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    Anemia Defisiensi Besi: Pendekatan Hematologi Muhammad Riza

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    proman wazowski
    1) This document discusses iron deficiency anemia (IDA), outlining its causes, stages, diagnosis, and treatment recommendations. 2) It recommends universal iron supplementation for children, especially infants and toddlers aged 0-2 years, at doses of 2-3 mg/kg/day depending on age. 3) Screening for iron deficiency is not currently necessary due to limitations of laboratories and tests, but hemoglobin checks are recommended starting at age 2 and annually through adolescence.

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    Anemia Defisiensi Besi: Pendekatan Hematologi Muhammad Riza

    Uploaded by

    proman wazowski
    30 views26 pages
    1) This document discusses iron deficiency anemia (IDA), outlining its causes, stages, diagnosis, and treatment recommendations. 2) It recommends universal iron supplementation for children, especially infants and toddlers aged 0-2 years, at doses of 2-3 mg/kg/day depending on age. 3) Screening for iron deficiency is not currently necessary due to limitations of laboratories and tests, but hemoglobin checks are recommended starting at age 2 and annually through adolescence.

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    ADB

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    1) This document discusses iron deficiency anemia (IDA), outlining its causes, stages, diagnosis, and treatment recommendations. 2) It recommends universal iron supplementation for children, especially infants and toddlers aged 0-2 years, at doses of 2-3 mg/kg/day depending on age. 3) Screening for iron deficiency is not currently necessary due to limitations of laboratories and tests, but hemoglobin checks are recommended starting at age 2 and annually through adolescence.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    30 views26 pages

    Anemia Defisiensi Besi: Pendekatan Hematologi Muhammad Riza

    Uploaded by

    proman wazowski
    1) This document discusses iron deficiency anemia (IDA), outlining its causes, stages, diagnosis, and treatment recommendations. 2) It recommends universal iron supplementation for children, especially infants and toddlers aged 0-2 years, at doses of 2-3 mg/kg/day depending on age. 3) Screening for iron deficiency is not currently necessary due to limitations of laboratories and tests, but hemoglobin checks are recommended starting at age 2 and annually through adolescence.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 26

    ANEMIA DEFISIENSI BESI:

    Pendekatan Hematologi

    Muhammad Riza

    Departement Of Child Health, Faculty Of Medicine,


    University Of Sebelas Maret, Moewardi Hospital
    Surakarta
    1 g Hb = 3.4 6 mg iron
    Each loss 1 ml =
    1 ml x 150 x 3.46 = 0.5 mg iron
    1000 ml
    Transport Besi
    Iron Absorption
    PENYEBAB
    TIGA TAHAPAN DEFISIENSI BESI

    Deplesi besi
    Besi

    Defisiensi besi

    ADB

    Depot Plasma Eritrosit

    Stadium IIII
    II(Deplesi
    (Anemiabesi)
    defisiensi
    (Defisiensi besi): besi)
    Kekurangan
    •Penurunan dipersediaan
    Kadar besi kadar besiturun
    hemoglobin,
    dalam serum diMCV,
    dalam depot
    (SIMCH, MCHC
    turun, TIBC meningkat)
    •Kadar besi di dalamdidepot
    hemoglobin Sitokimia
    dalamdarah masihjar. hati/sumsum
    normal
    tulang Kadar feritin/saturasi transferin
    DIAGNOSIS

    No single measurement is currently available that


    will characterize the iron status of a child…

    Baker RD, Greer FR, Committee of Nutrition. Clinical report diagnosis and prevention of
    iron deficiency and iron deficiency anemia in infants and young children (0-3 years of age).
    Pediatrics. 2010;126:1040-50.
    DIAGNOSIS
    Hemoglobin

    WHO. Worldwide Prevalence of Anaemia 1993-2005.


    .
    Ferritin

    WHO. Worldwide Prevalence of Anaemia 1993-2005.


