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    Anemia is defined as a decrease in hemoglobin or red blood cell volume below the normal range for age and sex. Common causes include iron, folate, or vitamin B12 deficiencies, blood loss, increased red blood cell destruction, bone marrow disorders, infections, and toxins. Iron deficiency anemia is caused by an imbalance between iron intake, absorption, and loss. Risk groups include pregnant women, infants, young children, adolescents, and those with low socioeconomic status. Treatment involves oral iron supplementation tailored to age and duration. Regular screening and treatment can help prevent and manage iron deficiency anemia.

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    Anemia is defined as a decrease in hemoglobin or red blood cell volume below the normal range for age and sex. Common causes include iron, folate, or vitamin B12 deficiencies, blood loss, increased red blood cell destruction, bone marrow disorders, infections, and toxins. Iron deficiency anemia is caused by an imbalance between iron intake, absorption, and loss. Risk groups include pregnant women, infants, young children, adolescents, and those with low socioeconomic status. Treatment involves oral iron supplementation tailored to age and duration. Regular screening and treatment can help prevent and manage iron deficiency anemia.

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    Anemia is defined as a decrease in hemoglobin or red blood cell volume below the normal range for age and sex. Common causes include iron, folate, or vitamin B12 deficiencies, blood loss, increased red blood cell destruction, bone marrow disorders, infections, and toxins. Iron deficiency anemia is caused by an imbalance between iron intake, absorption, and loss. Risk groups include pregnant women, infants, young children, adolescents, and those with low socioeconomic status. Treatment involves oral iron supplementation tailored to age and duration. Regular screening and treatment can help prevent and manage iron deficiency anemia.

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    49 views29 pages

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    Anonymous RvZtu8Jwq
    Anemia is defined as a decrease in hemoglobin or red blood cell volume below the normal range for age and sex. Common causes include iron, folate, or vitamin B12 deficiencies, blood loss, increased red blood cell destruction, bone marrow disorders, infections, and toxins. Iron deficiency anemia is caused by an imbalance between iron intake, absorption, and loss. Risk groups include pregnant women, infants, young children, adolescents, and those with low socioeconomic status. Treatment involves oral iron supplementation tailored to age and duration. Regular screening and treatment can help prevent and manage iron deficiency anemia.

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    Referat

    Anemia

    Prof. Dr. Heda Melinda D. N, dr., Sp.A (K)., M.Kes


    Anemia
    • Definisi :
    “ berkurangnya konsenrasi hemoglobin atau volume RBC dari
    rentang nilai orang sehat yang bervariasi sesuai usia da
    jenis kelamin”-Nelson textbook of Pediatrics 20th edition

    “Berkurangnya level hemoglobin, hematokrit, atau RBC count


    yang bervariasi sesuai usia dan jenis kelamin’’-Clinical
    hematology and fundamental of hemostasis 5th edition
    (Harmening)
    Nelson textbook of pediatrics 20th edition. Saunders. Elsevier. 2016
    Populasi Hb diagnostik anemia (g/dL)
    Children aged 6 months to 6 years old < 11.0
    Children aged 6-14 years old <12.0
    Non-pregnant women (>15 years) <13.0
    Pregnant women <12.0
    Men (>15 years) <11.0

    WHO (2008) Worldwide prevalence of anaemia 1993-2005. WHO Global Database on


    Anaemia, Centers for Disease, Control and Prevention, Atlanta
    Global estimates of the prevalence of anaemia in infants and children aged 6–
    59 months, 2011

    The Global Prevalence of Anemia in 2011.WHO.2015


    Etiologi
    Penyebab contoh
    Defisiensi nutrisi defisiensi Fe , folate atau vit. B12
    Blood loss Hemorrhage
    Peningkatan destruksi RBC anemia hemolitik
    Bone marrow replacement kanker, infeksi
    Infeksi virus, bakteri, parasit
    Toksisitas hidrokarbon, medikamentosa, radiasi

    Hematopoietic stem cell arrest atau aging, cytokines


    damage
    Hereditary atau acquired defect Defisiensi G6PD, spherocytosis
    Idiopathic/unknown

    Clinical hematology and fundamental of hemostasis 5th edition (Harmening)


    Klassifikasi Anemia
    Metabolisme Iron
    • Daily iron requirement dan absorbsi
    Minimum daily requirement(MDR)
    Individual MDR (mg)
    Infant 1.0
    Child 0.5
    Menstruating woman 2.0
    Pregnant or lactating woman 3.0
    Adult man or non menstruating woman 1.0

    Harmening, D.M (2009). Clinical Hematology and Fundamentals of Hemostasis.


    Philadelphia: F.A Davis
    Kumar, Abbas, dkk (2013). Regulation of iron absorption. Robbins Basic
    Pathology 9th edition. Philadelphia : Elsevier
    Anemia Defisiensi Besi
    • Definisi:
    “ anemia yang disebabkan oleh tidak seimbangnya
    antara iron intake, iron absorption dan iron loss”
    Kelompok berisiko tinggi ADB

    Prenatal/Neonatal Infancy/Childhood Adolescence/Adult Socio-economic


    Prematur Diet Ketat Menstruasi Low socioeconomic
    Low birth weight Growth spurts Pregnancy Low education
    Anemia during Infeksi kronis Elderly
    pregnancy
    Kurang suplemen Chronic bleeding Chronic bleeding
    iron saat laktasi

    Harmening, D.M (2009). Clinical Hematology and Fundamentals of Hemostasis.


