I. Folate Deficiency Anemia 叶酸缺乏性贫血 A. Description 说明
1. A macrocytic anemia in which red blood cells are larger than normal and are oval-shaped rather than round-shaped due to the lack of inadequate intake of folate (vitamin B9).
为大细胞性贫血，此病红血细胞大于正常，为椭圆形而非圆形，原因是缺乏足够的叶酸摄入（维生素B9）。
2. Folic acid is required for DNA synthesis required for red blood cell formation and maturation.
红血细胞生成和成熟所需的DNA合成需要叶酸。
3. Common causes include dietary deficiency; malabsorption syndromes such as Celiac disease, Crohn's disease, or small bowel resection; medications (such as antiseizure medications) that decrease the absorption of folic acid, a condition (including pregnancy) that increases the requirement of folic acid; chronic alcoholism; and chronic hemodialysis.
常见原因包括饮食性缺乏；吸收不良综合征，如乳糜泻，克罗恩病、或小肠切除；减少叶酸吸收的药物（如抗癫痫药）；增加叶酸需求的情况（包括妊娠）；慢性酒精中毒；长期血液透析。 B. Assessment评估
1. Dyspepsia 消化不良
2. Smooth, beefy red tongue 平滑、牛肉样红舌头
3. Pallor, fatigue and weakness 苍白、疲劳、虚弱
4. Tinnitus 耳鸣
5. Tachycardia 心动过速 C. Interventions 措施
1. Encourage the client to eat foods rich in folic acid, such as green leafy vegetables, meat, liver, fish, legumes, peanuts, orange juice, and avocado.
鼓励患者食用富含叶酸的食物，如绿叶蔬菜、肉、肝、鱼、豆类、桔子汁、油梨
2. Administer folic acid as prescribed. 按处方使用叶酸。 II. Medications to Treat Anemia 治疗贫血的药物
A. Iron-deficiency anemia: Iron, oral or intravenous
缺铁性贫血：铁，口服或IV
B. Vitamin B12 deficiency anemia: Vitamin B12, oral or intramuscular
维生素B12缺乏性贫血：维生素B12，口服或IV
C. Folate-deficiency anemia: Folate, oral
叶酸缺乏性贫血：叶酸，口服
D. Acute blood loss anemia: Blood transfusion, packed red blood cells, platelets, or fresh frozen plasma depending on cause
急性失血性贫血：输血，压积红细胞，血小板，或鲜冻血浆，根据病因而定
E. Anemia of chronic disease: Iron, oral or intravenous, erythropoietic growth factors, leukopoietic growth factors, and thrombopoietic growth factors.
慢性疾病引起的贫血：铁，口服或IV，红细胞生长因子，白细胞生长因子，血小板生长因子
★Vocabulary for Today ★
folate – n. 叶酸
folate deficiency anemia -- 叶酸缺乏性贫血
macrocytic – a. 大细胞的
macrocytic anemia – 大细胞性贫血
oval-shaped – a. 椭圆形的
round-shaped – a. 圆形的
folic acid – 叶酸
maturation – n. 成熟
malabsorption – n. 吸收不良
Celiac disease –乳糜泻
Crohn's disease –克罗恩病
resection – n. 切除
dyspepsia – n. 消化不良
packed red blood cells – 压积红细胞
fresh frozen plasma -- 鲜冻血浆
erythropoietic – a. 红细胞生成的
erythropoietic growth factors – 红细胞生长因子
leukopoietic – a. 白细胞生成的
thrombopoietic – a. 血小板生成的
inactivate – v. 使失活，减除活性，使钝化
fluid overload – 液体过载
outweigh – v. 比…重要/有价值，优于
fluid retention – 液体潴留
cytokine release syndrome – 细胞因子释放综合征
hemolysis – n. 溶血
★Video ★ Treatment for Anemia
★Test ★
1. Which client should the nurse recommend taking oral contraceptive pills for birth control?
A. The client who smokes two packs of cigarettes a day.
B. The client who is taking an ACE inhibitor medication.
C. The client who is 65" tall and weighs 100 kg.
D. The client who has a family history of ovarian cancer. 2. The client diagnosed with RA has been taking methotrexate for 2 weeks. Which laboratory data warrants intervention by the nurse?
A. A serum creatinine level of 0.9 mg/dL.
B. A red blood cell (RBC) count of 2.5 million/mm.
C. A WBC count of 9,000 mm.
D. A hemoglobin (Hgb) level of 14.5 g/dL and hematocrit (Hct) level of 43%.
答案 Key to Question 1. D. The client who has a family history of ovarian cancer. Rationale: Oral contraceptives decrease the risk for several disorders, including ovarian cancer, endometrial cancer, pelvic inflammatory disease, premenstrual syndrome, toxic shock, fibrocystic breast disease, ovarian cysts, and anemia. In addition to providing birth control for the client, the client gets a secondary benefit of decreasing her risk for ovarian cancer. 2. B. A red blood cell (RBC) count of 2.5 million/mm. Rationale: This RBC count indicates anemia (low RBC count and Hgb/Hct resulting from low RBCs), which would warrant intervention by the nurse. The normal RBC is 4.6 to 6.0 million/mm for men and 4.0 to 5.0 million/mm for women.
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