— 生理適應 · MEDIUM · MCQ —
護理師正在照護一位慢性病貧血（anemia of chronic disease）病人。哪項實驗室發現最符合此診斷？
A nurse is caring for a client with anemia of chronic disease. Which laboratory finding is most consistent with this diagnosis?
- AElevated hemoglobin and hematocrit血紅素和血容比升高
- BLow serum iron, low total iron-binding capacity (TIBC), normal or elevated ferritin✓ 正解血清鐵低，總鐵結合力(TIBC)低，鐵蛋白正常或升高
- CLow serum iron, high TIBC, low ferritin血清鐵低，TIBC高，鐵蛋白低
- DNormal serum iron, low hemoglobin血清鐵正常，血紅素低
— Explanation · 中文詳解 —
慢性病貧血的特徵是身體儲存鐵質（ferritin）正常或升高，但無法有效利用鐵質來製造紅血球，導致血清鐵質（serum iron）下降，而結合鐵質的能力（TIBC）卻因身體試圖抓住更多鐵質而可能降低或正常。鐵質缺乏性貧血則會有低鐵、低鐵蛋白和高 TIBC。
Anemia of chronic disease is characterized by normal or elevated iron stores (ferritin), with impaired ability to utilize iron for erythropoiesis. Serum iron is decreased, while the total iron-binding capacity (TIBC) may be decreased or normal because the body attempts to retain available iron. In contrast, iron deficiency anemia is characterized by low iron, low ferritin, and high TIBC.
✦ 台美臨床差異
美國的實驗室診斷標準化程度高，對於貧血的鑑別診斷有明確的流程；台灣的檢驗項目與判讀標準也相似，但病人因慢性病接受的檢查頻率可能因健保政策而異。