I. Medical history and symptoms
⑴ medical history questions: pay attention to ① eating habits, whether there is a partial eclipse or pica. ② Whether there are digestive system diseases (atrophic gastritis, gastric ulcer or duodenal ulcer, etc.) and hookworm disease; Whether women have menorrhagia; Whether you have had gastrointestinal surgery, etc. Men and postmenopausal women should consider whether it is the first symptom of gastrointestinal tumor.
⑵ Clinical symptoms: fatigue, irritability, palpitation, shortness of breath, dizziness and headache. Children show growth retardation and inattention. Some patients have gastrointestinal symptoms such as anorexia, heartburn, flatulence, nausea and constipation. A few serious patients may have dysphagia, angular stomatitis and glossitis.
Second, the physical examination found that
In addition to the appearance of anemia, there are dry and shriveled skin, and dry hair is easy to fall off. Nails are thin and flat, not smooth, easy to break, and even spoon-shaped nails (seen in long-term serious patients).
Third, the auxiliary inspection
Small cell hypochromic anemia: male hemoglobin <: 120g/L, female hemoglobin < 1 10g/L, maternal hemoglobin < 100g/L； MCV< 80fl，MCH< 26pg，MCHC< 0.3 1； Morphology can have obvious low pigment performance. Serum iron <: 10.7mmol/L, total iron binding force >: 64.44mmol/L, transferrin saturation < 0. 15。 Serum ferritin < 14mg/L。 Iron staining of bone marrow showed that small particles of iron in bone marrow disappeared, and young red blood cells with iron particles <: 15％。
Fourth, differential diagnosis
Thalassemia: There is a family history, and a large number of target red blood cells can be seen on blood slides, with an increase in hemoglobin A2 and an increase in serum ferritin and bone marrow stained iron.
Chronic inflammatory anemia: the total iron binding capacity is normal or decreased, and serum ferritin is increased.
Sideroblastic anemia: Annular sideroblasts can be seen, with increased serum iron and ferritin and decreased total iron binding capacity.
1. Remove the cause:
Find out the cause as much as possible and treat it according to the cause. Such as: treating ulcer bleeding, menorrhagia of women, etc.
2. Oral iron:
Ferrous sulfate is effective and economical. Usage: Take it 0.3 times a day with meals. If the gastrointestinal symptoms are obvious, give it 0. 1 a day first, and then gradually increase the dose, and the gastrointestinal symptoms will be obviously alleviated. Iron fumarate: 0.2, taken orally, 3 times/d; Fornaide: 1 tablet orally, 1 time/d; Sulifei: 0. 1, taken orally, twice a day, etc.
3. Injection of iron:
The following patients can be treated with iron injection:
(1) oral iron is intolerant;
(2) Blood loss is too fast to be compensated by oral iron;
(3) Patients with ulcerative colitis or localized colitis are ineffective after oral iron therapy;
(4) those who cannot absorb iron from gastrointestinal tract, such as patients undergoing gastrointestinal surgery. Usage: The formula of total dose for correcting anemia and restoring stored iron is: iron amount (mg) = [15-patient's hemoglobin (g/dl)]× body weight (kg)×3. Sensitivity test should be done before intravenous administration. Iron dextran: 100mg, 1 time /d, deep intramuscular injection (first dose of 50mg, observe whether there is allergic reaction). Or iron dextran: 500mg, 1 time /d, intravenous injection within 5 minutes without dilution; Or calculate the dosage of single dose of iron for intravenous injection and input it once, dilute it with normal saline according to 1:20, and then drip it intravenously, starting with 20 drops per minute. After observing for 5 minutes without side effects, the dropping speed will increase to 40 ~ 60 drops per minute. Intravenous administration has a great reaction and is rarely used in clinic.
Generally speaking, iron that is easily converted into ionic state in gastrointestinal tract is easy to be absorbed, and ferrous iron is easier to be absorbed than ferric iron, while phytate and phosphate can reduce the absorption of iron, while ascorbic acid and meat can increase the absorption of iron. Good sources of iron are animal liver, egg yolk, beans, lean meat and some vegetables. * (People with hypertension should avoid eating less animal liver and egg yolk, etc.)
There is also the fact that cooking in an iron pan can't supplement iron. People with iron deficiency anemia should drink less milk, which will hinder the absorption of iron; Eat more things containing vitamin C.
When the number of red blood cells in blood or the content of hemoglobin in blood is lower than the normal level, it is anemia. In normal blood
The number of red blood cells in male is 4 million to 5 million/m3, and that in female is 3.5 million to 4.5 million/
Cubic millimeter; The concentration of hemoglobin in normal blood is12 ~15g/100 ml for male and female.
10.5 ~13.5g/100ml. Anemia is a common syndrome. There are many factors that can lead to anemia.
But to sum up, the causes of anemia can be divided into three aspects, one is the lack of raw materials for hematopoiesis, and the other is the hematopoietic machine of human body.
It can be reduced (that is, the hematopoietic function of bone marrow is reduced). Third, red blood cells have been damaged or lost too much. Anemia can be divided into
Various types, such as iron deficiency anemia, megaloblastic anemia, aplastic anemia, hemolytic anemia, etc.
Iron deficiency anemia refers to the anemia caused by the failure of erythropoiesis because the stored iron that can be used to make hemoglobin in the body has been exhausted. It is characterized by the lack of dyeable iron in bone marrow, liver, spleen and other tissues.
Serum ferritin concentration decreased, as did serum iron concentration and serum transferrin saturation. It is characterized by small cell hypochromic anemia.