{"id":28649,"date":"2023-04-26T23:02:45","date_gmt":"2023-04-26T16:02:45","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28649"},"modified":"2023-04-26T23:02:45","modified_gmt":"2023-04-26T16:02:45","slug":"tiep-can-thieu-mau-thieu-sat-o-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/26\/tiep-can-thieu-mau-thieu-sat-o-tre-em\/","title":{"rendered":"Ti\u1ebfp c\u1eadn thi\u1ebfu m\u00e1u thi\u1ebfu s\u1eaft \u1edf tr\u1ebb em"},"content":{"rendered":"

Thi\u1ebfu m\u00e1u thi\u1ebfu s\u1eaft (TMTS) l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t g\u00e2y thi\u1ebfu m\u00e1u \u1edf tr\u1ebb em. Th\u01b0\u1eddng g\u1eb7p \u1edf l\u1ee9a tu\u1ed5i d\u01b0\u1edbi 5 tu\u1ed5i hay tr\u00ean 10 tu\u1ed5i. \u0110a s\u1ed1 do ch\u1ebf \u0111\u1ed9 \u0103n kh\u00f4ng ph\u00f9 h\u1ee3p theo tu\u1ed5i hay b\u1ecb nhi\u1ec5m giun m\u00f3c hay b\u1ec7nh l\u00fd ti\u00eau h\u00f3a m\u1ea1n.<\/strong><\/p>\n

\"thieu-mau-thieu-sat\"<\/p>\n

1. \u0110\u1ea1i c\u01b0\u01a1ng thi\u1ebfu m\u00e1u thi\u1ebfu s\u1eaft<\/h2>\n

1.1 s\u1ef1 ph\u00e2n b\u1ed1 s\u1eaft<\/strong><\/p>\n

B\u00ecnh th\u01b0\u1eddng, l\u01b0\u1ee3ng s\u1eaft (Fe) c\u1ea3 c\u01a1 th\u1ec3 kho\u1ea3ng 4,5g \u1edf ng\u01b0\u1eddi l\u1edbn. Ph\u00e2n ph\u1ed1i:
\n+ 2.5g trong huy\u1ebft s\u1eafc t\u1ed1 (hemoglobin)
\n+ 1.5g d\u01b0\u1edbi d\u1ea1ng d\u1ef1 tr\u1eef (ferritin)
\n+ 0.4g d\u01b0\u1edbi d\u1ea1ng myoglobin \u1edf c\u01a1
\n+ 0.1g trong c\u00e1c men chuy\u1ec3n h\u00f3a: cytochrome, catalase, peroxydase\u2026
\n– Ngu\u1ed3n cung c\u1ea5p Fe ch\u00ednh cho c\u01a1 th\u1ec3 l\u00e0 t\u1eeb h\u1ed3ng c\u1ea7u: m\u1ed7i ng\u00e0y c\u00f3 kho\u1ea3ng 1% hemoglobin b\u1ecb ph\u00e1 h\u1ee7y v\u00e0 gi\u1ea3i ph\u00f3ng 25mg Fe. S\u1ed1 n\u00e0y \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o d\u1ef1 tr\u1eef v\u00e0 \u0111\u1ee7 \u0111\u1ec3 t\u00e1i t\u1ea1o h\u1ed3ng c\u1ea7u
\n– Ngo\u00e0i ra s\u1eaft c\u00f2n \u0111\u01b0\u1ee3c cung c\u1ea5p qua th\u1ee9c \u0103n: S\u1ef1 h\u1ea5p thu s\u1eaft qua ni\u00eam m\u1ea1c t\u00e1 tr\u00e0ng r\u1ea5t b\u1ecb h\u1ea1n ch\u1ebf. M\u1ed7i ng\u00e0y, ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng ch\u1ec9 h\u1ea5p thu kho\u1ea3ng 1mg Fe, \u0111\u1ee7 \u0111\u1ec3 th\u1ea3i 0.4mg theo n\u01b0\u1edbc ti\u1ec3u v\u00e0 0.6mg theo m\u1eadt.<\/p>\n

