贫血 英语介绍(课堂PPT)

鐮刀型貧血（Sickle-Cell Anemia）
血紅素本身又是由四個蛋白質分子α1、α2、β1、β2拼 湊起來的，而這每一個小單位，都各自有一個鐵化合物 （heme、血鐵質）在蛋白質的中心，負責與氧結合。
如果β2蛋白的第六個胺基酸（蛋白質的組成分子）發生突 變，β2蛋白的結構會產生變化，進而影響到血紅素的整體 構造與功能。不但不能載氧，更會與鄰近的血紅素聚集成 一條條棍子狀的結晶。
重度的β地中海貧血胎兒出生時並無症狀，一個月 後嬰兒才出現貧血、黃疸、脾臟腫大。重度的乙 型患者自此即需終身輸血才能度日，否則五歲左 右即因心臟衰竭死亡。 中度的患者血色素常能保持7-10公克左右。此類 病患不需輸血仍可存活，但因長期處於持續且輕 微的缺氧狀態，刺激骨髓增生作為代償，長期會 顯現額骨突出、兩側骨高、上鄂骨外突使門牙外 露、形成一大特徵，此被稱作地中海貧血面容。
鐮刀型血球會阻塞血管，造成疼痛、 心臟衰弱、風濕症等。此種因一個基 因改變，造成多種性狀的變化，遺傳 學上稱為基因多效性(Pleiotropy)]
治療與展望
地中海貧既然是遺傳性造血障礙，當然可以利用骨髓 移植來治療，患者若有吻合的親屬捐髓者時，即可進 行。地中海貧血患者骨髓幹細胞移植行之多年，是目 前唯一的根本治療法。（但仍無助於缺陷基因及遺傳 的矯正）
幹細胞移植祇能治療地中海貧血患者先天性的造血缺 憾，但對病程續發的併發症如鐵質存積、脾臟腫大及 紅血球抗體產生並無任何助益，故患者應及早接受移 植，以免併發症已形成，影響移植療效。
當α基因病變時所造成的貧血，就稱為α地中海貧血， 國人亦稱作甲型地中海貧血。同樣也會有β地中海貧 血，國人亦稱作乙型地中海貧血。我國是甲型地中 海貧血好發區，發生率較乙型高（約3:1，全國約 6%的人有地中海貧血基因）。 而一般所說的重症海洋性貧血就是指「β重型海洋性 貧血」，它又叫做庫利氏貧血，是β血紅蛋白鏈合成 嚴重的不足。

8
Macrocytic anemia
•Megaloblastic anemias ( folic acid and vitamin B12 deficiency) •Alcoholism •Drugs •Liver diseases •Primary bone marrow disorder •Hypothyroidism •Splenectomy
hematologic adj. hematology n.
2
Definition
Anemia is defined as a decrease in the circulating RBC or hemoglobin and a corresponding decrease in the oxygencarrying capacity of the blood.
Hemorrhage
Due to trauma
Due to disorders: e.g.cancer, ulcers, tuberculosis, diverticular disease, and irritable bowel syndrome (including ulcerative colitis and Crohn’s disease)
ANEMIA
Tian jin Medical University, College of Nursing
1
Introduction
Anemia is a commonly encountered clinical symptom that is caused by an acquired or hereditary abnormality of red blood cells (RBC) or its precursors, or may be a manifestation of an nonhematologic disorder

幼稚粒(Immature myeloid cells)， 分叶过多(Hypersegmented
neutrophils)， 红细胞畸形，形态大小不一， 靶形(Target cells)、球形(Spherocytic)、 泪滴样(Tear-drop red cell)、缗线状
(Rouleaux)
靶形红细胞
病因发病机理
Etiotogy and Pathogenesis
贫血分类—形态学
1、正常细胞性(Normocytic anemias) MCV=80~100fl 见于再障(Aplastic anemia) ，溶贫 (Hemolytic anemias)早期，急性 失血(Acute blood loss anemia)
【医学ppt课件】 贫血 ANEMIAS
一、贫血(Anemias)
周围血 Hemoglobin ,erythrcyte count, Hemetocrit低于正常
男 Hb <125 g/L RBC<4.51012/L HCT < 0.42
女 Hb <110 g/L RBC<4.01012/L HCT < 0.37
评价Hb影响因素：
高 新生儿属于正常 高原居民 失水
低 妊娠、婴儿、儿童、充血心衰、 脾大(Hypersplenism)、 低蛋白血症(Hypoproteinemia)
急性失血：主要是血容量减少 ， Hb 难反映贫血否。
二、贫血分类 Classification of Anemias 形态学
Morphology
（二）病因发病机理
Etiology and Pathog因发病机理—RBC生成减少
（1）造血干细胞增生和分化异常： 再障(Aplastic anemia) MDS(Myelodysplastic disords) 甲低(Hypothyoidesm) 肾衰(Chronic renal failure)

