Treatment is awaiting in adults. Iron deficiency anemia (Hypochromic anemia, Microcytic anemia)
Interesting Facts
- The first documented mention of iron deficiency anemia dates back to 1554. In those days, mainly girls aged 14 - 17 suffered from this ailment, in connection with which the disease was called "de morbo virgineo", which means "virgin disease".
- The first attempts to treat the disease with iron preparations were made in 1700.
- Latent ( hidden) iron deficiency can be observed in children during periods of intensive growth.
- The iron requirement of a pregnant woman is twice that of two healthy adult men.
- During pregnancy and childbirth, a woman loses more than 1 gram of iron. With a normal diet, these losses will recover only after 3 to 4 years.
What are red blood cells?
Red blood cells, or red blood cells, are the most abundant population of blood cells. These are highly specialized cells, devoid of a nucleus and many other intracellular structures ( organelle). The main function of red blood cells in the human body is to carry oxygen and carbon dioxide. Structure and function of red blood cells
The size of a mature erythrocyte ranges from 7.5 to 8.3 micrometers ( micron). It has the shape of a biconcave disc, which is maintained due to the presence of a special structural protein in the cell membrane of the erythrocyte - spectrin. This form provides the most efficient process of gas exchange in the body, and the presence of spectrin allows erythrocytes to change when passing through the smallest blood vessels ( capillaries) and then restore its original shape.More than 95% of the intracellular space of the erythrocyte is filled with hemoglobin - a substance consisting of a protein globin and a non-protein component - heme. The hemoglobin molecule consists of four globin chains, in the center of each of which is heme. Each red blood cell contains over 300 million hemoglobin molecules.
The non-protein part of hemoglobin, namely the iron atom, which is part of the heme, is responsible for the transport of oxygen in the body. Enrichment of blood with oxygen ( oxygenation) occurs in the pulmonary capillaries, when passing through which each iron atom attaches to itself 4 oxygen molecules ( oxyhemoglobin is formed). Oxygenated blood is carried through the arteries to all tissues of the body, where oxygen is transferred to the cells of the organs. Instead, carbon dioxide is released from the cells ( byproduct of cellular respiration), which joins hemoglobin ( carbhemoglobin is formed) and transported through the veins to the lungs, where it is released into the environment along with the exhaled air.
In addition to the transport of respiratory gases, additional functions of erythrocytes are:
- Antigenic function. Red blood cells have their own antigens, which determine belonging to one of the four main blood groups ( according to the AB0 system).
- Transport function. Antigens of microorganisms, various antibodies and some medications can be attached to the outer surface of the erythrocyte membrane, which are carried with the bloodstream throughout the body.
- Buffer function. Hemoglobin takes part in maintaining the acid-base balance in the body.
- Stopping bleeding. Erythrocytes are included in the blood clot that forms when the vessels are damaged.
Formation of red blood cells
In the human body, red blood cells are formed from the so-called stem cells. These unique cells are formed during the stage of embryonic development. They contain a nucleus in which the genetic apparatus is located ( DNA - deoxyribonucleic acid), as well as many other organelles, providing the processes of their life and reproduction. Stem cells give rise to all the cellular elements of the blood.For the normal process of erythropoiesis, you need:
- Iron. This trace element is part of the heme ( non-protein part of the hemoglobin molecule) and has the ability to reversibly bind oxygen and carbon dioxide, which determines the transport function of erythrocytes.
- Vitamins ( B2, B6, B9 and B12). They regulate the formation of DNA in hematopoietic cells of the red bone marrow, as well as the processes of differentiation ( ripening) erythrocytes.
- Erythropoietin. A hormonal substance produced by the kidneys that stimulates the formation of red blood cells in the red bone marrow. With a decrease in the concentration of red blood cells in the blood, hypoxia develops ( lack of oxygen), which is the main stimulant of the production of erythropoietin.
In the process of transformation into an erythrocyte, the stem cell undergoes a number of changes. It decreases in size, gradually loses its nucleus and almost all organelles ( as a result of which its further division becomes impossible), and also accumulates hemoglobin. The final stage of erythropoiesis in the red bone marrow is reticulocyte ( immature erythrocyte). It is washed out of the bones into the peripheral bloodstream, and within a day it matures to the stage of a normal erythrocyte, capable of fully performing its functions.
Destruction of red blood cells
The average lifespan of red blood cells is 90 to 120 days. After this period, their cell membrane becomes less plastic, as a result of which it loses its ability to reversibly deform when passing through the capillaries. "Old" erythrocytes are captured and destroyed by special cells of the immune system - macrophages. This process occurs mainly in the spleen, as well as ( to a much lesser extent) in the liver and red bone marrow. An insignificantly small proportion of erythrocytes is destroyed directly in the vascular bed.When the erythrocyte is destroyed, hemoglobin is released from it, which quickly breaks down into protein and non-protein parts. Globin undergoes a number of transformations, resulting in the formation of a yellow pigment complex - bilirubin ( unbound form). It is insoluble in water and highly toxic ( able to penetrate the cells of the body, disrupting their vital processes). Bilirubin is rapidly transported to the liver, where it binds to glucuronic acid and is excreted along with bile.
The non-protein part of hemoglobin ( heme) also undergoes destruction, resulting in the release of free iron. It is toxic to the body, so it quickly binds to transferrin ( transport protein of blood). Most of the iron released during the destruction of red blood cells is transported to the red bone marrow, where it is reused for the synthesis of red blood cells.
What is iron deficiency anemia?
Anemia is a pathological condition characterized by a decrease in the concentration of red blood cells and hemoglobin in the blood. If the development of this condition is due to insufficient supply of iron to the red bone marrow and the associated erythropoiesis disorder, then the anemia is called iron deficiency. The body of an adult contains about 4 grams of iron. This figure varies by gender and age.
The concentration of iron in the body is:
- in newborns - 75 mg per 1 kilogram of body weight ( mg / kg);
- in men - more than 50 mg / kg;
- in women - 35 mg / kg ( which is associated with monthly blood loss).
- erythrocyte hemoglobin - 57%;
- muscles - 27%;
- liver - 7 - 8%.
Absorption of iron in the human body occurs mainly in the duodenum, while all iron entering the body is usually divided into heme ( bivalent, Fe +2), contained in meat of animals and birds, in fish, and non-heme ( trivalent, Fe +3), the main source of which is dairy products and vegetables. An important condition for the normal absorption of iron is a sufficient amount of hydrochloric acid, which is part of the gastric juice. With a decrease in its amount, the absorption of iron slows down significantly.
The absorbed iron binds to transferrin and is transported to the red bone marrow, where it is used for the synthesis of red blood cells, as well as to the depot organs. Iron stores in the body are mainly represented by ferritin - a complex consisting of the protein apoferritin and iron atoms. Each ferritin molecule contains on average 3-4 thousand iron atoms. With a decrease in the concentration of this trace element in the blood, it is released from ferritin and used for the needs of the body.
The rate of absorption of iron in the intestine is strictly limited and cannot exceed 2.5 mg per day. This amount is sufficient only to restore the daily loss of this microelement, which is normally about 1 mg in men and 2 mg in women. Consequently, in various pathological conditions, accompanied by impaired absorption of iron or increased iron losses, a deficiency of this microelement may develop. With a decrease in the concentration of iron in the plasma, the amount of synthesized hemoglobin decreases, as a result of which the resulting erythrocytes will be smaller. In addition, the growth processes of erythrocytes are disrupted, which leads to a decrease in their number.