    .
    Parameter Normal Deplesi Defisiensi ADB
    besi besi

    SI (µg/dL) 115 115 <60 <40


    TIBC (µg/dL) 330 360 390 410

    Ferritin 100 20 10 <10


    (µg/dL)

    Sat. 35 30 <15 <10


    transferin (%)

    Protoporfirin 30 30 100 200


    (µg/dL)
    Dengan keterbatasan:

    1.Laboratorium yang mahal dan belum tersedia luas

    2.Dukungan pemerintah ???

    Perlukah skrining?
    When the prevalence of iron
    deficiency anaemia reaches the
    20-30% level in the age-gender
    group under evaluation, it may be
    more effective - and possibly more
    efficient - to provide universal
    supplementation to that entire
    group than to screen for individual
    case-management purposes.
    Penegakkan diagnosis ADB (WHO 2001)
    Penegakkan diagnosis ADB (AAP 2010)

    Usia 12 bln Ferritin dan CRP


    Kadar Hb < 11 g/dL CHr
    +faktor risiko
    Atau
    Klinis baik
    Berikan suplementasi besi
    Kadar Hb antara 10
    and 11 g/dL Tatalaksana penyebab ADB

    Terjadi peningkatan kadar Hb 1


    g/dL setelah 1 bulan
    suplementasi ADB
    The AAP has concluded that universal screening for anemia
    should be performed with determination of Hb
    concentration at approximately 1 year of age.

    Include an assessment of risk


    factors associated with ID/IDA
    Tatalaksana ADB

    • Ferrous (sulfat, gluconat,fumarat)  murah,


    hasil memuaskan
    • Besi elemental 4- 6 mg/kg BB/ hr terbagi
    dalam 3 dosis  diberikan s/d 2 bln Hb normal
    •Tatalaksana penyebab ADB

    •Tidak respon preparat besi parenteral (iron


    dextran, iron sucrose)
    Respon Terapi Besi pada ADB

    Waktu setelah pemberian Respon


    12- 24 jam Penggantian enzim besi
    intraseluler

    36- 48 jam Respon bone marrow


    48- 72 jam Retikulositosis (puncak 5-
    7 hari)

    4- 30 hari hemoglobin
    1- 3 bulan Replesi simpanan
    Rekomendasi 1.
    Suplementasi besi diberikan kepada semua anak, dengan prioritas usia balita (0-5 tahun),
    terutama usia 0-2 tahun

    Rekomendasi 2.
    Dosis dan lama pemberian suplementasi besi (Rekomendasi A):
    Usia (tahun) Dosis besi elemental Lama pemberian
    Bayi* : BBLR (< 2.500 g)
    Cukup bulan 3 mg/kgBB/hari
    2 mg/kgBB/hari Usia 1 bulan sampai 2 tahun
    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
    Rekomendasi 2.
    Dosis dan lama pemberian suplementasi besi (Rekomendasi A):

    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
    Rekomendasi 3.
    Saat ini belum perlu dilakukan uji tapis (skrining) defisiensi besi
    secara massal.

    Rekomendasi 4.
    Pemeriksaan kadar hemoglobin (Hb) dilakukan mulai usia 2
    tahun dan selanjutnya setiap tahun sampai usia remaja
    (Rekomendasi A). Bila dari hasil pemeriksaan ditemukan
    anemia, dicari penyebab dan bila perlu dirujuk.
    Rekomendasi 5.
    Pemerintah harus membuat kebijakan mengenai penyediaan
    preparat besi dan alat laboratorium untuk pemeriksaan
    status besi.
    Simpulan

    • Skrining ADB belum perlu dilakukan


    - Pemeriksaan penunjang blm tersedia
    - Biaya yang mahal

    • Suplementasi segera diberikan jika terdapat faktor risiko

    • Dianjurkan untuk melakukan pemeriksaan Hb pada usia

    1 th jika terdapat faktor risiko

    • ADB  Selain memberikan terapi besi elemental


    Atasi penyebab/ etiologi ADB
    Terima Kasih

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