학동기 전후 소아의 철결핍성빈혈에 대한 임상적 고찰

Abstract

[한글]

철결핍성빈혈은 전세계적으로 가장 빈도가 많은 빈혈로 특히 이유기 영유아에 많다. 이

시기의 철분결핍의 원인은 철요구량이 많은데 비해 음식물중의 철함량이 부족한데 있다.

그러나 이 시기를 지난 3세이후의 아동에 있어서는 식생활의 개선에 의하여 철분결핍에

빠지는 경우는 많지 않다. 따라서 저자는 3세이후의 학동기전후 소아에서 철결핍성빈혈

의 연령별 및 성별분포, 원인, 임상증상, 검사소견 및 치료에 대해 조사하여 다음과 같은

결과를 얻었다.

1. 3세 이상의 철결핍성빈혈환아 175예중 10세 이후가 85예로 가장 많았으며 3세에서 6

세사이가 51예, 6세에서 10세사이가 39예이었으며 성별은 남아가 90예, 여아가 85예로 비

슷하였다.

2. 3세이후 철결핍성빈혈에서 원인으로는 과다손실이 36.6%로 가장 많았으며, 요구량증

대, 섭취 및 흡수장애 순이었다. 과다손실의 원인으로는 위장관출혈이 가장 많았으며 요

구량이 증가한 경우는 신체적으로 급성장하는 사춘기, 청색증을 동반한 선천성심기형이

있었고 흡수장애의 원인으로는 결핵성장염이 많았다.

3. 병원을 방문한 이유로는 타질환을 의심하여 본원에 입원하여 철결핍성빈혈이 발견된

경우와 빈혈과 연관된 전신증상(창백, 전신쇠약감, 현기 등)이 대부분이었고 심폐계증상

(호흡곤란, 흉통, 빈맥 등) 및 출혈이 있었다.

4. 검사소견은 혈색소치는 평균 8.28 ± 2.35 gm%이었고 8∼10 gm%가 29.1%로 가장 많

았으며 4 gm% 이하가 1예 있었고 청색증을 동반한 심기형 7예에서 12 gm% 이상이었다. 적

혈구수는 평균 3,870,000± 935,000 /mm**3 이었고 71.6%에서 3,500,000/mm**3 이상으로

정상범주였다.

교정 망상구수는 평균 1.23±0.90%이었고 0.5∼1.5%가 70.4%이었다.

혈소판수는 53.5%에서 200,000∼400,000/mm**3 이었고 36.6%에서 400.000/mm**3 이상으

로 증가되어 있었다.

5. 평균적혈구용적은 평균 68.6±11.1 fl이었고 91.2%가 80 fl 이하이었으며 평균적혈

구혈색소는 평균 21.5±4.0 pg 이었으며 26 pg이하가 86.5%이었다. 평균적혈구혈색소농도

는 평균 25.5±3.1%이었고 98.2%가 30%이하이었다. 적혈구분포폭(RDW)은 평균 18.79±3.5

3으로 정상소아에서의 13.0±1.0보다 증가되어 있었다.

6. 혈청철은 30 ㎍%이하가 40.0%이었다. 총철결합능은 59.1%에서 350㎍% 이상이었다.

Transferrin포화도는 81.7%에서 16%이하이었다.

7. 말초혈액도말표본에서 61.2%가 소구저색성의 형태를 보였으며 8.8%에서는 정구정색

성이었다.

64예에서 골수검사가 시행되어 68.8%에서 철염색이 음성이었으며 trace가 20.3%이었다.

대변검사는 127예에서 시행되어 58예 (45.7%)에서 잠혈반응이 양성이었으며 9예 (7.1%)

에서 기생충란이 발견되었다.

8. 치료로는 147예 (84.0%)에서 철분제제를 경구투여하였으며 5예에서 비경구투여하였

고 23예 (13.1%)에서 수혈을 시행하였다. 치료에 대한 반응은 79.5%에서 완전회복을 보였

으며 이중 80.8%에서 2개월이내에 수혈없이 철분투여만으로 빈혈이 교정되었다. 3예에서

는 회복이 되었다가 원인질환으로 인한 재출혈로 빈혈이 재발되었다.