1.2 Nguy\u00ean nh\u00e2n thi\u1ebfu s\u1eaft<\/strong><\/p>\n

Thi\u1ebfu cung c\u1ea5p: t\u1eeb m\u1eb9, t\u1eeb giai \u0111o\u1ea1n s\u01a1 sinh, nh\u1ee7 nhi, \u0103n d\u1eb7m, suy dinh d\u01b0\u1ee1ng.
\n– Fe kh\u00f4ng \u0111\u01b0\u1ee3c h\u1ea5p thu t\u1ef1 do qua ni\u00eam m\u1ea1c ru\u1ed9t, b\u00ecnh th\u01b0\u1eddng ch\u1ec9 kho\u1ea3ng 10% c\u1ee7a Fe th\u1ee9c \u0103n, v\u00ec v\u1eady l\u01b0\u1ee3ng Fe trong th\u1ee9c \u0103n ph\u1ea3i t\u1eeb 8-10 mg\/ng\u00e0y
\n– Th\u1ee9c \u0103n ch\u1ee7 y\u1ebfu \u1edf tr\u1ebb nh\u0169 nhi l\u00e0 s\u1eefa, s\u1eefa r\u1ea5t \u00edt Fe (0.4-1.5 mg\/l s\u1eefa m\u1eb9 v\u00e0 0.2-0.6 mg\/l s\u1eefa b\u00f2).
\nT\u1ec9 l\u1ec7 h\u1ea5p thu s\u1eaft c\u1ee7a s\u1eefa m\u1eb9 t\u1ed1t h\u01a1n s\u1eefa b\u00f2 v\u00e0 r\u1ea5t th\u1ea5p n\u1ebfu s\u1eefa b\u00f2 c\u00f3 pha \u0111\u01b0\u1eddng. \u00e0T\u1ec9 l\u1ec7 TMTS t\u0103ng \u1edf tr\u1ebb nu\u00f4i \u0103n nh\u00e2n t\u1ea1o (nh\u1ea5t l\u00e0 d\u00f9ng s\u1eefa b\u00f2 \u0111\u1eb7c c\u00f3 \u0111\u01b0\u1eddng)
\nv Gi\u1ea3m h\u1ea5p thu Fe: h\u1ed9i ch\u1ee9ng k\u00e9m h\u1ea5p thu, vi\u00eam t\u1ee5y m\u00e3n, h\u1ed9i ch\u1ee9ng ru\u1ed9t ng\u1eafn, \u0103n u\u1ed1ng c\u00e1c ch\u1ea5t c\u1ea3n tr\u1edf h\u1ea5p thu, c\u1ea1nh tranh s\u1eaft (tr\u00e0, \u0111\u1ea5t c\u00e1t),\u2026
\nv M\u1ea5t m\u00e1u k\u00e9o d\u00e0i: polyp tai m\u0169i h\u1ecdng- ti\u00eau h\u00f3a- sinh d\u1ee5c, vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng- \u0111\u1ea1i tr\u00e0ng- tr\u1ef1c tr\u00e0ng, xu\u1ea5t huy\u1ebft do c\u00e1c b\u1ec7nh l\u00fd gi\u1ea3m ti\u1ec3u c\u1ea7u- t\u00e1n huy\u1ebft k\u00e9o d\u00e0i, t\u00e1i \u0111i t\u00e1i l\u1ea1i, giun m\u00f3c\u2026
\n– M\u1ed7i 2ml m\u00e1u m\u1ea5t 1mg Fe.
\nv Thi\u1ebfu s\u1eaft do r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a: kh\u00f4ng c\u00f3 transferrin b\u1ea9m sinh, ng\u1ed9 \u0111\u1ed9c ch\u00ec, thi\u00eau m\u00e1u nguy\u00ean b\u00e0o s\u1eaft, r\u1ed1i lo\u1ea1n c\u00e1c d\u00f2ng chuy\u1ec3n h\u00f3a s\u1eaft,\u2026
\nv Fe kh\u00f4ng v\u00e0o \u0111\u01b0\u1ee3c t\u1ee7y x\u01b0\u01a1ng.<\/p>\n

