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DIK NIS ODELJENJE ZA HEMATOLOGIJU DIK NIS ODELJENJE ZA HEMATOLOGIJU Doc.dr. Kostić,Doc.dr. Kostić,
HIPOHROMNE ANEMIJE PREVENCIJA I TERAPIJA
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ERITROCITI
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GVOŽDJE-oligoelement
DETE-275 mg
ODRASLI-5g
DETINJSTVO-4,5g
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HEMOGLOBIN 65-67 %MIOGLOBIN 3,5REZERVNO Fe 27-30LABILNA REZ. 2,2ENZIMATSKO Fe 0,2Fe u PLAZMI 0,07
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SHEMA 1. DISTRIBUCIJA GVOŽDJASHEMA 1. DISTRIBUCIJA GVOŽDJA
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GVOŽDJE ULAZI U SASTAV:GVOŽDJE ULAZI U SASTAV:
FLAVOPROTEINA:citohrom-c-reduktaze, ksantin oksidaze, dehidrogenaze acil koenzima A,
HROMOPROTEIDA:citohrom,citohrom oksidaza,peroksidaza i katalaza, homogentinzinska oksidaza.
ENZIMI Krebsovog ciklusa
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DNEVNE POTREBEDNEVNE POTREBE UZRAST Fe mg
Odojče 0-4 mes 0,5
Odojče 6-12 mes
1,0
Deca 1-12 god
1,0
Dečaci 13-16god 1,8
Devojčice13-16god 2,4
Žene u fertilnom p. 2,8
Trudnice 3,0
Dojilje 2,8
Muškarci 0,9
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ResorpcijaResorpcija
Pomažu: HCl, piruvat, sukcinat, laktat, askorbinska kiselina
Otežavaju: fosfati, fitati, oksalati
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Regulacija resorpcije FeRegulacija resorpcije Fe
Feritin u crevnoj cirkulaciji
Vancrevni činioci: hipoksija, hipofermija, eritropoetin
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HIPOHROMNE ANEMIJEHIPOHROMNE ANEMIJE
UČESTALOST10% svetske populacije30% predškolske dece (12-24m)20% žena50% trudnica3% muškaraca u SAD
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FAZE NASTANKA BOLESTIFAZE NASTANKA BOLESTI
PRELATENTNI PERIOD “iron depletion”
LATENTNI PERIOD smanjeno Fe
MANIFESTNA ANEMIJA ETIOLOGIJA
– NEDOVOLJAN UNOS HRANOM(Baby milk syndrom)
– POVEĆANE POTREBE(odojčad, rizik bebe, pubertet)
– HRONIČNI GUBITAK (krvarenje)
– NEDOVOLJNA RESORPCIJA (celiakia)
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KLINIČKA SLIKAKLINIČKA SLIKA
CNS - mentalna aktivnost, motorika
KVS - sistolni sum
DT - anorexia, duodenitis
Endokrini
Koža i adnexe kože
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LABORATORIJSKA DIJAGNOSTIKALABORATORIJSKA DIJAGNOSTIKA
Hb, Er, Hct sniženih vrednosti, Rct nor. ili sniženi MCV, MCH, MCHC sniženi Fe u serumu ispod 7 mol TIBIC povećan UIBIC povećan Zasićenje transferina ispod 16% FERITIN smanjen ispod 10 SLOBODNI ERITROCITNI PORFIRIN preko 100g/l TfR-transferinski receptori povećani
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DIFERENCIJALNA DgDIFERENCIJALNA Dg
SEKUNDARNE ANEMIJE
ANEMIJE KOD DEFICITA B6
TALASEMIJE
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Ddg IDA i ACDDdg IDA i ACD
Anaemia MCV Rct TIBC Fe-TIBC Feritin Tfr
Fe-deficit
Sekundarne N ili N ili N N ili
smanjeno
povećano
N normalno
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PATOGENEZA ACDPATOGENEZA ACDINFECTION / INFLAMMATION
CYTOKINES(TNF, INF-, IL-1)
ERYTHROPOIETINPRODUCTION
(Diminished response to anemia)
RETICULOENDOTHELIAL SYSTEM(Alteration in iron storage
and demished release of iron)
NEUTROPHILS
Release of lactoferrin
Iron shunt
ERYTHROIDPROGENITORS
(Diminished proliferation and iron incorporation)
ANEMIA
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TERAPIJA IDATERAPIJA IDA
PREVENCIJA8-15 mg/d 6-8 ned. od 2. mes. (Velisavljev)5-10 mg/d (Tifenbah)1mg/kg tt do kraja prve god. (WHO)2mg/kg za prematurusa (max. 15 mg)od 2. mes
do 1. god,a 1mg za donesene (Wolfe)Obogaćene formule mleka (Fe,E vit.)
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TERAPIJA IDATERAPIJA IDAFEROSULFAT4-6mg/kg tt : u 3 doze (Nelson)2-4 mg/kg tt: u 3 doze (Stefanović)2-6 mg/kg tt: u 3 doze (Wolfe)Lečenje 4-6 meseci
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Naša ispitivanjaNaša ispitivanjaPrimena leka traje 2 meseca kod grupe dece od 6 mes
do 12 godina. 0-6 mes. 8 dece6-12 mes. 91-2 god. 53-4 god. 45-6 god. 211-12.g. 2Ukupno 30
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HEMOGLOBINHEMOGLOBIN
Manje od 70 g/l 2 dece
70-80 g/l 8
80-90 g/l 20
X= 81,33 g/l
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ERITROCITIERITROCITI
2500-3000 2 dece
3000-3500 24
3500-4000 4
X=3100
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EFIKASNOST TERAPIJEEFIKASNOST TERAPIJE
115110
81,33
5060708090
100110120
0,00 1,00 2,00 3,00 4,00
dani
Hb (g/l)
0 30 60
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EFIKASNOST TERAPIJEEFIKASNOST TERAPIJE
3100,00
4000,00
0
1000
2000
3000
4000
5000
1 2
dani
Er x 10 6
0 60
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EFIKASNOST TERAPIJEEFIKASNOST TERAPIJE
30
34
38
25
30
35
40
0,00 1,00 2,00 3,00 4,00
dani
Hct
0 30 60
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NEŽELJENI EFEKTINEŽELJENI EFEKTI
Opstipacija
Diareja
Gadjenje
Kožni osip
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