教育演讲:常见小儿疾病预防与处理-贫血症

林凱信
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摘要

贫血可以定义为血红蛋白、红细胞压积或每立方毫米红细胞数量低于正常值。6~23月龄血红蛋白低于10 gm/dL, 2~5岁血红蛋白低于11 gm/dL, 6~12岁血红蛋白低于12 gm/dL,需要进一步检查以解决问题。良好的家族史的重要性值得强调,因为贫血通常有遗传基础。贫血的各种原因在不同年龄的儿童中有相对的发生率。婴儿期早期以新生儿ABO不相容溶血病、急慢性出血、早产儿贫血、缺铁性贫血最为常见。而慢性病贫血、再生障碍性贫血、获得性免疫溶血性贫血、地中海贫血、红细胞贫血异常或酶病在婴儿期后期和儿童期普遍存在。本文着重介绍了红细胞生成和功能的发育变化、贫血的体征和症状、各种疾病中红细胞的形态变化、贫血的骨骼变化,以及台湾地区地中海贫血的重要性。根据病因诊断,给予铁制剂、叶酸、维生素B12、类固醇、输血、铁螯合治疗、抗胸腺细胞球蛋白、脾切除、骨髓移植等治疗。
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教育演講:常見小兒疾病預防與處理-貧血症
Anemia can be defined as a lower than normal value for hemoglobin, hematocrit or number of red blood cells per cubic millimeter. Those who are aged 6~23 months with hemoglobin below 10 gm/dL, or aged 2~5 years with hemoglobin below 11 gm/dL, or aged 6~12 years with hemoglobin below 12 gm/dL need further examination to solve the problem. The importance of a good family history deserves emphasis because anemia often have a hereditary basis. The various causes of anemia have relative frequency in various ages of children. In early infancy, ABO incompatible hemolysis disease of newborn, hemorrhage either acute or chronic, anemia of prematurity, and iron deficiency anemia are the most common. While anemia of chronic disease, aplastic anemia, acquired immune hemolytic anemia, thalassemia, anemia of the red cell membrane abnormalities or enzymopathy are prevalent in later infancy and childhood. This article emphasizes the developmental changes in red cell production and function, the signs and symptoms of anemia, the morphologic changes of red cells in various disease, the skeletal changes in anemia, and lastly the importance of thalassemia in Taiwan. The treatment, such as: iron preparation, folic acid, vitamin B12, steroid, transfusion, iron chelation therapy, anti-thymocyt globulin, splenectomy and bone marrow transplantation, should be given according to the etiological diagnosis.
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