Causes of iron deficiency anemia
Iron deficiency anemia can develop as a result of insufficient intake of iron in the body, and in violation of the processes of its use. Iron deficiency in the body can be caused by:
- insufficient intake of iron from food;
- increasing the body's need for iron;
- congenital lack of iron in the body;
- violation of iron absorption;
- violation of transferrin synthesis;
- increased blood loss;
- the use of drugs.
Insufficient intake of iron from food
Malnutrition can lead to the development of iron deficiency anemia in both children and adults.The main reasons for insufficient intake of iron in the body are:
- prolonged fasting;
- monotonous diet low in animal products.
Increased body iron requirements
Under normal physiological conditions, there may be an increased demand for iron. This is typical for women during pregnancy and lactation.Despite the fact that a certain part of iron remains during pregnancy ( due to the absence of menstrual bleeding), the need for it increases several times.
Causes of the increased need for iron in pregnant women
| Cause | Approximate amount of consumable iron |
| Increase in circulating blood volume and red blood cell count | 500 mg |
| Iron passed on to the fetus | 300 mg |
| Iron, which is part of the placenta | 200 mg |
| Blood loss during childbirth and the postpartum period | 50 - 150 mg |
| Iron lost in breast milk during the entire nursing period | 400 - 500 mg |
Thus, during the period of gestation and breastfeeding of one child, a woman loses at least 1 gram of iron. These numbers increase with multiple pregnancies, when 2, 3 or more fetuses can develop in the mother's body at the same time. Considering that the rate of iron absorption cannot exceed 2.5 mg per day, it becomes clear that almost any pregnancy is accompanied by the development of an iron deficiency state of varying severity.
Congenital lack of iron in the body
The child's body receives from the mother all the necessary nutrients, including iron. However, if the mother or fetus has certain medical conditions, it is possible for a baby to be born with iron deficiency.Congenital iron deficiency in the body can be caused by:
- severe iron deficiency anemia in the mother;
- multiple pregnancy;
- prematurity.
Impaired iron absorption
Absorption of iron in the duodenum is possible only with the normal functional state of the mucous membrane of this part of the intestine. Various diseases of the gastrointestinal tract can damage the mucous membrane and significantly reduce the rate of iron intake in the body.A decrease in iron absorption in the duodenum can lead to:
- Enteritis - inflammation of the mucous membrane of the small intestine.
- Celiac disease - an inherited disorder characterized by intolerance to gluten protein and associated malabsorption in the small intestine.
- Helicobacter Pylori - an infectious agent that affects the gastric mucosa, which ultimately leads to a decrease in the secretion of hydrochloric acid and impaired absorption of iron.
- Atrophic gastritis - disease associated with atrophy ( reduction in size and function) the mucous membrane of the stomach.
- Autoimmune gastritis - a disease caused by a malfunction of the immune system and the production of antibodies to its own cells of the gastric mucosa, followed by their destruction.
- Removal of the stomach and / or small intestine - at the same time, both the amount of hydrochloric acid formed and the functional area of the duodenum, where iron is absorbed, decrease.
- Crohn's disease - an autoimmune disease manifested by an inflammatory lesion of the mucous membrane of all parts of the intestine and, possibly, the stomach.
- Cystic fibrosis - hereditary disease, manifested by a violation of the secretion of all glands of the body, including the gastric mucosa.
- Cancer of the stomach or duodenum.
Disruption of transferrin synthesis
Disruption of the formation of this transport protein can be associated with various hereditary diseases. The newborn will not have symptoms of iron deficiency, since he received this trace element from the mother's body. After birth, the main way of iron intake in the child's body is absorption in the intestine, however, due to a lack of transferrin, the absorbed iron cannot be delivered to the depot organs and to the red bone marrow and cannot be used in the synthesis of erythrocytes.Since transferrin is synthesized only in liver cells, its various lesions ( cirrhosis, hepatitis and others) can also lead to a decrease in the concentration of this protein in plasma and the development of symptoms of iron deficiency anemia.
Increased blood loss
A one-time loss of a large amount of blood usually does not lead to the development of iron deficiency anemia, since the body's iron stores are sufficient to replace the loss. At the same time, with chronic, prolonged, often imperceptible internal bleeding, the human body can lose several milligrams of iron daily, for several weeks or even months.Chronic blood loss can be caused by:
- nonspecific ulcerative colitis ( inflammation of the colon mucosa);
- intestinal polyposis;
- disintegrating tumors of the gastrointestinal tract ( and other localization);
- hernia of the esophageal opening of the diaphragm;
- endometriosis ( proliferation of cells in the inner layer of the uterine wall);
- systemic vasculitis ( inflammation of blood vessels of various localization);
- donation of blood by donors more than 4 times a year ( 300 ml of donated blood contains about 150 mg of iron).
Alcoholism
Long-term and frequent use of alcohol leads to damage to the gastric mucosa, which is associated, first of all, with the aggressive effect of ethyl alcohol, which is part of all alcoholic beverages. In addition, ethyl alcohol directly inhibits hematopoiesis in the red bone marrow, which can also increase the manifestations of anemia.The use of drugs
Taking certain medications can interfere with the absorption and utilization of iron in the body. This usually occurs with prolonged use of large doses of medication.Drugs that can cause iron deficiency in the body are:
- Non-steroidal anti-inflammatory drugs ( aspirin and others). The mechanism of action of these drugs is associated with an improvement in blood flow, which can lead to the appearance of chronic internal bleeding. In addition, they contribute to the development of stomach ulcers.
- Antacids ( Rennie, Almagel). This group of drugs neutralizes or reduces the rate of secretion of gastric juice containing hydrochloric acid, which is necessary for the normal absorption of iron.
- Iron binding drugs ( Desferal, Exjade). These drugs have the ability to bind and remove iron from the body, both free and included in transferrin and ferritin. In case of an overdose, the development of an iron deficiency state is possible.
Iron deficiency anemia symptoms
The symptoms of this disease are due to a lack of iron in the body and a violation of hematopoiesis in the red bone marrow. It is worth noting that iron deficiency develops gradually, therefore, at the onset of the disease, symptoms can be rather scarce. Latent ( hidden) iron deficiency in the body can lead to symptoms of sideropenic ( iron deficiency) syndrome. Somewhat later, anemic syndrome develops, the severity of which is due to the level of hemoglobin and erythrocytes in the body, as well as the rate of development of anemia ( the faster it develops, the more pronounced the clinical manifestations will be), compensatory capabilities of the organism ( in children and the elderly, they are less developed) and the presence of concomitant diseases. The manifestations of iron deficiency anemia are:
- muscle weakness;
- increased fatigue;
- cardiopalmus;
- changes in the skin and its appendages ( hair, nails);
- damage to the mucous membranes;
- defeat of the tongue;
- violation of taste and smell;
- tendency to infectious diseases;
- violations of intellectual development.