2. L\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng theo giai \u0111o\u1ea1n:<\/h2>\n\n\n\n\n\n\n
Giai \u0111o\u1ea1n<\/td>\nL\u00e2m s\u00e0ng<\/td>\nC\u1eadn l\u00e2m s\u00e0ng<\/td>\n<\/tr>\n
Ti\u1ec1n ti\u1ec1m \u1ea9n<\/td>\nGi\u1ea3m Fe d\u1ef1 tr\u1eef trong m\u00f4<\/p>\n

Ch\u01b0a c\u00f3 tri\u1ec7u ch\u1ee9ng LS<\/td>\n

Ferritin < 12 \u00b5g\/L<\/td>\n<\/tr>\n
Ti\u1ec1m \u1ea9n<\/td>\nGi\u1ea3m Fe trong m\u00e1u
\nH\u1ed3ng c\u1ea7u l\u01b0\u1edbi ban \u0111\u1ea7u gi\u1ea3m
\nC\u00f3 th\u1ec3 c\u00f3 d\u1ea5u hi\u1ec7u b\u1ec7nh n\u1ec1n g\u00e2y thi\u1ebfu s\u1eaft<\/td>\n		Ferritin < 12 \u00b5g\/L
\nFe huy\u1ebft thanh < 60 \u00b5g\/dL
\nTransferrin > 390 \u00b5g\/dL
\nH\u1ec7 s\u1ed1 b\u00e3o h\u00f2a (Fe huy\u1ebft
\nthanh\/Transferrin) > 15%
\nProtoporphyrine t\u1ef1 do h\u1ed3ng c\u1ea7u > 100 \u00b5g\/dL (bt: 10)<\/td>\n<\/tr>\n
To\u00e0n ph\u00e1t<\/td>\nD\u1ea5u hi\u1ec7u thi\u1ebfu m\u00e1u: da ni\u00eam nh\u1ea1t (xem l\u00f2ng b\u00e0n tay nh\u1ea1t ho\u1eb7c
\nr\u1ea5t nh\u1ea1t), tim nhanh, c\u00f3 \u00e2m th\u1ed5i t\u00e2m thu.
\nD\u1ea5u hi\u1ec7u thi\u1ebfu oxy n\u00e3o: l\u1eeb \u0111\u1eeb, v\u1eadt v\u00e3, k\u00e9m v\u1eadn \u0111\u1ed9ng, than m\u1ec7t, hay qu\u00ean, ch\u00f3ng m\u1eb7t, qu\u1ea5y kh\u00f3c, bi\u1ebfng \u0103n.
\nD\u1ea5u hi\u1ec7u thi\u1ebfu dinh d\u01b0\u1ee1ng: \u0111\u1ee9ng c\u00e2n hay s\u1ee5t c\u00e2n, l\u01b0\u1ee1i l\u00e1ng, m\u00f4i kh\u00f4, m\u00f3ng bi\u1ebfn d\u1ea1ng, t\u00f3c kh\u00f4 d\u1ec5 r\u1ee5ng.
\nD\u1ea5u hi\u1ec7u b\u1ec7nh n\u1ec1n g\u00e2y thi\u1ebfu s\u1eaft: xem c\u00f3 \u0111au th\u01b0\u1ee3ng v\u1ecb, quan s\u00e1t ph\u00e2n.<\/td>\n		Ferritin < 12 \u00b5g\/L
\nFe huy\u1ebft thanh < 60
\n\u00b5g\/dL
\nH\u1ed3ng c\u1ea7u nh\u1ecf nh\u01b0\u1ee3c
\ns\u1eafc<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

