sour urine. Regardless of the cause, the morphology of the juvenile cells is the same. After proper treatment, these giant young cells can quickly become normal immature red blood cells. Giant erythrocyte anemia may be relatively iron-deficient in the later stages of treatment, and attention should be paid to the timely supplementation of iron.
5. "Malignant anemia": megaloblastic anemia lacking internal factors.