Muscle weakness and fatigue
Iron is part of myoglobin, the main protein in muscle fibers. With its lack, the processes of muscle contraction are disrupted, which will be manifested by muscle weakness and a gradual decrease in muscle volume ( atrophy). In addition, a large amount of energy is constantly needed for the muscles to work, which can only be generated with an adequate supply of oxygen. This process is disrupted with a decrease in the concentration of hemoglobin and erythrocytes in the blood, which is manifested by general weakness and intolerance to physical exertion. People get tired quickly when doing daily work ( climbing stairs, going to work and so on), and this can significantly reduce the quality of their life. Children with iron deficiency anemia are characterized by a sedentary lifestyle, prefer "sedentary" games.Shortness of breath and heart palpitations
An increase in respiration and heart rate occurs during the development of hypoxia and is a compensatory reaction of the body aimed at improving blood supply and oxygen delivery to various organs and tissues. This may be accompanied by a feeling of shortness of breath, chest pain, ( arising from insufficient oxygen supply to the heart muscle), and in severe cases - dizziness and loss of consciousness ( due to a violation of the blood supply to the brain).Changes in the skin and its appendages
As mentioned earlier, iron is part of many enzymes involved in the processes of cell respiration and division. A deficiency of this trace element leads to damage to the skin - it becomes dry, less elastic, flakes and cracks. In addition, erythrocytes, which are located in the capillaries of these organs and contain oxygenated hemoglobin, give the usual red or pinkish tint to the mucous membranes and skin. With a decrease in its concentration in the blood, as well as as a result of a decrease in the formation of red blood cells, pallor of the skin may be noted.Hair becomes thinner, loses its usual shine, becomes less durable, breaks easily and falls out. Gray hair appears early.
Nail damage is a very specific manifestation of iron deficiency anemia. They become thinner, matte, exfoliate and break easily. The transverse striation of the nails is characteristic. With a pronounced iron deficiency, koilonychia may develop - the edges of the nails rise and bend in the opposite direction, acquiring a spoon-like shape.
Lesion of the mucous membranes
Mucous membranes refer to tissues in which the processes of cell division occur as intensively as possible. That is why their defeat is one of the first manifestations of iron deficiency in the body.With iron deficiency anemia, it is affected:
- Oral mucosa. It becomes dry, pale, areas of atrophy appear. Difficulty chewing and swallowing food. It is also characterized by the presence of cracks on the lips, the formation of a jam in the corners of the mouth ( cheilosis). In severe cases, the color changes and the strength of the tooth enamel decreases.
- Mucous membrane of the stomach and intestines. Under normal conditions, the mucous membrane of these organs plays an important role in the absorption of food, and also contains many glands that produce gastric juice, mucus and other substances. With her atrophy ( caused by iron deficiency) digestion is disturbed, which can manifest itself as diarrhea or constipation, abdominal pain, and malabsorption of various nutrients.
- The mucous membrane of the respiratory tract. The defeat of the larynx and trachea can be manifested by sore throat, a feeling of the presence of a foreign body in the throat, which will be accompanied by unproductive ( dry, without phlegm) cough. In addition, the mucous membrane of the respiratory tract normally performs a protective function, preventing foreign microorganisms and chemicals from entering the lungs. With its atrophy, the risk of developing bronchitis, pneumonia and other infectious diseases of the respiratory system increases.
- The mucous membrane of the genitourinary system. Violation of its function can be manifested by pain during urination and during intercourse, urinary incontinence ( more often in children), as well as frequent infectious diseases in the affected area.
Defeat of the tongue
Tongue changes are a common manifestation of iron deficiency. As a result of atrophic changes in his mucous membrane, the patient may feel pain, burning sensation and distention. The appearance of the tongue also changes - the normally visible papillae ( which contain a large number of taste buds), the tongue becomes smooth, covered with cracks, areas of redness of an irregular shape may appear ( "Geographic language").Disturbances in taste and smell
As already mentioned, the mucous membrane of the tongue is rich in taste buds located mainly in the papillae. With their atrophy, various taste disturbances may appear, starting with a decrease in appetite and intolerance to certain types of foods ( usually sour and salty foods), and ending with a perversion of taste, addiction to eating earth, clay, raw meat and other inedible things.Smell disorders can manifest as olfactory hallucinations ( a sense of smells that are not really there) or addiction to unusual smells ( varnish, paint, gasoline and others).
Propensity for infectious diseases
With iron deficiency, the formation of not only erythrocytes is disturbed, but also leukocytes - the cellular elements of the blood that provide the body's protection from foreign microorganisms. The lack of these cells in the peripheral blood increases the risk of developing various bacterial and viral infections, which increases even more with the development of anemia and impaired microcirculation of blood in the skin and other organs.
Intellectual development disorders
Iron is part of a number of brain enzymes ( tyrosine hydroxylase, monoamine oxidase and others). Violation of their education leads to impaired memory, concentration and intellectual development. In the later stages, with the development of anemia, intellectual impairment is aggravated due to insufficient supply of oxygen to the brain.Diagnosis of iron deficiency anemia
A doctor of any specialty may suspect a person's anemia based on the external manifestations of the disease. However, the establishment of the type of anemia, the identification of its cause and the appointment of appropriate treatment should be dealt with by a hematologist. In the process of diagnosis, he can prescribe a number of additional laboratory and instrumental studies, and, if necessary, involve specialists from other fields of medicine. It is important to note that treatment of iron deficiency anemia will be ineffective if the cause is not identified and eliminated.
In the diagnosis of iron deficiency anemia, the following is used:
- interview and examination of the patient;
- bone marrow puncture.
Patient interview and examination
The first thing a doctor should do if iron deficiency anemia is suspected is to carefully interview and examine the patient.The doctor may ask the following questions:
- When and in what sequence did the symptoms of the disease begin to appear?
- How quickly did they develop?
- Do family members or immediate family members have similar symptoms?
- How does the patient eat?
- Does the patient suffer from any chronic medical conditions?
- What is the attitude towards alcohol?
- Has the patient taken any medication in the past months?
- If a pregnant woman is sick, the duration of pregnancy, the presence and outcome of previous pregnancies, and whether she is taking iron supplements are specified.
- If a child is sick, his weight at birth is specified, whether he was born full-term, whether the mother took iron supplements during pregnancy.
- Nutritional nature- according to the severity of subcutaneous fat.
- Skin color and visible mucous membranes- special attention is paid to the oral mucosa and tongue.
- Skin appendages - hair, nails.
- Muscle strength- the doctor asks the patient to squeeze his hand or uses a special device ( dynamometer).
- Blood pressure - it can be reduced.
- Taste and smell.
General blood analysis
This is the first test given to all patients with suspected anemia. It allows you to confirm or deny the presence of anemia, and also provides indirect information about the state of hematopoiesis in the red bone marrow.Blood for general analysis can be taken from a finger or from a vein. The first option is more suitable if the general analysis is the only laboratory test assigned to the patient ( when a little blood is enough). Before taking blood, the skin of the finger is always treated with cotton wool soaked in 70% alcohol to avoid infection. The puncture is made with a special disposable needle ( scarifier) to a depth of 2 - 3 mm. Bleeding in this case is mild and completely stops almost immediately after taking blood.
In the event that it is planned to carry out several studies at once ( e.g. general and biochemical analysis) - they take venous blood, since it is easier to get it in large quantities. Before collecting blood, a rubber tourniquet is placed over the middle third of the upper arm, which fills the veins with blood and makes it easier to locate them under the skin. The puncture site should also be treated with an alcohol solution, after which the nurse punctures the vein with a disposable syringe and draws blood for analysis.
The blood obtained by one of the described methods is sent to a laboratory, where it is analyzed in a hematology analyzer - a modern high-precision device available in most laboratories in the world. Part of the resulting blood is stained with special dyes and examined in a light microscope, which allows you to visually assess the shape of erythrocytes, their structure, and in the absence or malfunction of the hematological analyzer, to count all the cellular elements of the blood.