3. \u0110\u1ec1 ngh\u1ecb c\u1eadn l\u00e2m s\u00e0ng:<\/h2>\n

– C\u00f4ng th\u1ee9c m\u00e1u, ph\u1ebft m\u00e1u ngo\u1ea1i bi\u00ean: thi\u1ebfu m\u00e1u h\u1ed3ng c\u1ea7u nh\u1ecf, nh\u01b0\u1ee3c s\u1eafc, Hct gi\u1ea3m, Hb gi\u1ea3m, MCV < 80 fL, MCH < 28 pg, MCHC < 30%.
\n– R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a s\u1eaft:
\n+ Fe huy\u1ebft thanh gi\u1ea3m (b\u00ecnh th\u01b0\u1eddng tr\u1ebb nh\u1ecf l\u00e0 30 \u2013 70 \u00b5g\/dL, tr\u1ebb l\u1edbn l\u00e0 55 \u2013 125 \u00b5g\/dL).
\n+ Ferritin gi\u1ea3m < 12 \u00b5g\/L (b\u00ecnh th\u01b0\u1eddng: 13 \u2013 300 ng\/dL).
\n+ H\u1ec7 s\u1ed1 b\u00e3o h\u00f2a < 30%.
\n+ Protoporphyrine t\u1ef1 do h\u1ed3ng c\u1ea7u > 30 \u00b5g\/dL.
\n– T\u1ee7y \u0111\u1ed3: d\u00f2ng h\u1ed3ng c\u1ea7u t\u0103ng sinh, h\u1ed3ng c\u1ea7u non nh\u01b0\u1ee3c s\u1eafc, kh\u00f4ng th\u1ea5y hemosiderin, d\u00f2ng ti\u1ec3u c\u1ea7u c\u0169ng c\u00f3 th\u1ec3 t\u0103ng do ph\u1ea3n \u1ee9ng thi\u1ebfu m\u00e1u ngo\u1ea1i vi.
\n– Soi ph\u00e2n t\u00ecm giun m\u00f3c (tr\u1ebb tr\u00ean 2 tu\u1ed5i).<\/p>\n


\n<\/strong>4. Ch\u1ea9n \u0111o\u00e1n thi\u1ebfu m\u00e1u thi\u1ebfu s\u1eaft:<\/h2>\n

4.1. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/strong>: thi\u1ebfu m\u00e1u k\u00e8m Fe huy\u1ebft thanh gi\u1ea3m, Ferritin gi\u1ea3m.
\n4.2. Ch\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3:<\/strong>
\n+ Tr\u1ebb nh\u1ecf (< 2 tu\u1ed5i) thi\u1ebfu m\u00e1u m\u1ea1n, bi\u1ebfng \u0103n, ti\u1ec1n c\u0103n \u0111\u1ebb non hay ch\u1ebf \u0111\u1ed9 \u0103n kh\u00f4ng h\u1ee3p l\u00fd.
\n+ Tr\u1ebb l\u1edbn: thi\u1ebfu m\u00e1u m\u1ea1n bi\u1ebfng \u0103n hay \u0111au b\u1ee5ng ho\u1eb7c ti\u00eau ph\u00e2n \u0111en.
\n4.3. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/p>\n\n\n\n\n\n\n\n\n
Fe huy\u1ebft thanh<\/td>\nFerritin<\/td>\nXN \u0111\u1eb7c hi\u1ec7u<\/td>\n<\/td>\n<\/tr>\n
Atransferrin<\/td>\nBt<\/td>\nBt<\/td>\nTransferrin = 0<\/td>\n<\/tr>\n
Sideroblaste<\/td>\nT\u0103ng<\/td>\nT\u0103ng<\/td>\nT\u1ee7y: Sideroblaste (+)<\/td>\n<\/tr>\n
Ng\u1ed9 \u0111\u1ed9c ch\u00ec<\/td>\nT\u0103ng<\/td>\nT\u0103ng<\/td>\nPb m\u00e1u > 10 \u00b5g\/dL<\/td>\n<\/tr>\n
B\u1ec7nh NT m\u1ea1n<\/td>\nGi\u1ea3m<\/td>\nT\u0103ng<\/td>\nVS, CRP t\u0103ng<\/td>\n<\/tr>\n
Thalassemia<\/td>\nT\u0103ng<\/td>\nT\u0103ng<\/td>\n\u0110i\u1ec7n di Hb<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