Blood Loss
Excessive blood loss due to heavy menstrual periods, gastrointestinal bleeding, or frequent blood donations can cause iron deficiency anemia.
Support Groups
Recommend joining support groups or seeking counseling to cope with the emotional and psychological impact of iron deficiency anemia.
结语和展望
患者教育和自我管理
Lifestyle Changes
Encourage patients to adopt a healthy lifestyle, including regular exercise and stress management techniques.
Self-Monitoring
Iron is essential for the production of hemoglobin, a protein in red blood cells that carries oxygen throughout the body.
病因及发病机制
Dietary Factors
Inadequate intake of ironrich foods, such as red meat, poultry, fish, leafy greens, and legumes, can contribute to iron deficiency anemia.

? 1、marrow ：
?2、extramedullary ：when requirement of haemopoiesis increase ，liver、spleen、
lymphadenectasis ，hepatomegaly and splenomegaly, in circulating blood immature erythrocytes and granulocytes .
Physiological haemolysis
Normal newborns have higher hemoglobin(HB) and hematocrit levels and a shortened survival period of the fetal RBCs contributes to the development of physiologic anemia.
Disease of hematopoietic system
?infantile anemia （1）nutritional iron deficiency anemia(IDA) （2）nutritional megaloblastic anemia ?Primary/immunity thrombocytopenia
Anemia in childhood (小儿贫血)
? To understand features of hematopoiesis and blood in children.
? To comprehend clinical features, diagnosis and therapy of anemia.
? the sizable expansion of blood volume that accompanies rapid weight gain during the first 3 mo of life adds to the need for increased RBC production.

80-100 胞性
小细 <80 胞性
32-35
<32
再障 溶贫 失血
缺铁性 海洋贫血 铁粒幼细胞性贫血
缺铁性贫血外周血红细胞形态
巨幼细胞贫血
根据病情轻重分为： 轻度贫血 Hb>90g/L 中度贫血 Hb≤ 90g/L, >60g/L 重度贫血 Hb≤ 60g/L, >30g/L 极重度贫血 Hb≤ 30g/L
实验检查
血常规 Hb RBC MCV MCHC WBC PLT Ret 骨髓 增生活跃 明显活跃、极度活跃、 增生减低、增生重度减低 红系：20～40% 粒系：40～60%（原粒＋早幼粒∠5%） 淋巴系：20～40%（原幼淋0%） 单核系：3～8%（原幼单0%） 白细胞系:原始＋早期幼稚细胞∠5% 其它：针对病因检查
诊断(Diagnosis ) 确定是否贫血→贫血原因 1 病史 ：起病情况，病程长短（先天或后天）， 伴随表现 2 体征：出血、肝、脾、淋巴结肿大，黄疸等。 3 实验检查:血常规,骨髓 检查,贫血病因检查等
治疗( Treatment ) 去除病因：治疗原发病，如消化道疾病、月 经过多、免疫性疾病、造血系统 疾病等 对症治疗：补充造血原料，输注红细胞制 品，免疫抑制剂等
，
2 红细胞破坏过多——溶血性贫血 RBC形态异常 血红蛋白异常 红细胞酶异常 红细胞外环境异常 3 红细胞丢失—— 失血性贫血 常见于消化道急、慢性出血，女性 生殖道出血，反复鼻衄，创伤出血
根据红细胞形态分类
贫血 MCV(fl) MCHC (%) 类型 大细 >100 胞性 32-35 常见疾病 巨幼贫 MDS
根据起病情况分为： 急性贫血 慢性贫血