In iron deficiency anemia, a peripheral blood smear is characterized by:
- Poikilocytosis - the presence of various forms of erythrocytes in the smear.
- Microcytosis - the predominance of erythrocytes, the size of which is less than normal ( normal red blood cells can also be found).
- Hypochromia - the color of red blood cells changes from bright red to pale pink.
The results of a general blood test for iron deficiency anemia
| The investigated indicator | What does it mean? | Norm | |
| Erythrocyte concentration
(RBC) | With the depletion of iron stores in the body, erythropoiesis in the red bone marrow is disrupted, due to which the total concentration of red blood cells in the blood will be reduced. | Men
(M
)
:
4.0 - 5.0 x 10 12 / l. | Less than 4.0 x 10 12 / l. |
| Women(F):
3.5 - 4.7 x 10 12 / l. | Less than 3.5 x 10 12 / l. | ||
| Average erythrocyte volume
(MCV ) | With iron deficiency, the processes of hemoglobin formation are disrupted, as a result of which the size of the erythrocytes themselves decreases. The hematological analyzer allows you to determine this indicator as accurately as possible. | 75 - 100 cubic micrometers ( μm 3). | Less than 70 μm 3. |
| Platelet concentration (PLT) | Platelets are the cellular elements of the blood that are responsible for stopping bleeding. A change in their concentration can be observed if iron deficiency is caused by chronic blood loss, which will lead to a compensatory increase in their formation in the bone marrow. | 180 - 320 x 10 9 / l. | Normal or increased. |
| Leukocyte concentration (WBC) | With the development of infectious complications, the concentration of leukocytes can increase significantly. | 4.0 - 9.0 x 10 9 / l. | Normal or increased. |
| Concentration of reticulocytes
( RET) | Under normal conditions, the body's natural response to anemia is to increase the rate of red blood cell production in the red bone marrow. However, with iron deficiency, the development of this compensatory reaction is impossible, due to which the number of reticulocytes in the blood decreases. | M: 0,24 – 1,7%. | Reduced or is at the lower limit of the norm. |
| F: 0,12 – 2,05%. | |||
| Total hemoglobin level (HGB) | As already mentioned, iron deficiency leads to a violation of the formation of hemoglobin. The longer the illness lasts, the lower this indicator will be. | M: 130 - 170 g / l. | Less than 120 g / l. |
| F: 120 - 150 g / l. | Less than 110 g / l. | ||
| Average hemoglobin content in one erythrocyte
( MCH ) | This indicator more accurately characterizes the violation of the formation of hemoglobin. | 27 - 33 picograms ( pg). | Less than 24 pg. |
| Hematocrit (Hct) | This indicator displays the number of cellular elements in relation to the volume of plasma. Since the main majority of blood cells are erythrocytes, a decrease in their number will lead to a decrease in hematocrit. | M: 42 – 50%. | Less than 40%. |
| F: 38 – 47%. | Less than 35%. | ||
| Color index (Cpu) | The color index is determined by passing a light wave of a certain length through a suspension of erythrocytes, which is absorbed exclusively by hemoglobin. The lower the concentration of this complex in the blood, the lower the value of the color index will be. | 0,85 – 1,05. | Less than 0.8. |
| Erythrocyte sedimentation rate (ESR) | All blood cells, as well as endothelium ( inner surface) vessels have a negative charge. They repel each other, which helps to keep the red blood cells in suspension. With a decrease in the concentration of erythrocytes, the distance between them increases, and the repulsive force decreases, as a result of which they will settle to the bottom of the tube faster than under normal conditions. | M: 3 - 10 mm / hour. | More than 15 mm / hour. |
| F: 5 - 15 mm / hour. | More than 20 mm / hour. |
Blood chemistry
In the course of this study, it is possible to establish the concentration of various chemicals in the blood. This gives information about the state of internal organs ( liver, kidney, bone marrow and others), and also allows you to identify many diseases.There are several dozen biochemical parameters determined in blood. This section will describe only those of them that are important in the diagnosis of iron deficiency anemia.
Biochemical blood test for iron deficiency anemia
| The investigated indicator | What does it mean? | Norm | Possible changes in iron deficiency anemia |
| Serum iron concentration | Initially, this indicator may be normal, since iron deficiency will be compensated by its release from the depot. Only with a prolonged course of the disease will the concentration of iron in the blood begin to decrease. | M: 17.9 - 22.5 μmol / L. | Normal or decreased. |
| F: 14.3 - 17.9 μmol / L. | |||
| Ferritin level in the blood | As mentioned earlier, ferritin is one of the main types of iron storage. With a lack of this element, it begins to mobilize from the depot organs, and therefore a decrease in the concentration of ferritin in the plasma is one of the first signs of an iron deficiency state. | Children: 7 - 140 nanograms in 1 milliliter of blood ( ng / ml). | The longer the iron deficiency lasts, the lower the ferritin level. |
| M: 15 - 200 ng / ml. | |||
| F: 12 - 150 ng / ml. | |||
| Total iron binding capacity of serum | This assay is based on the ability of transferrin in the blood to bind iron. Under normal conditions, each transferrin molecule is only 1/3 bound to iron. With a deficiency of this trace element, the liver begins to synthesize more transferrin. Its concentration in the blood increases, but the amount of iron per molecule decreases. Having determined what proportion of transferrin molecules are in a state unbound with iron, one can draw conclusions about the severity of iron deficiency in the body. | 45 - 77 μmol / l. | Significantly higher than normal. |
| Erythropoietin concentration | As mentioned earlier, erythropoietin is excreted by the kidneys when the body's tissues lack oxygen. Normally, this hormone stimulates erythropoiesis in the bone marrow, however, with iron deficiency, this compensatory reaction is ineffective. | 10 - 30 international milliunits per milliliter ( mIU / ml). | Significantly higher than normal. |
Bone marrow puncture
This study consists in piercing one of the bones of the body ( usually sternum) with a special hollow needle and taking a few milliliters of bone marrow substance, which is then examined under a microscope. This allows you to directly assess the severity of changes in the structure and function of the organ.At the onset of the disease, there will be no changes in the bone marrow punctate. With the development of anemia, there may be an increase in the erythroid germ of hematopoiesis ( increasing the number of erythrocyte progenitor cells).
To identify the cause of iron deficiency anemia, it is used:
- analysis of feces for the presence of occult blood;
- X-ray examination;
- endoscopic examinations;
- consultation of other specialists.
Stool examination for occult blood
The reason for the appearance of blood in the feces ( melena) can become bleeding from ulcers, tumor breakdown, Crohn's disease, ulcerative colitis and other diseases. Abundant bleeding is easily identified visually by a change in the color of feces to bright red ( with bleeding from the lower intestinal calving) or black ( with bleeding from the vessels of the esophagus, stomach and upper intestine).Massive single bleeding practically does not lead to the development of iron deficiency anemia, as it is quickly diagnosed and eliminated. The danger in this regard is represented by long-term, low-volume blood loss arising from damage ( or ulceration) small vessels of gastrointestinal waste. In this case, it is possible to detect blood in the feces only with the help of a special study, which is prescribed in all cases of anemia of unknown origin.
X-ray examinations
Contrast X-rays are used to detect tumors or ulcers in the stomach or intestines that could cause chronic bleeding. In the role of contrast, a substance is used that does not absorb X-rays. Usually it is a suspension of barium in water, which the patient should drink immediately before starting the study. Barium coats the mucous membranes of the esophagus, stomach and intestines, as a result of which their shape, contour and various deformations become clearly visible on an x-ray.Before conducting the study, it is necessary to exclude food intake during the last 8 hours, and when examining the lower intestines, cleansing enemas are prescribed.