[영문]

Iron deficiency anemia is the most common nutritional deficiency in children and

is recognized throughout the world. It is especially prevalent in infancy because

rapid growth imposes large iron needs and most infant diets contain a marginal

supply.

But beyond this periods iron deficiency anemia is less common due to advances in

nutritional state. Therefore this study was planned to obtain informations on the

age and sex incidence, causes of iron deficiency and treatment on iron deficiency

anemia in children over 3 years of age who were admitted at Yonsei University

Severance hospital during the 8 years between 1978 and 1985.

The results were as follows:

1. Out of 175 cases, 85 occured among children above 10 years of aged 51 at ages

between 3 and 6 years and 39 between 6and 10 years. Ninety cases were male and 85

cases female.

2. In children over 3 years of age, iron deficiency came about as a manifestation

of negative iron balance (excessive loss 36.6%, decreased intake 12.6%, and

impaired absorption 4.0%), and also because of failure to meet an increased

requirement for iron(15.4%). Gastrointestinal bleeding was the most common cause of

excessive loss. The cause of increased requirement were puberty and cyanotic

congenital heart disease. Intestinal tuberculosis was the most frequent cause of

malabsorption.

3. Above half of the patients saught medical attention because of other illness;

the anemia is secondarily discovered. Clinical manifestations associated with

anemia were general(pallor, fatigue, dizziness, etc.), cardiopulmonary dyspnea,

chest discomforts palpitation, etc.) or bleeding.

4. The mean hemoglobin level was 8.28±2.35gm%. In 29.1% of the cases hemoglobin

level was between 8-10gm% and 1 case, hemoglobin level was less than 4gm%. Seven

cases with cyanotic congenital heart disease showed hemoglobin level over 12gm%.

The mean red blood cell count was 3,870,000±935,000/mm**3 and most of them

(71.6%) had normal red blood cell count. The mean reticulocyte count(corrected) was

1.23±0.90% and 70.4% of the cases had counts between 0.5-1.5%. In 53.5% of cases,

platelet counts was between 200,000-400,000/mm**3. Increased platelet counts were

showed in 36.6% of cases.

5. The mean MCV(mean corpuscular volume) was 68.6±11.1 fl and 91.2% of cases had

below 80fl. The mean MCH(mean corpuscular hemoglobin) was 21.5±4.Opg and 86.5% of

cases were below 26pg. The mean MCHC(mean corpuscular hemoglobin concentration) was

25.5±3.1% and 98.2% of cases were below 30%. The mean RDW(red cell distribution

width) was increased as 18.79±3.53 compared to the normal value in Korean

children(13.0±1.0).

6. In 40.O% of the cases, serum iron level were below 30 g%(mean: 39.98±39.46

g/dl).

In 59.1% of the cases total iron binding capacity levels were above 350 g%(mean:

385.1±117.8 g%).

In 81.7% of the cases transferrin saturations were below 16%(mean: 10.96±9.01%).

7. On periphral blood smears, 61.2% of the cases showed microcytic hypochromic

pictures and 8.8% showed normocytic normochromic pictures.

Bone marrow aspiration was performed in 64 cases. Stainable iron was absent in

68.8% and trace in 20.3%.

Stool examination was performed in 127 cases. 58 cases(45.7%) had occult blood

positive stools and 9 cases(7.1%) had parasite infestations.

8. 147 cases(84.0%) were treated with oral iron preparation, and 23 cases(13.1%)

with transfusion. In 88 cases followed over 3 months, 79.5% showed complete

recovery with therapeutic maneuvers. 80.8% required less than two months of period

for normalization of hemoglobin without transfusion. Relapse after recovery were

noticed in 3 cases due to rebleeding from the etiologic disease.

From these studies, there are underlying causes in most cases of iron deficiency

anemia in children over 3 years of age. Therefore the treatment of anemia should be

considered with the investigation and correction of underlying causes.