– Thalassemia: MCV v\u1eeba ph\u1ea3i, ti\u1ec3u c\u1ea7u b\u00ecnh th\u01b0\u1eddng ho\u1eb7c gi\u1ea3m tr\u1eeb tr\u01b0\u1eddng h\u1ee3p \u0111\u00e3 c\u1eaft l\u00e1ch. Thi\u1ebfu m\u00e1u thi\u1ebfu s\u1eaft: MCV gi\u1ea3m r\u00f5, ti\u1ec3u c\u1ea7u t\u0103ng \u0111\u1ebfn 600 \u2013 700 k\/mm3 (do \u0111\u1ebfm nh\u1ea7m h\u1ed3ng c\u1ea7u nh\u1ecf v\u1edbi ti\u1ec3u c\u1ea7u).<\/p>\n

5. \u0110i\u1ec1u tr\u1ecb<\/h2>\n

5.1. \u0110i\u1ec1u tr\u1ecb thi\u1ebfu s\u1eaft:<\/strong>
\n– Cho u\u1ed1ng vi\u00ean s\u1eaft 3mg s\u1eaft c\u01a1 b\u1ea3n\/kg\/ng\u00e0y \u0111\u1ed1i v\u1edbi thi\u1ebfu m\u00e1u trung b\u00ecnh v\u00e0 nh\u1eb9, 4 \u2013 6 mg s\u1eaft c\u01a1 b\u1ea3n\/kg\/ng\u00e0y chia 3 l\u1ea7n v\u1edbi thi\u1ebfu m\u00e1u n\u1eb7ng. Theo d\u00f5i trong 3 th\u00e1ng ho\u1eb7c \u00edt nh\u1ea5t 1 th\u00e1ng sau khi Hb tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng. C\u00e1c mu\u1ed1i s\u1eaft th\u01b0\u1eddng g\u1eb7p nh\u01b0 Ferrous fumarate, Ferrous gluconate, Ferrous sulfate, Ferrous sulfate exsiccate (ch\u1ee9a kho\u1ea3ng 65 mg s\u1eaft c\u01a1 b\u1ea3n).<\/p>\n\n\n\n\n\n\n\n
Mu\u1ed1i s\u1eaft<\/td>\nL\u01b0\u1ee3ng Fe c\u01a1 b\u1ea3n
\n(% c\u1ee7a mu\u1ed1i s\u1eaft)<\/td>\n		L\u01b0\u1ee3ng Fe t\u01b0\u01a1ng \u0111\u01b0\u01a1ng khi t\u00ednh lu\u00f4n mu\u1ed1i (mg c\u1ee7a mu\u1ed1i s\u1eaft)<\/td>\n<\/tr>\n
Ferrous fumarate<\/td>\n33<\/td>\n197<\/td>\n<\/tr>\n
Ferrous gluconate<\/td>\n11,5<\/td>\n560<\/td>\n<\/tr>\n
Ferrous sulfate<\/td>\n20<\/td>\n324<\/td>\n<\/tr>\n
Ferrous sulfate
\nexsiccate<\/td>\n		30<\/td>\n217<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