Endoscopic examinations
This group includes a number of studies, the essence of which is the introduction into the body cavity of a special apparatus with a video camera at one end connected to a monitor. This method allows you to visually examine the mucous membranes of internal organs, assess their structure and function, and also identify swelling or bleeding.In order to establish the cause of iron deficiency anemia, it is used:
- Fibroesophagogastroduodenoscopy ( FEGDS) – introduction of the endoscope through the mouth and examination of the lining of the esophagus, stomach and upper intestines.
- Sigmoidoscopy - examination of the rectum and the lower part of the sigmoid colon.
- Colonoscopy - examination of the mucous membrane of the large intestine.
- Laparoscopy - piercing the skin of the anterior abdominal wall and introducing an endoscope into the abdominal cavity.
- Colposcopy - examination of the vaginal part of the cervix.
Consultation of other specialists
When a disease of various systems and organs is detected, the hematologist can involve specialists from other fields of medicine in order to formulate a more accurate diagnosis and prescribe adequate treatment.To identify the cause of iron deficiency anemia, you may need to consult:
- Nutritionist - when a malnutrition is detected.
- Gastrologist - if you suspect an ulcer or other diseases of the gastrointestinal tract.
- Surgeon - in the presence of bleeding from the gastrointestinal tract or other localization.
- Oncologist - if you suspect a stomach or intestinal tumor.
- Obstetrician-gynecologist - if there are signs of pregnancy.
Treatment for iron deficiency anemia
Therapeutic measures should be aimed at restoring the level of iron in the blood, replenishing the reserves of this trace element in the body, as well as identifying and eliminating the cause that caused the development of anemia. Diet for iron deficiency anemia
One of the important directions in the treatment of iron deficiency anemia is proper nutrition. When prescribing a diet, it is important to remember that iron, which is part of meat, is most well absorbed. At the same time, only 25 - 30% of the heme iron taken with food is absorbed in the intestine. Iron from other animal products is absorbed only by 10 - 15%, and from plant products - by 3 - 5%.Estimated iron content in various foods
| The product's name | Iron content in 100 g of product |
| Animal products | |
| Pork liver | 20 mg |
| Chicken liver | 15 mg |
| Beef liver | 11 mg |
| Egg yolk | 7 mg |
| Rabbit meat | 4.5 - 5 mg |
| Lamb, beef | 3 mg |
| Chicken meat | 2.5 mg |
| Cottage cheese | 0.5 mg |
| Cow's milk | 0.1 - 0.2 mg |
| Vegetable products | |
| Dog-rose fruit | 20 mg |
| Seaweed | 16 mg |
| Prunes | 13 mg |
| Buckwheat | 8 mg |
| Sunflower seeds | 6 mg |
| Black currant | 5.2 mg |
| Almond | 4.5 mg |
| Peach | 4 mg |
| Apples | 2.5 mg |
Treatment of iron deficiency anemia with medications
The main direction in the treatment of this disease is the use of iron preparations. Diet therapy, although it is an important stage of treatment, is not able to independently compensate for the iron deficiency in the body.Tablets are the method of choice. Parenteral ( intravenous or intramuscular) the introduction of iron is prescribed if the full absorption of this trace element in the intestine is impossible ( for example, after removing part of the duodenum), it is necessary to quickly replenish iron reserves ( with massive blood loss) or with the development of adverse reactions from the use of oral forms of the drug.
Drug therapy for iron deficiency anemia
| Drug name | The mechanism of therapeutic action | Method of administration and dosage | Monitoring the effectiveness of treatment |
| Hemofer prolongatum | A preparation of ferrous sulfate, which replenishes the reserves of this trace element in the body. | Take orally, 60 minutes before or 2 hours after a meal, with a glass of water.
Duration of treatment is 4-6 months. After normalization of the hemoglobin level, they switch to a maintenance dose ( 30 - 50 mg / day) for another 2 - 3 months. | The criteria for the effectiveness of treatment are:
|
| Sorbifer Durules | One tablet of the drug contains 320 mg of ferrous sulfate and 60 mg of ascorbic acid, which improves the absorption of this trace element in the intestine. | Take orally, without chewing, 30 minutes before meals, with a glass of water.
|
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| Ferro-foil | A complex medication that contains:
| Take orally, 30 minutes before meals, 1 - 2 capsules 2 times a day. Treatment period - 1 - 4 months ( depending on the underlying disease). | |
| Ferrum Lek | Iron preparation for intravenous administration. | Intravenous, drip, slowly. Before administration, the drug must be diluted in a sodium chloride solution ( 0,9%
) in a ratio of 1:20. The dose and duration of use are determined by the attending physician individually in each case. With intravenous administration of iron, there is a high risk of overdose, therefore, this procedure should be performed only in a hospital setting under the supervision of a specialist. |
It is important to remember that some medicines ( and other substances) can significantly accelerate or slow down the rate of absorption of iron in the intestine. It is worthwhile to use them in conjunction with iron preparations, as this can lead to an overdose of the latter, or, conversely, to the absence of a therapeutic effect.
Substances affecting the absorption of iron
| Medications that promote iron absorption | Substances that interfere with the absorption of iron |
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Red blood cell transfusion
With an uncomplicated course and correctly carried out treatment, there is no need for this procedure.Indications for erythrocyte transfusion are:
- massive blood loss;
- a decrease in the concentration of hemoglobin less than 70 g / l;
- a persistent decrease in systolic blood pressure ( below 70 millimeters of mercury);
- upcoming surgical intervention;
- upcoming birth.
Prognosis for iron deficiency anemia
At the present stage of development of medicine, iron deficiency anemia is a relatively easily curable disease. If the diagnosis is made in a timely manner, comprehensive, adequate therapy is carried out and the cause of iron deficiency is eliminated, there will be no residual effects. Difficulties in treating iron deficiency anemia can be caused by:
- incorrectly diagnosed;
- an unknown cause of iron deficiency;
- late started treatment;
- taking insufficient doses of iron preparations;
- violation of the regimen of taking medications or diet.
Complications of iron deficiency anemia can be:
- Growth and developmental delays. This complication is typical for children. It is caused by ischemia and associated changes in various organs, including the brain tissue. There is both a delay in physical development and a violation of the child's intellectual abilities, which, with a prolonged course of the disease, may be irreversible. into the bloodstream and body tissues), which is especially dangerous in children and the elderly.
Anemia is a complex clinical and hematological syndrome, manifested by a decrease in the number of red blood cells and blood hemoglobin. Anemia is a fairly common disease and, according to various sources, the incidence ranges from 7 to 17% of the population.
Anemias vary in causes, course, symptoms, and prognosis. Among all the first place is occupied by iron deficiency anemia, which accounts for up to 80% of cases. According to the World Health Organization, every third woman and every sixth man in the world suffers from iron deficiency anemia, as well as up to 50% of young children, which is about 2 billion people.
Iron deficiency anemia is hypochromic (a decrease in the hemoglobin content in an erythrocyte) microcytic (a decrease in the size of red blood cells) anemia, which develops as a result of an absolute iron deficiency in the body.
The human body receives the first reserves of iron from the mother through the mother-placenta-fetus system; after birth, iron is replenished with food or iron-containing preparations.
