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Anemia Defisiensi Besi Diagnosis dan Tatalaksana
Anemia Defisiensi Besi Populasi Umum : 1.5%. Iron deficiency inadequate replacement kehilangan besi tubuh. Asymptomatic anemia variasi etiologi . Defisiensi besi : - wanita usia pertumbuhan - menstruating women - ♀ hamil kadar Hb > Hamil Perdarahan akut Malabsorbsi Gastrectomy Regional enteritis Peradangan kronik Terapi plebotomi Diet
Perdarahan kronik Peptic Ulcer Tumor kolon Diverticulitis Parasit Malabsorbsi berat Myoma uteri Diet
Diagnosis
Anamnesis Riwayat penyakit pasien Pemeriksaan fisik laboratorium
Gambaran Klinik Fatigue koilonychia (spoon nails) glossitis Dysphagia konsentrasi daya ingat
Konjungtiva anemis Gejala penyakit penyerta Rambut rontok Papil lidah atropi Pallor
koilonychia
Serum Iron LOW Serum Iron (SI) : jumlah besi yang terikat dengan transferin
Total Iron Binding Capacity (TIBC) HIGH TIBC : ukuran Laboratorium Anemia Defisiensi dari jumlah besi yang Besi dapat diikat transferin
Serum Ferritin LOW Can be “falsely”normal in inflammatory states
Saturasi Transferin : SI TIBC - 20-30% - < 20 % : kurang
Laboratorium defisiensi besi Deplesi Fe Defisiensi Fe
An. Def Fe
Hb
Normal
ringan
Mikrositer hipokrom
Iron store (mg)
< 100
0
0
SI(ug/dl)
Normal
< 60
< 40
TIBC(ug/dl)
360-390
> 390
> 410
% saturasi
20-30
< 15
< 10
Ferritin
< 40
< 20
< 10
% sideroblast
40-60
> 100
> 200
Blood film: Hypochromic microcytic Picture. Occasional Target cells. Pencil shaped poikilocytes. Normal reticulocyte count. Bone marrow iron: Normal to hypercellular. RBC precursors are increased in number. Iron stain negative.
Iron Deficiency Anemia
cigar cell
Mikrositer Hipokrom ?? Anemia defisiensi besi Anemia penyakit kronik Thallasemia
Perbedaan antara thalasemia dan anemia defisiensi besi
Lab
Def besi
thalasemia
SI
Low
Normal
Feritin
Low
Normal/high
TIBC
High
Fe SST
Low
Normal/high
RDW
High
Normal
MCV RBC
> 13
< 13
Perbedaan antara anemia penyakit kronik dan anemia defisiensi besi
Hematology 2000
Diagnostic algorithm for iron deficiency anemia
American Family Physician, Volume 75, Number 5 March 1, 2007
Tatalaksana Anemia Defisiensi Fe
Koreksi defisiensi besi restore hemoglobin level. Cadangan besi . Parenteral iron mungkin dibutuhkan Terapi penyakit dasar
Terapi lini pertama - oral iron therapy 1 g/dL: 2-3 mgg Iron sulfate 300 mg: 60 mg elemental iron 325 mg iron gluconate 36 mg elemental iron
Teh, bran, cereal,atau pengobatan pH lambung (antacid,PPI, H2 blockers) absorpsi. Terapi besi IV - chronic uncorrectable bleeding, - intestinal malabsorption - intolerance thd oral iron - Hb < dari 6 g per dL
Peningkatan Hb yang diinginkan BB (kg)
1g
2g
3g
4g
5g
6g
7g
40
6
7
8
9
10
11
12
45
6
7
8
9
10
11
12
50
6
7
9
10
11
12
13
55
6
8
9
10
12
13
14
60
6
8
9
11
13
14
16
65
7
8
10
11
13
14
16
70
7
8
10
12
13
15
17
75
7
9
10
12
14
16
18
80
7
9
11
13
15
17
18
85
7
9
11
13
15
17
19
90
7
9
11
14
16
18
20
95
7
10
12
14
16
19
21
100
7
10
12
15
17
19
22
Total defisit besi : BB(kg) x (target Hb-actual Hb)x 2,4 + depot besi. depot besi : 500 g/dl Transfusi - fatigue - sesak nafas - penyakit jantung (asimptomatik) Hb < 10 g/dl
Algorithm for evaluation and treatment of iron deficiency anemia.
American Family Physician, Volume 75, Number 5 March 1, 2007