    Philadelphia: F.A Davis
    Etiologi ADB
    • Absorbsi inadekuat:
    – Inflammatory bowel disease
    – Antacid therapy
    – High gastric pH
    • Kurang intake iron
    – Meat poor-diet
    – elderly
    • Meningkatnya penggunaan iron
    – Growth spurt
    – pregnancy
    • Loss of iron
    – Gastrointestinal blood loss
    pathophysiology
    • Stage 1 : Iron depletion
    – Tidak anemia /asymptomatic
    – Berkurangnya iron storage di bone marrow
    – Serum ferritin ↓
    – Kompensasi : TIBC ↑
    – morfologi RBC normal
    – Red cell width (RDW) ↑
    • Stage 2 : Iron deficient erythropoiesis
    – Subclinical
    – Berkurangnya iron untuk erythropoiesis
    – Hb, hct normal atau ↓
    – Serum ferritin ↓, TIBC↑
    – Tidak anemia atau RBC slight hypochrom
    microcyter
    • Stage 3: Iron Deficiency Anemia
    – Hb,hct ↓
    – Peripheral tissue oxygen delivery ↓
    – Delayed hb formation hypochrom, microcyter
    – total body iron ↓
    Clinical feature
    • Hematologis :
    – Pallor : palms, palmar creases, nail beds,
    conjunctiva
    • Non hematologis :
    – Irritable, anorexia, lethargy, apathy, poor
    concntration, defisit kognitif
    – systolic murmur, tachycardia, cardiac output ↑,
    dyspnea
    – Atrofi papil lidah, stomatitis angularis, spoon nail
    Sangat sering Sering Jarang
    Pale Alopesia Hemodinamik tidak stabil
    Exhaustion, tiredness Atrophic glossitis syncope
    dyspnoea Restless leg syndrome Koilonychia
    Headache Kulit kering dan kasar Plumner-Vinson syndrome
    Rambut kering dan rusak
    Cardiac murmur
    Tachycardia
    Disfungsi neurokognitif
    Vertigo
    Labratorium features
    • Decreased : Hb, hct, RBC, MCV, MCH, MCHC,
    serum ferritin, serum iron, normal to decrease
    reticulocyte
    • Increased : TIBC
    • Peripheral blood smear :
    – Hypochromic, microcyter
    – Red cell width↑, anisocytosis, poikilogytosis
    (beberapa ada target cells, elliptocytes,
    ovalocytes, teardrop cells)
    Assessing the Second edition Including Literature Reviews. WHO.2007
    Differensial diagnosis

    Iron Deficiency Anemia. Nelson Textbook of pediatrics 20th Edition. Elsevier. 2016
    Prevensi
    Tata laksana
    • Oral iron therapy:
    – Supplemen iron diberikan kepada semuan anak
    dengan prioritas usia 0-5 tahun, terutama 0-2
    tahun
    – Pemeriksaan kadar hemoglobin dilakukan pada
    usia 2 tahun dan selanjutnya setiap satu tahun
    sampai usia remaja. Bila hasil pemeriksaan
    ditemukan anemia, dicari penyebabnya dan dirujk
    bila perlu.
    Usia (tahun) Dosis besi elemental Lama pemberian
    Bayi* : BBLR (< 2.500 g) 3 mg/kgBB/hari Usia 1 bulan sampai 2 tahun
    Cukup bulan 2 mg/kgBB/hari Usia 4 bulan sampai 2 tahun
    2 - 5 (balita) 1 mg/kgBB/hari 2x/minggu selama 3 bulan berturut-
    turut setiap tahun
    > 5 - 12 (usia sekolah) 1 mg/kgBB/hari 2x/minggu selama 3 bulan berturut-
    turut setiap tahun
    12 - 18 (remaja) 60 mg/hari# 2x/minggu selama 3 bulan berturut-
    turut setiap tahun
    Keterangan: *Dosis maksimum untuk bayi: 15 mg/hari, dosis tunggal
    #Khusus remaja perempuan ditambah 400 µg asam folat

    Supplementasi besi untuk anak. Rekomendasi IDAI Tahun 2011.


    Repon setelah iron therapy pada ADB
    Setelah pemberian iron Respons
    12-24 jam Penggantian enzim iron intracelular; keluhan
    subjektif berkurang; nafsu makan bertambah
    36-48 jam Response awal bone marrow; hiperplasia
    eritroid
    48-72 jam Retikulositosis, memuncak pada hari ke 5-7
    4-30 hari Kadar hemoglobin meningkat
    1-3 bulan Penambahan cadangan iron
    Preparat besi setara dengan 60 mg besi elemental
    Nama obat sediaan
    Askorbat 437 mg
    Aspartat 422mg
    Karbamat 125 mg
    Fumarat 183 mg
    Klorida 214 mg
    Gluseptat 544 mg
    Glukonat 518 mg
    Laktat 310 mg
    Oksalat 193 mg
    Sulfat 300 mg
    Tortrat 268 mg
    Iron Polimaltose Complex ( IPC) 176.47 mg
    Ferazon 452 mg
    Refferensi
    • Nelson Textbook of Pediatrrics 20th edition. Philadelphia :
    Elsevier
    • Harmening, D.M (2009). Clinical Hematology and
    Fundamentals of Hemostasis. Philadelphia: F.A Davis
    • The Global Prevalence of Anemia in 2011.WHO.2015
    • Kumar, Abbas, dkk (2013). Regulation of iron absorption.
    Robbins Basic Pathology 9th edition. Philadelphia : Elsevier
    • Supplementasi besi untuk anak. Rekomendasi IDAI Tahun
    2011.
    • AlDallal S (2016) Iron Deficiency Anaemia: A Short Review. J
    Immunooncol 2: 106
    Terimakasih

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