The elimination of iron from the body is carried out through the urinary and digestive systems, sweat glands and during menstruation in women. About 2 grams of iron is excreted per day, therefore, in order to prevent depletion of reserves, it must be replenished in one way or another.
Causes of iron deficiency anemia:
1) Insufficient intake of iron from food
Starvation,
- vegetarianism or a diet low in iron and protein for a long time,
- in breastfed babies, the cause may be maternal iron deficiency anemia,
- early transfer to artificial feeding,
- late introduction of complementary foods.
2) Increased need for iron
Growth and puberty in adolescents
- the formation of menstrual function in girls,
- frequent ARVI (consumption of iron by infectious agents),
- tumor growth of any localization,
- playing sports,
- pregnancy,
- breast-feeding.
Despite the fact that during pregnancy, part of the iron is saved due to the absence of menstrual flow, the need for iron increases so much that it needs to be replenished, most often with drugs. Almost every pregnancy is accompanied by an iron deficiency state, expressed to one degree or another. The need increases proportionally with multiple pregnancies.
3) Congenital lack of iron in the body
Prematurity
- birth from multiple pregnancies,
- severe iron deficiency anemia in the mother,
- pathological bleeding during pregnancy and childbirth,
- placental insufficiency.
4) Impaired absorption of iron.
In this case, it is not so much the percentage of iron in food or preparations that matters, as the efficiency of its entry into the blood. Impaired absorption of iron is caused by various diseases of the gastrointestinal tract, absorption occurs mainly in the duodenal jejunum and depends on the state of the mucous membrane of these parts of the intestine:
Enteritis (inflammation of the lining of the small intestine caused by infection or helminthic invasion),
- gastritis (atrophic, autoimmune) and peptic ulcer of the stomach and duodenum (often caused by the bacterium Helicobacter Pylori),
- hereditary diseases: here cystic fibrosis and celiac disease are of paramount importance. In addition to impaired absorption of trace elements (including iron), they manifest themselves as a severe symptom complex, and such children need special nutrition. Therefore, the analysis for these diseases is performed on 3-4 days in the hospital;
- Crohn's disease (autoimmune damage to the intestinal mucosa and possibly stomach),
- condition after removal of the stomach and / or duodenum,
- cancer of the stomach and intestines (there is a complex mechanism of anemia, the absorption of iron from the mucous membrane is impaired, the risk of bleeding is high, and consumption increases due to chronic disease).
5) Increased iron loss:
Chronic blood loss. This is the largest cause in this group, anemia occurs as a result of regular loss of small blood volumes, this includes losses due to:
~ pulmonary bleeding (bronchiectasis, lung cancer, tuberculosis), hemosiderosis of the lungs (chronic lung disease, manifested by repeated hemorrhages in the pulmonary vesicles - alveoli);
~ micro- and macrohematuria (chronic pyelonephritis and glomerulonephritis, polycystic and kidney cancer, polyposis and bladder tumors), loss during hemodialysis;
~ in women, frequent causes of chronic iron deficiency anemia are uterine fibroids, endometriosis, hyperpolymenorrhea, cervical cancer and other localization;
~ in children and adolescents, nosebleeds are a common cause (Randu-Osler disease and other causes);
- allergic diseases (loss of a trace element in the exfoliating epithelium).
6) Violation of transferrin synthesis. Transferrin is an iron transport protein that is synthesized in the liver.
Congenital defect in transferrin synthesis (often hereditary)
- the presence of antibodies (protective proteins that block its action) to transferrin
- chronic hepatitis of various nature and liver cirrhosis
7) Alcoholism. Alcohol damages the mucous membrane of the stomach and intestines, thereby hampering the absorption of iron, and also inhibits the hematopoietic function of the red bone marrow.
8) The use of medicines.
Non-steroidal anti-inflammatory drugs (diclofenac, ibuprofen, aspirin) reduce blood viscosity and may contribute to bleeding, in addition, these drugs can provoke stomach and duodenal ulcers.
Antacids (Almagel, Gastal, Rennie) reduce the production of hydrochloric acid, which is necessary for effective absorption of iron
Iron-binding drugs (desferal), these drugs bind and remove free iron and iron as part of ferritin and transferrin, and in case of an overdose, they can lead to iron deficiency states.
9) Donation. 300 ml of donated blood contains about 150 mg of iron; with donations, iron deficiency develops more often 4 times a year.
Iron deficiency anemia symptoms
1) Anemic syndrome
2) Sideropenic syndrome
3) Non-hematological manifestations of anemia
Anemic syndrome formed due to a decrease in erythrocytes and blood hemoglobin, which causes a decrease in the saturation of cells and tissues with oxygen. Signs of anemic syndrome are nonspecific, but they help to suspect the presence of anemia and, in combination with data from other examinations, make a diagnosis.
Subjective signs first appear with a load more than usual, and then (with the progression of the disease) and at rest:
General weakness
- increased fatigue and decreased performance
- dizziness
- tinnitus and flashing "flies" in front of the eyes
- episodes of rapid heartbeat
- increased shortness of breath during exercise
- fainting conditions
An objective examination reveals:
Pallor of the skin and visible mucous membranes (for example, the inner surface of the lower eyelid)
- pasty (slight swelling) of the legs, feet, face (mainly the area around the eyes)
- tachycardia, various types of arrhythmia
- moderate heart murmurs, muffled heart sounds
Sideropenic syndrome caused by a deficiency of iron in tissues, which causes a decrease in the activity of many enzymes (protein substances that regulate many vital functions).
Sideropenic syndrome manifests itself in numerous symptoms:
A change in taste (an irresistible desire to eat unusual foods: sand, chalk, clay, tooth powder, ice, as well as raw minced meat, unbaked dough, dry cereals), is more pronounced in women and adolescents
Addiction to eating spicy, salty, spicy foods
Perverted sense of smell (attracted by odors perceived by the majority as unpleasant: gasoline, acetone, the smell of varnishes, paints, lime)
Decreased muscle strength and muscle wasting due to deficiencies in myoglobin (an oxygen-binding protein in skeletal muscle) and tissue respiration enzymes
Dystrophic changes in the skin (dryness up to cracking, peeling), hair (fragility, loss, dullness, early graying), nails (dullness, cross striation, koilonychia - spoon-shaped concavity of nails). The regenerative function of the skin decreases (minor injuries and abrasions do not heal for a long time).
Angular stomatitis (dryness and cracks in the corners of the mouth) in 10-15% of patients
Glossitis (inflammation of the tongue), characterized by a feeling of pain and swelling in the tongue, redness and atrophy of the papillae (the so-called "lacquered tongue", the surface of the tongue in this case is not velvety, as normal, but smooth and even shiny), frequent periodontal disease and caries
Atrophic changes in the mucous membrane of the gastrointestinal tract (dryness of the mucous membrane of the esophagus, which causes pain when swallowing and difficulty in swallowing solid food - sideropenic dysphagia), the development of atrophic gastritis and enteritis
Dystrophic changes in the muscles of the sphincters of the bladder (urgent urge to urinate, inability to hold urine when coughing, laughing, sneezing, episodes of bedwetting)
The symptom of "blue sclera" is characterized by a bluish color of the sclera (due to iron deficiency and insufficient function of some enzymes, collagen synthesis in the tunica albuginea of the eyes is disrupted, it becomes thinner and small vessels are visible through it)
- "sideropenic subfebrile condition" - a prolonged increase in body temperature to subfebrile numbers (37.0-37.9 ° C) for no apparent reason
Predisposition to infectious and inflammatory diseases (frequent ARVI and other infections), a tendency to chronic infection
Decreased resistance to heavy metal poisoning
Non-hematological consequences of anemia:
Slower fetal growth in a pregnant woman with anemia,
- violation of the menstrual cycle,
- impotence,
- changes in behavior, decreased motivation, intellectual abilities, these symptoms are more pronounced in children and adolescents and disappear when iron stores are restored.
