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V I TA E
General Practitioner
FK.UNHAS
1978
Pediatrician
FK.UNHAS
1981
Hemato-Oncology of
Pediatric Consultant
FKUI/RSCM
1992
Doctoral
FK.UNHAS
201
ORGANIZATION
Head of Pediatric Dept, FK.UNHAS/RSWS Makassar
Head of Hemato-Oncology Division, Pediatrics Dept, FK.UNHAS/RSWS
Makassar
Head of Combine Degree Program, FK.UNHAS
Head of Ethic Commision, RSWS Makassar
Professor of Pediatric, Medical Faculty University of Hasannudin, Makassar
Dasril Daud
Function
Compound
Oxygen transport
Hemoglobin
Myoglobin
Cytochrome
Catalase
Peroxidase
Mitochondrial respiration
Succinate dehydrogenase
Ribonucleotide reductase
ZAT BESI:
Proliferasi, diferensiasi, tumbuh & kembang
Zat besi sangat esensial:
- Hemoglobin
- Mioglobin
- Sitokrom
Multifungsi
berbagai
bentuk ingatan
Otot atrofi
& lemah
Proliferation
Differentiation
Maturation
Iron
Enzymes
Cytochrom
Neurotransmitter
Hemoglobin
Growth
Development
Year -place
Incidence (%)
Dirjen Kesmas RI
2000
SKRT
2001
Nelly R, Bidasari L
at.al
2008 in Medan
52 % (9-12 y.o )
Hasil: sampel terdiri dari 55 bayi, 63,6% laki-laki, 58,2% berumur 812 bulan, dan 87,3% berasal dari keluarga dengan pendapatan per
kapita per bulan rendah. Sebagian besar berstatus gizi kurang (60%),
96,4%
cukup bulan,
3,6% bayi
dengan
berat
badan rendah
38,2%lahir
mengalami
anemia
danlahir
71,4%
bayi
anemia
pemberian ASI ekslusif 94,5%. Diantara 55 bayi 38,2% mengalami
tersebut
menderita anemia defisiensi besi. Prevalensi
anemia dan 71,4% bayi anemia tersebut menderita anemia defisiensi
anemia
defisiensi
besi
lebih besar
pada
bayi
8-12
besi. Prevalensi
anemia
defisiensi
besi lebih
besar
pada
bayibulan
8-12
daripada
bayibayi
yang
lebih
yaitu73,3%.
73,3%.
bulan daripada
yang
lebihmuda,
muda, yaitu
The prevalence of Hb<90 g/L was 13,4%, <100 g/dl, 37%, <110
g/L,71%. Normal birth weight infants (>2500 g) of anemic mothers
(<120 g/L had an odds ratio (OR) 1,81 [1,34 2,43] to have a low Hb
(<100 g/L) compared of with infants of nonanemic mothers with a
normal birth weight. Infants of nonanemic mothers but with low birth
weight had an OR of 1,15 [0,61 2,16], and those with low birth
weight and anemic mothers of 3,68 [1,69 8,02], anemic mothers
(Hb<120 g/L) had an odds ratio (OR) of 1,81 [1,34 2,43]
Menstruation >>
Weinberg 1974
Free iron is essential for the multiplication of bacteria including
species of Candida, Escherichia, Mycobacterium, Pasteurella,
Shigella and Staphylococcus.
Oppenheimer, 1989
Parenteral iron is also associated with increased risk of serious
Esche richia coli sepsis in neonates
IRON REGULATION
IRON REGULATION
Hepatocyte
Enterocyte
Fe2+
Macrophage
P
Fe2+
FPN
FPN
P
Absorption
Hepcidin
Fe2+
FPN
Recycling
Hepcidin (LEAP-1):
Powerful negative regulator of iron
Inhibits:
Dietary iron absorption
The efflux of recycled iron (macrophage)
Release of iron from stroge in hepatocyte
Hepcidin controls the entry of iron into plasma by regulating ferroportin
IRON REGULATION
Mucosal block"
Mucosal intelligence
In man the normal diet should contain 1318 mg of iron per day of which
only 1 mg is absorbed. Even in iron deciency, absorption is only 24 mg
and in iron overload it is reduced to 0.5 mg.
Review Articles
Conclusion:
- iron supplementation increases the levels of hematologic indicators
- reduces the prevalence of IDA/ID in low birth weight/premature infants.
- There is insufficient evidence to make a definitive statement regarding
the effects of Iron supplementation on growth,neurodevelopment, or
the occurrence of adverse effects in low birth weight/premature infants.
Sedikit
cadangan besi
saat lahir
ANEMIA
Potential neurologic
dysfunction associated with
dietary iron overload early in
life (animal study ) in human is
less clear. Srigiridhar,1998
Iron def is
thought to be
commonenst
cause
Blood sampling,
blood loss with
medical procedure
before
anemia ID
iassociated
with many
adveerse effect
The cognitive
performance,
behaviour, and
physical growth of
infants, preschool
and school-aged
children
The immune
status and
morbidity
from
infections of
all age
groups
Iron def is
thought to be
commonenst
cause
Blood sampling,
blood loss with
medical procedure
ID generally
develops slowly
and is not clinically
apparent until
anemia eventhough
functional
consequencies
aleeady exist
Need
Iron
supplemen
tation
The cognitive
performance,
behaviour, and
physical growth of
infants, preschool
and school-aged
children
The immune
status and
morbidity
from
infections of
all age
groups
Rationale
Tepat Diagnosis
Tepat Terapi
Tepat dosis
Tepat Indikasi
Waspada efek samping
Kesimpulan
Bayi yang mendapat supplementasi besi :
- terjadi peningkatan kadar Hb
- Peningkatkan cadangan besi , menurunkan risiko akan ADB
- Belum jelas ada hub antara suplementasi besi pada preterm dan BBLR
terhadap neurodevelopmental , dan pertumbuhan dikemudian hari .
- Dosis standar Fe : 2-3 mg/kgbb/hari
- Supplementasi dimulai usia 2 bulan dilajutkan hingga usia 12 bulan
Dosage schedule
Duration
Universal supplementation
age
age
above 40%
to 30 mg
Iron : 30 mg/day
months)
above 40%
Iron : 60 mg/day
above 40%
Universal supplementation
Iron : 60 mg/day
Pregnant women
3 months
3 months
3 months
Iron : 60 mg/day
above 40%
39
Usia (tahun)
Lama pemberian
3 mg/kgBB/hari
2 mg/kgBB/hari
1 mg/kgBB/hari
Cukup bulan
2-5 (balita)
setiap tahun
>5-12 (usia sekolah)
1 mg/kgBB/hari
12-18 (remaja)
60 mg/hari*
Iron supplementation
Iron
Percent
compound
(%)
per tablet
200
33
66
Ferrous glukonat
300
12
36
300
20
60
200
37
74
30
60
(1H2O)
International Nutritional Anemia Consultative Group (INACG). Guidelines for the use of iron supplements to prevent and treat iron
deficiency anemia. Washington, D. C.: ILSI PRESS; 1998.
1. Reticulocyte increase
2. Increased appetite
KESIMPULAN