临床表现(clinical manifestation) 贫血病因 贫血程度 贫血发生速度 机体代偿能力有关

磷酸甘油酸（2、3－DPG）的合 成增加 2、3－DPG使Hb与氧的亲和力减 低 促进Hb O2解离曲线右移，使组织 在氧分压降低的情况下能摄取更多 的氧
Clinical manifestation
First symptom - decreased work tolerance - shortness of breath - palpitations - other signs of cardiorespiratory adjustments to anemia - at times, they feel fine, but their friends or family notes the pallor
Noticeable only after exertion or excitement
Dyspnea and awareness of vigorous or rapid heart action noted at rest
Shortness of breath, tachycardia, dizziness or faintness, and extreme fatigue
贫血的病理生理
增加组织的灌注 ：贫血时血液供应重新 分配，供血减少区域为皮肤组织和肾脏， 故皮肤苍白，对缺氧敏感的心肌、脑和肌 肉供血量增加
肺的代偿机能 ：贫血时呼吸加快、加深、 呼吸增强，但这并不能得到更多的氧，这 可能是对组织缺氧的一种反应
贫血的病理生理
氧解离曲线右移 在缓慢发生的贫血，RBC内2、3二
• Hemoglobinopathy (reduced oxygen affinity)
Anemias due to inadequate marrow response to erythropoietin

Mediterranean (Gd Med)
Autoimmune Hemolysis
❖ Due to formation of autoantibodies that attack patient’s own RBC’s
❖ Type characterized by ability of autoantibodies to fix complement & site of RBC destruction
- deficiency of the GPI anchored membrane proteins(CD55 and CD59)
- red cells are more sensitive to the lytic effect of complement
- intravascular hemolysis
transplantation
G-6-PD Deficiency
❖acute hemolytic anemia ❖congenital nonspherocytic
hemolytic anemia ❖neonatal hyperbilirubinemia
（kernicterus） ❖ favism
spherocytes in blood smear ❖ Erythroid hyperplasia in bone marrow
diagnosis and differential diagnosis
❖hemolysis or not? ❖type of hemolysis ❖another anemia? ❖another jaundice with anemia? ❖another jaundice without anemia?

Clinical Manifestations and Diagnosis
临床表现
营养性贫血的常见症状包括面色苍白、乏力、头晕、心悸、气短等，严重时可 出现水肿、消化系统症状和神经系统症状等。
诊断
诊断营养性贫血需要进行血液检查，包括血常规、血清铁蛋白、叶酸和维生素 B12水平的测定等。根据检查结果和临床表现，医生可作出诊断并制定相应的治 疗方案。
If necessary, provide iron supplements under the guidance of a doctor.
Regular follow-up
Monitor the patient's condition regularly to assess the effectiveness of treatment and adjust the treatment plan accordingly.
总结词
孕妇营养性贫血的预防与治疗
详细描述
孕妇营养性贫血是由于孕期对铁、叶酸等营养素需求增加而摄入不足引起的贫血。预防和治疗孕妇营 养性贫血的关键是提供富含铁、叶酸等营养素的食物，如瘦肉、绿叶蔬菜等，并定期进行产前检查和 筛查。
Case 3: Nutritional Anemia in the Elderly
Increasing iron intake
Including iron-rich foods such as lean red meat, poultry, fish, beans, and leafy greens in the diet can help to prevent iron deficiency anemia.
02
Prevention of nutritional anemia

women 19–54 years
54+ years
10–13mg 12–16mg 5–7mg
men 19+ years
men 19+ years
第8页，共11页。
V&S
Iron in plant foods is not as easily absorbed as that in meat, so vegetarians and vegans may get too little iron. You should tell your doctor if you have a non-meat diet so he or she can test you for iron deficiency and, if necessary, refer you to a dietitian for advice.
第9页，共11页。
Iron boosts your immune system, helps fight infections, and is vital for normal child growth and intellectual development.
teenagers 12–18 You may develop
years iron deficiency
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