Diagnosis of iron deficiency anemia
I. General examination (color of skin and mucous membranes, body type), patient survey (chronic diseases, attitude to alcohol, heredity, for a woman the nature of menstruation and the date of the last menstruation), palpation (soreness of the abdomen and lower back, volumetric formations of the abdomen and mammary glands, size and mobility of lymph nodes), percussion (percussion to determine the boundaries of the heart and liver, soreness of flat and tubular bones), auscultation (listening to possible wheezing in the lungs, heart murmurs and rhythm).
II. KLA (complete blood count) or CRAC (complete clinical blood count) Is the main study in the primary diagnosis of anemia.
Here we present the most important indicators so that you can navigate as a result of the analysis:
Hb (hemoglobin) - the norm in women is 120-150 g / l, in men 130-170 g / l.
RBC (erythrocytes) - the norm is 3.9-6.0 * 1012 in men, 3.7-5.0 * 1012 / l in women, the number of erythrocytes in newborns is maximum and is 6.0-9.0 * 1012 / l, in the elderly, the concentration of erythrocytes can also be increased to 6.0 * 1012 / l. In both cases, such indicators are considered the norm.
RET (reticulocytes) - the norm is from 0.8 - 1.3 to 0.2 - 2%.
Hct (hematocrit, that is, the ratio of blood cells to its liquid part) - in men it reaches 40-48%, in women it is slightly lower - 36-42%.
MCV (average erythrocyte volume) - the norm is 75-95 microns 3.
MCH (average hemoglobin content in erythrocytes) - the norm is 24-33 pg.
MCHC (average concentration of hemoglobin in erythrocytes) - the norm is 30-38%.
WBC (leukocytes) - 3.6-10.2 * 10 9 / l.
PLT (platelets) - 152-343 * 10 9 / l.
III. OAM (general urinalysis) protein loss in urine and the presence of blood in the urine are of paramount importance
IV. General biochemical studies(total protein, glucose, total and direct bilirubin, ALT, AST, ALP, creatinine, urea, LDH, CRP)
V. Specific biochemical studies
1.determination of iron in blood serum
Norm: children under 1 year old - 7.16-17.90 μmol / l;
children from 1 year to 14 years old - 8.95-21.48 μmol / l;
women - 8.95-30.43 μmol / l;
men - 11.64-30.43 μmol / l.
2.total iron-binding capacity of blood serum (norm in women: 38.0-64.0 μm / l, in men 45.0 - 75.0 μm / l)
3.saturation with iron transferrin (normally about 30%)
newborns 25 - 200
1 month 200 - 600
6 months - 15 years 30 - 140
men 20 - 350
women 10 - 150
Pregnancy:
1st trimester 56 - 90
2nd trimester 25 - 74
3rd trimester 10 - 15
6. desferal test (after intravenous administration of 500 mg of desferal in a healthy person, 0.8 to 1.2 mg of iron is excreted in the urine, in patients with iron deficiency anemia this figure is lower).
1.Diet
2.Oral iron supplementation
3.Injectable iron preparations
4.Hemotransfusion
Diet in the treatment of iron deficiency anemia
Diet in the complex treatment of iron deficiency anemia can be effective with normal absorption of iron from food, the absence of diseases of the gastrointestinal tract.
The diet for iron deficiency anemia should include foods rich in iron (beef tongue, chicken, turkey, liver, sea fish, heart, buckwheat and millet, eggs, greens, peas, nuts, cocoa, apricots, apples, peaches, persimmons, quince , blueberries, pumpkin seeds), ascorbic acid, which improves the absorption of iron (bell pepper, cabbage, rose hips, currants, citrus fruits, sorrel).
Foods that interfere with iron absorption should be limited: black tea, all dairy products.
Medications for iron deficiency anemia
Oral iron preparations (in tablets, drops, syrup, solution) are the initial treatment for mild to moderate anemia; in the presence of pregnancy, the reception is agreed with the obstetrician-gynecologist.
Sorbifer durules / fenuls 100 1-2 tablets 1-2 times a day until the hemoglobin level is restored (in pregnant women, for prophylaxis 1 tablet once a day, for treatment 1 tablet 2 times a day).
Ferretab 1 capsule per day, up to a maximum of 2-3 capsules per day in 2 doses, the minimum intake period is 4 weeks, then according to indications.
Maltofer comes in three dosage forms (drops, syrup, tablets), taken for iron deficiency anemia, 40-120 drops / 10-30 ml of syrup / 1-3 tablets per day in 1-2 doses. Children under 1 year old 10-20 drops, 2.5-5 ml of syrup in 1-2 doses, children from 1 year to 12 years old 20-40 drops, 5-10 ml of syrup in 1-2 doses; reception for 3-5 months under the control of hemoglobin levels.
Tardiferron / ferrogradumet 1-2 tablets per day until the hemoglobin level is restored, for pregnant women 1 tablet per day II-III trimester.
Aktiferrin, 1 capsule 2-3 times a day for 8-12 weeks, for newborns and infants, the drug is given in the form of drops 10-15 drops 2-3 times a day, for preschool children 25-35 drops 3 times a day.
Totem (a combined preparation of iron, copper and manganese), 2-4 ampoules per day, the solution is diluted in 1 glass of water, taken within 3-6 months, for children 5-7 mg / kg of body weight in 3-4 doses.
Injection drugs are used exclusively in a hospital (it is necessary to be able to provide anti-shock care), are contraindicated in pregnancy and lactation.
Venofer (the solution is strictly for intravenous administration, the dose and rate of administration are calculated individually).
Cosmofer (solution for intravenous and intramuscular administration, calculation of the dose and route of administration is made individually).
Ferrinject (solution for administration in / in or into the dialysis system).
Transfusion (transfusion of blood components) It is performed in case of severe anemia, according to strict indications and in a hospital setting.
Features of the course and treatment of iron deficiency anemia in children
Anemia in children is manifested by general symptoms (pallor of the skin and mucous membranes, general lethargy, tearfulness, sweating, decreased appetite, sleep disturbances), infants have frequent regurgitation and vomiting after feeding, children after a year may experience regression of motor skills, decreased vision, degenerative changes in the skin, hair and nails, tooth decay.
With the progression of the disease, one can observe the development of functional murmur in the heart, tachycardia, headaches, fainting, an increase in the size of the liver and spleen, the appearance of unusual gustatory drives - the desire to eat chalk, clay, earth.
Treatment of anemia in children includes 4 principles: normalization of regimen and nutrition, possible elimination of the cause of iron deficiency, therapy with iron preparations, concomitant therapy.
Prioritizing breastfeeding
- long walks in the air, prevention of ARVI,
- the introduction of meat complementary foods from 6 months,
- exclude complementary feeding with semolina, rice, bearberry, give preference to buckwheat, barley, millet,
- taking iron preparations (maltofer, aktiferrin, totems) under the supervision of a pediatrician.
