Dr. Eiffel - Anemia Defisiensi Besi [PDF]

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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