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[缺铁性贫血:临床表现、生物学诊断及管理]

[Iron deficiency anaemia: clinical presentation, biological diagnosis and management].

作者信息

Espanel C, Kafando E, Hérault B, Petit A, Herault O, Binet C

机构信息

Service d'hématologie, hôpital Bretonneau, CHRU de Tours, 2 boulevard Tonnellé, 37044 Tours cedex 9, France.

出版信息

Transfus Clin Biol. 2007 May;14(1):21-4. doi: 10.1016/j.tracli.2007.04.005. Epub 2007 May 11.

Abstract

The iron deficiency is the first cause of anaemia. In healthy young adult, anemia is well tolerated because of its progressive installation. The most common symptoms of anemia are pallor, fatigue and dyspnea. In biological exams, anemia is classically associated with microcytosis and hypochromia. The origins of microcytic anemia are iron deficiency, inflammatory aetiologies, thalassemia and sideroblastic anaemia. The iron-deficiency diagnosis includes two explorations: biological and clinical. The biological exploration is based on interpretation of serum biologics tests as blood iron, ferritin, transferrin with saturation, total iron-binding capacity and its soluble receptors. This interpretation is simple if it is not associated with clinical disorders influencing the internal iron cycle. The clinical exploration must always be followed by a careful assessment of the underlying cause as blood loss. The most common causes in women of reproductive age are gynaecologic. In men and menopausal women, the gastrointestinal tract bleeding is source of anemia. Therapeutic management of anemia is oral iron therapy. Etiological diagnostic of microcytosis is essential before iron therapy. If not, the treatment could be inefficient or it could mask or delay the etiological diagnostic.

摘要

缺铁是贫血的首要原因。在健康的年轻成年人中,由于贫血是逐渐发生的,所以耐受性较好。贫血最常见的症状是面色苍白、疲劳和呼吸困难。在实验室检查中,贫血通常与小红细胞症和低色素血症相关。小细胞性贫血的病因包括缺铁、炎症性病因、地中海贫血和铁粒幼细胞性贫血。缺铁性贫血的诊断包括两项检查:实验室检查和临床检查。实验室检查基于对血清生物学检测结果的解读,如血铁、铁蛋白、转铁蛋白及其饱和度、总铁结合力及其可溶性受体。如果不伴有影响体内铁循环的临床疾病,这种解读很简单。临床检查之后必须始终仔细评估潜在病因,如失血情况。育龄女性中最常见的病因是妇科疾病。在男性和绝经后女性中,胃肠道出血是贫血的根源。贫血的治疗方法是口服铁剂治疗。在进行铁剂治疗之前,小细胞症的病因诊断至关重要。否则治疗可能无效,或者可能掩盖或延误病因诊断。

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