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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
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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
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Kuliah
Selasa 03-05-2011Pukul 07.30 08.20
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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]
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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]
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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).
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MICROCYTIC anemia
Blood smear microcytosis (MCV
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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
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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)
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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
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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)
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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%
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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
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Iron metabolism parameters
Serum iron
Total Iron Binding Capacity (TIBC)
Serum ferritinSideroblasts
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Possible causes of IDA
increased blood loss hemorrhage
(menorrhagia, chronic gastrointestinal blood
loss)increased requirements
pregnancy, children (growth)
poor dietary intakemalabsorption
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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
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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
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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
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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
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TKS
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