– Cho t\u0103ng c\u01b0\u1eddng ch\u1ebf \u0111\u1ed9 \u0103n gi\u00e0u s\u1eaft: b\u1ed5 sung th\u00eam nhi\u1ec1u th\u1ef1c ph\u1ea9m ch\u1ee9a s\u1eaft. Tr\u00e1nh c\u00e1c th\u1ee9c \u0103n gi\u1ea3m h\u1ea5p th\u1ee5 s\u1eaft: s\u1eefa, ng\u0169 c\u1ed1c, tr\u00e0, c\u00e0 ph\u00ea, tr\u1ee9ng.
\n– S\u1eaft ti\u00eam b\u1eafp v\u00e0 s\u1eaft truy\u1ec1n t\u0129nh m\u1ea1ch: \u00edt d\u00f9ng.<\/p>\n

– Truy\u1ec1n h\u1ed3ng c\u1ea7u l\u1eafng 3 \u2013 5 ml\/kg\/l\u1ea7n t\u0129nh m\u1ea1ch ch\u1eadm trong 3 gi\u1edd khi Hb < 4 g\/dL hay tr\u1ebb thi\u1ebfu m\u00e1u n\u1eb7ng k\u00e8m theo r\u1ed1i lo\u1ea1n tri gi\u00e1c, nh\u1ecbp th\u1edf, m\u1ea1ch ngo\u1ea1i bi\u00ean y\u1ebfu, suy tim. Sau truy\u1ec1n cho u\u1ed1ng s\u1eaft.
\n5.2. \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n g\u00e2y thi\u1ebfu s\u1eaft:<\/strong>
\n– T\u0103ng c\u01b0\u1eddng dinh d\u01b0\u1ee1ng: \u0111\u1ed1i v\u1edbi tr\u1ebb d\u01b0\u1edbi 5 tu\u1ed5i c\u00f3 thi\u1ebfu m\u00e1u \u0111\u00e1nh gi\u00e1 ch\u1ebf \u0111\u1ed9 \u0103n v\u00e0 h\u01b0\u1edbng d\u1eabn c\u00e1ch cho \u0103n ph\u00f9 h\u1ee3p theo l\u1ee9a tu\u1ed5i.
\n– S\u1ed5 giun \u0111\u1ed1i v\u1edbi tr\u1ebb tr\u00ean 24 th\u00e1ng tu\u1ed5i, ch\u01b0a s\u1ed5 giun tr\u01b0\u1edbc \u0111\u00f3 6 th\u00e1ng.
\n– V\u1ec7 sinh th\u00e2n th\u1ec3, kh\u00f4ng \u0111i ch\u00e2n \u0111\u1ea5t.
\n5.3. \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3:<\/strong>
\n– \u0110ang suy dinh d\u01b0\u1ee1ng th\u00ec \u0111i\u1ec1u tr\u1ecb SDD \u1ed5n r\u1ed3i m\u1edbi b\u1ed5 sung Fe v\u00ec SDD n\u1eb7ng kh\u00f4ng chuy\u1ec3n h\u00f3a Fe hi\u1ec7u qu\u1ea3 \u0111\u01b0\u1ee3c \u00e0 l\u00e0m t\u0103ng g\u1ed1c t\u1ef1 do, g\u00e2y nguy hi\u1ec3m l\u00ean th\u00e0nh t\u1ebf b\u00e0o.
\n– \u0110ang vi\u00eam nhi\u1ec5m n\u1eb7ng (NTH) th\u00ec \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng huy\u1ebft \u1ed5n m\u1edbi b\u00f9 Fe v\u00ec Fe v\u00e0o s\u1edbm s\u1ebd gi\u00fap vi tr\u00f9ng t\u0103ng ho\u1ea1t \u0111\u1ed9ng.
\n– Vitamin C, tr\u00e1nh c\u00e1c th\u1ee9c \u0103n gi\u1ea3m h\u1ea5p th\u1ee5 s\u1eaft.<\/p>\n","protected":false},"excerpt":{"rendered":"

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