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Foliyevodefitsitny anemia - Practical hematology of children's age

Table of contents
Practical hematology of children's age
Embryonal hemopoiesis
Morfofunktsionalny characteristic of cells of marrow and peripheral blood
Marrow parenchyma cells
Peripheral blood of children of different age
The system of a hemostasis is normal
Etiology and pathogeny of leukoses
Acute leukoses
Acute leukoses - a preleukosis
Possibilities of a predictive assessment of a course of an acute lymphoblastoid leukosis at children
General principles of treatment of an acute leukosis
Chemotherapeutic drugs
Treatment of an acute lymphoblastoid leukosis
Treatment of myeloid forms of an acute leukosis
Infectious complications and symptomatic therapy of an acute leukosis
Consolidation and maintenance therapy of an acute leukosis
Immunotherapy
Remission and recurrence of an acute leukosis
Inborn leukosis
Neuroleukosis
Myelosis
Lymphogranulomatosis
Gematosarkoma
Macrofollicular lymphoma
Angioimmunoblastny lymphadenopathy
Leukemoid tests
Infectious lymphocytosis
Infectious mononucleosis
Leukemoid tests of different types
Dysfunctions of granulocytes
Leukopenias
Histiocytoses
Histiocytoses - an eosinophilic granuloma
Malignant histiocytosis
Family erythrophagocytal histiocytosis
Accumulation diseases
Nimann's illness — Peak
Angiopathies
Hemorrhagic vasculitis (Shenleyn's illness — Genokh)
Mayokki's purpura
Ataxy teleangiectasia
Entsefalotrigeminalny angiomatosis
Kortiko-meningealny diffusion angiomatosis
Cerebroretinal angiomatosis
Hypertrophic gemangiektaziya
Multiple and huge hemangiomas
Elastic fibrodisplaziya
Coagulopathies
Hereditary coagulopathies
Hemophilia And
Clinic of hemophilia
Treatment of hemophilia
Angiohemophilia
Cristmas disease (Kristmas's illness)
Hereditary deficit of factors of XI, XII, XIII and I
Dysfibrinogenemias
Hereditary deficit of factors of VII, X, V and II
Deficit K-vitaminozavisimykh of factors of coagulation
Syndrome of the disseminated intravascular coagulation
Clinic and diagnosis of the IDCS
Treatment of the IDCS
Thrombocytopenia
Idiopathic Werlhof's disease
Clinic and diagnosis of an idiopathic Werlhof's disease
Treatment of an idiopathic Werlhof's disease
Isoimmune Werlhof's disease
Transimmune Werlhof's disease of newborns
Trombogemolitichesky Werlhof's disease (syndrome Moshkovich)
Hereditary Werlhof's diseases
Trobotsitopatiya
Anemias
The anemias connected with blood loss
Chronic posthemorrhagic anemia
Iron deficiency anemias
Clinic and diagnosis of an iron deficiency anemia
Treatment of iron deficiency anemias
Sideroakhrestichesky, sideroblastny anemias
Megaloblastny anemias
Foliyevodefitsitny anemia
Hereditary forms of megaloblastny anemias
Hereditary dizeritropoetichesky anemias
The anemias connected with oppression of proliferation of cells of marrow
Hereditary hypoplastic anemias
Hemolitic anemias
Hemolitic anemias - an ovalocytosis, a hereditary stomatocytosis
Acanthocytosis, piknotsitoz
The hereditary hemolitic anemias connected with disturbance of activity of enzymes of erythrocytes
The hereditary hemolitic anemias connected with disturbance of structure or synthesis of hemoglobin
The acquired immune hemolitic anemias
Isoimmune hemolitic anemias
Treatment of a hemolitic illness of newborns
Autoimmune hemolitic anemias
List of references

Participation of folic acid in the course of a haemo cytopoiesis is closely bound with B12 vitamin. Deficit of folates leads to disturbance of processes of synthesis of DNA, RNA and development of megaloblastny anemia. Folates in enough come to an organism with foodstuff (meat, a liver, spinach, yeast etc.) and are soaked up in a small bowel. Reserves of folic acid in an organism it is less, than B12 vitamin therefore they are exhausted quicker.
At development of foliyevodefitsitny megaloblastny anemia the marrowy kinetics is characterized by disturbance of processes of proliferation of haemocytes, their death in S period — G2 of a cellular cycle, the high level of an inefficient haemo cytopoiesis.
Ways of emergence of deficit of folic acid are in many respects similar to those at deficit of B12 vitamin though there are certain features.

  1. Insufficiency of folates arises at absorption disturbance — diseases of a digestive tract, a Gee's disease, to a spr etc. One of causes of infringement of digestion of folates is long reception of anticonvulsant drugs — dipheninum, phenobarbital.
  2. The insufficient depot of folic acid is observed at newborns whose mothers had deficit of folates.

It should be noted that at pregnant women the need for folic acid increases many times over therefore at bad food, abuse of alcoholic drinks its deficit can develop. Especially easily deficit of folic acid arises at premature children.

  1. Exogenous deficit is observed at the babies raised by the goat milk poor in folates.
  2. Infectious and inflammatory diseases, diseases of biliary system quickly lead to exhaustion of reserves of folic acid.

In a clinical picture the asthenic syndrome is noted — children are uneasy, the sleep, appetite is interrupted. Patients complain of dizziness, the general weakness. Pallor of skin, an ikterichnost of scleras, a glossitis are objectively noted.

Table 39. Laboratory criteria of diagnosis of B12-scarce and foliyevodefitsitny anemia


Disease form

Insufficiency of folic acid

Insufficiency of vitamin B"

Latent

Concentration of folates in blood serum is reduced to 3 ng/ml
Concentration of folic acid in erythrocytes normal

Concentration of B12 vitamin in blood serum is reduced to 100 ng/ml
Concentration of folic acid in an erythrocyte normal

Manifest

Concentration of folates in blood serum makes less than 3 ng/ml
Concentration of folic acid in erythrocytes is reduced and makes less than 100 ng/ml excretion with urine of formiminglutaminovy acid Is increased

Concentration of Bi2 vitamin in blood serum makes less than 100 ng/ml Concentration of folic acid in erythrocytes decreases to 150 ng/ml
Excretion with urine of methyl-malonic acid is increased

The hematologic picture is similar that at B12-scarce anemia: anemia of hyperchromic character, an anisocytosis with tendency to a macrocytosis, decrease in quantity of reticulocytes, a leukopenia, thrombocytopenia. In a miyelogramma — signs of irritation of a red sprout of a blood formation, change of a leucio-erythrocyte ratio, in a large number megaloblasts.
Differential diagnosis is carried out with B12-scarce anemia (tab. 39). Using special methods, reveal decrease in level of folic acid in blood serum and erythrocytes.
The special test — coloring of marrow alizeriny red at which the megaloblasts caused by deficit of B12 vitamin are painted over is offered and the megaloblasts caused by deficit of folic acid are not painted (L. Kass, 1976).
Treatment is directed to elimination of the reasons which caused deficit of folic acid. For this purpose it is enough to appoint folic acid inside, even at disturbance of intestinal absorption. The daily dose makes 10 — 30 mg. Treat within 20 — 30 days.



 
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