S DNG

THUC IU
TR THIU MU
T: DSH

Ths. Phm Th Huyn Trang

LOGO
 Thiu mu: phn loi v iu tr

Mc tiu:

Trnh by c khi nhim v phn loi nguyn nhn thiu mu theo hnh
thi

Trnh by vai tr, nhu cu, qu trnh chuyn ha st trong c th

Phn tch cch s dng 1 s thuc iu tr thiu mu

 NH NGHA THIU MU

Thiu mu l tnh trng gim nng huyt sc t

trung bnh lu hnh mu ngoi vi di mc bnh
thng so vi ngi cng tui, cng gii, cng trng
thi v cng iu kin sng
 TRIU CHNG

- C nng: mt mi, chn n, kh th khi gng sc

- Thc th: Da xanh, nim mc nht, cc triu chng

km theo ty nguyn nhn
PHN LOI THIU MU THEO HNH THI
 CHUYN HA ST-THIU MU THIU ST

Vai tr v nhu cu st trong c th:

Tng hp hemoglobin

Thnh phn cu to nn 1 s enzym t bo

Thnh phn ca myoglobin d tr oxy cho hot ng ca c vn

Nhu cu
Bng. Nhu cu st hng ngy ca ngi (mg/ngy)
 PHN B ST TRONG C TH
Duodenum Dietary iron
(average, 1 - 2 mg
Utilization Utilization
per day)

Plasma
transferrin (TIBC)
(3 mg)
Bone
Muscle marrow
(myoglobin) Circulating (300 mg)
(300 mg) erythrocytes
Storage
iron (hemoglobin)
(Ferritin) (1,800 mg)

Sloughed mucosal cells

Desquamation/Menstruation
Other blood loss
(average, 1 - 2 mg per day) Reticuloendothelial
Liver
(1,000 mg) macrophages
Iron loss (600 mg)

Tng s lng st trong c th 3000-4000 mg

S hp thu st Ch n 10-20 mg
Fe2+ ; Fe3+

Fe2+ ;
D dy Fe3+ => Fe2+

Lng Mu
rut TB nm rut

+ glycoprotein

Ty xng
C, D tr(gan, Thi
(to HC)
enzym lch, ty) tr
75%
 NGUYN NHN THIU ST

Thc n khng cung cp st

Tng nhu cu st: c thai, cho con b, tr ang ln, tr

em 5-12 thng tui

Mt mu

Gim hp thu st
 CH NH

Thiu mu do thiu st: st huyt thanh thp, TIBC cao

Ph n c thai v cho con b

 Ch phm
Ung

St sulfat, fumarat, gluconat.

Ung xa ba n (trc n 1 gi hay sau n 2 gi)

TDKMM: bun nn, nn, kch ng, RL tiu ha, phn en

Tng tc thuc: antacid, khng H2, c ch bm proton,

tetracyclin

Liu dng: 200-400 mg st nguyn t/ngy trong 3-6 thng

Tim: st dextran, st sucrose, natri st gluconat

TDKMM: au ni tim, nn, m ay, h huyt p, sc phn v

Liu dng: 1-2g st hoc 20-40ml st dextran IM/ TTM

 C TNH

c tnh cp (tr em > ngi ln): chy mu d dy rut, try tim mch,
nhim acid chuyn ha, hn m, t vong

iu tr:
Loi b st khi ng tiu ha: gy nn, ty x

iu chnh rl in gii v acid base (NaHCO3)

Tim deferoxamin

c tnh mn: nhim sc t m

iu tr:

Trch mu tnh mch

Vitamin B12
 VITAMIN B12

S hp thu vitamin B12

 VITAMIN B12

Ch nh:
Thiu mu c tnh ( B12 huyt < 100pg/ml, Schilling test < 5%) v
thiu mu do ct d dy, thiu mu hng cu to MCV > 100fL

Thiu mu do thiu B12 (thiu mu HC to + c tnh v thn kinh)

Liu dng:
Khi u: IM 100-1000mcg/ngy hoc cch ngy trong 1-2 tun
(nu c rl thn kinh: dng trong 6 thng)

Duy tr: IM 100-1000mg/thng

 VITAMIN B9

Ch nh:

Thiu mu do thiu acid folic (MCV > 100fL, nng acid folic
huyt gim)

Liu dng:

PO 1mg/ngy
 ERYTHROPOEITIN (EFO)

Vai tr:

Thiu mu/gim O2 Thn (+) Erythropoietin ty (+) sn sinh hng

cu

Ch nh:

Thiu mu do suy thn hay suy ty xng (EFO <100 IU/l)

c tnh:
Tng Hb, tng Hct, tng HA, huyt khi
 ERYTHROPOEITIN (EFO)
Bng. Ch nh v ch iu tr ca Erythropoetin ti t hp
Thuc Nguyn nhn thiu mu
Do AIDS Do ha tr ung th Do suy thn
Epoetin alfa 100 IU/kg x 3 ln/tun, 150 IU x 3 ln/tun hoc 50IU x 3 ln/tun
p ng sau 8-12 40000IU/ln/tun, p ng
tun sau 2-8 tun
Darbopoetin alfa 2.25mcg/ln/tun IV, SC, 0.45 mcg/ln/tun IV,
p ng sau 2-8 tun SC, p ng sau 2-8
tun
* Ch nh ca vitamin B12, ngoi tr:

A. Thiu mu u sc

B. Vim au dy thn kinh

C. C th suy nhc, gi yu

D. Ung th tin trin

Pht biu no khng ng:

A. Acid dch v gip tng hp thu st t thc n

B. Mun hp thu vitamin B12 cn yu t ni do d dy tit ra

C. Thiu mu hng cu to p ng vi acid folic hoc vitamin B12

D. Trong thi k mang thai nn b sung vitamin B12 gim tai

bin khuyt tt ng thn kinh
Pht biu no v vitamin B12 l ng, ngoi tr:

A. Khng c trong thc vt

B. Ngun cung cp ch yu cho c th t bn ngoi

C. Tch tr ch yu gan

D. ngi, nhu cu vitamin B12 hng ngy c cung

cp y bi vi khun rut
Thuc ch yu tr thiu st nng v cc hi chng
km hp thu st:

A. St sulfat

B. St dextran

C. Acid folic

D. Cyanocobalamin
Cch s dng khng ng st II oxalat
A. Ung ngay sau ba n.
B. Ung vi nhiu nc.
C. Ung vi nc tr.
D. Ung vi nc un si ngui