The effectiveness of the treatment can be judged within 7-10 days (an increase in reticulocytes by 2 times compared with the initial one, an increase in hemoglobin by 10 g / l or more per week), the treatment lasts at least 3 months. If the prescribed treatment is ineffective, then other drugs should be considered, it is possible to increase the dose to the maximum therapeutic dose, it is necessary to exclude sources of chronic blood loss, foci of chronic infections, the presence of neoplasms and helminthic invasions, concomitant vitamin B12 deficiency.
If the principles of complex therapy are followed, the symptoms of anemia quickly regress.
Complications of iron deficiency anemia
Complications occur with prolonged course of anemia without treatment and reduce the quality of life.
Decreased immunity
- increased heart rate, which leads to greater stress on the heart and ultimately to heart failure,
- in pregnant women, the risk of premature birth and fetal growth retardation increases,
- in children, iron deficiency leads to a delay in growth and development,
- a rare and severe complication is hypoxic coma,
- hypoxia due to iron deficiency complicates the course of existing cardiopulmonary diseases (coronary artery disease, bronchial asthma, bronchiectasis and others).
Forecast
In the overwhelming majority of cases, iron deficiency anemia is successfully corrected, the signs and symptoms of anemia recede. However, if left untreated, complications develop and the disease progresses.
If you have a low hemoglobin level, then you need to undergo a complete clinical and laboratory examination and identify the cause of the anemia. A correct diagnosis is the key to successful treatment.
Physician therapist A.V. Petrova
The very concept of anemia reflects pathological changes in the composition of the blood - a decrease in the concentration of the protein component (hemoglobin) and red blood cells (hematocrit), the level of which depends on the volume and number of blood cells - erythrocytes. Anemia cannot be called a disease, it is only a symptom of various pathological disorders developing inside the body.
In medical circles, anemia is called fatigue syndrome. This term unites a whole group of hematological syndromes, united by common signs - pathological changes in the structure of the blood.
What is this disease?
These "plates" are erythrocytes in the blood
Iron deficiency anemia is one of the forms of anemia, manifested as a result of disturbances in the stages of protein synthesis and an imbalance in the blood of iron caused by disturbances in the metabolic system. Iron is vital for the body and is an important constituent of hemoglobin, allowing it to carry oxygen.
Circulating through the blood as part of erythrocytes, hemoglobin combines with oxygen (in the lungs) and delivers it to various cells and tissues (gives up). If the body receives an insufficient amount of iron minerals, the process of gas exchange - transporting oxygen to tissue structures and removing carbon dioxide from them - is disrupted. This leads to the gradual development of anemia.
Even with a sufficient number of red blood cells in the blood, with iron deficiency anemia, they are not able to provide tissue respiration - due to the low concentration of iron in their composition. As a result, tissue hypoxia develops in various systems and organs.
In a person (with an approximate weight of 70 kg), the optimal level of iron in the body should be maintained in an amount not less than 4 grams. This amount is maintained due to the precise regulation of the balance of the intake of the micronutrient and its loss. To maintain balance, a person (during the day) should receive from 20 to 25 mg. gland. More than half is spent on the needs of the body, the rest is put aside (deposited) in special storage facilities (tissue or cell depots) and is consumed when needed.
Reasons for the development of IDA in humans
Poor nutrition is one of the common causes
The development of pathological changes in the blood and the manifestation of symptoms of iron deficiency anemia is facilitated by many reasons due to two main factors - a lack of iron intake and disorders in its absorption. Let's consider these reasons in more detail.
Iron deficiency in the diet
An unbalanced diet can cause iron deficiency in childhood and adulthood, and serve as an impetus for the development of hemolytic pathology. Anemia can be provoked by prolonged hunger, a patient's adherence to a vegetarian lifestyle, or a monotonous diet with a lack of animal products.
In infants, micronutrient deficiencies are covered by breastfeeding with the milk of a nursing mother. And the processes of iron deficiency anemia in children can provoke an early transfer of the baby to low-quality artificial complementary foods.
Increased body need for iron
An increase in the body's need for iron is often seen in patients with perfectly normal health conditions. This is noted in pregnant women and after childbirth, during breastfeeding. It would seem that the absence of menstruation in this period should preserve the consumption of iron, but its need, on the contrary, increases significantly. It's related:
- with an increase in the volumetric amount of blood and erythrocytes in the bloodstream;
- transfer of iron to the placenta and fetus;
- with blood loss during and after childbirth;
- loss of iron in milk throughout the entire period of breastfeeding.
The development of anemia (of varying severity) in women during pregnancy is a common and frequent occurrence. Iron deficiency tends to increase with twins or triplets (multiple pregnancies).
Congenital iron deficiency
Signs of congenital iron deficiency anemia can be manifested already in the first weeks of a child's life. This is facilitated by various chronic pathological processes in the expectant mother, accompanied by an acute shortage of iron trace elements in the body, multiple births or premature birth.
The presence of malabsorption in the body
Various diseases, manifested by damage to the mucous structure of the gastrointestinal tract, lead to disturbances in the absorption of iron and a decrease in the rate of its entry into the body. It can be:
- lesions of the mucous lining of the gastrointestinal tract by inflammatory reactions with enteritis, cystic fibrosis and malignant tumors;
- Hereditary pathology (celiac disease) caused by intolerance to gluten - a protein that provokes malabsorption processes;
- Such disorders are caused by surgical interventions with resection of the stomach and intestines, stomach infections (in particular Helicobacter Pylori), affecting its mucous membrane and disrupting the absorption of iron;
- The development of atrophic processes and aggression of their own immunity to the cells of mucous tissues in atrophic and autoimmune gastritis.
Often the cause of IDA is long-term internal hemorrhages caused by ulcerative processes, polyps, neoplasms and hernias in the gastrointestinal tract, hemorrhoids and systemic diseases.
Not the least role in the development of iron deficiency anemia of the process is played by liver diseases (hepatitis, cirrhosis), which disrupt the processes of synthesis by liver cells of the main component of hemoglobin involved in the transport of iron - the protein transferrin.
And also, long-term use or overdose of medications that can cause disturbances in the absorption and utilization of iron in the body - these are drugs from the group of non-steroidal drugs (Aspirin, etc.), antacids (Almagel and Rennie) and iron-binding medications ("Exidzada" or "Desferal").
Degrees of manifestations of IDA
The severity of symptoms is assessed according to the scale of the severity of iron deficiency anemia. It depends on the age, sex of the patient and the amount of protein component (hemoglobin) in the blood. The disease is classified according to the manifestation of three degrees of severity of the process:
- 1st (light) - with the presence of a protein component in the test blood in an amount from 90 g / l to 110.
- 2nd (average) - with an indicator of 70 g / l, but not exceeding 90 g / l.
- 3rd (severe) - with the presence of hemoglobin no more than 70 g / l.
How do the signs of IDA appear?
Iron deficiency in humans develops gradually, the onset of the disease is manifested by rather insignificant signs. At the very beginning, iron deficiency syndrome appears, and a little later anemia develops. The severity of the manifestation depends on the level of hemoglobin, the rate of development of the anemic syndrome, the compensatory capacity of the body and background pathologies accompanying the disease.
The severity of symptoms is due to the rate of development of the anemic syndrome. It manifests itself:
- Muscle weakness and signs of asthenia. Rapid fatigability occurs even with light loads. Children are inactive, prefer quiet games.
- Signs of tachycardia and shortness of breath, chest pain, manifestations of vertigo and fainting, provoked by disruptions in the processes of oxygen transport to various tissue structures.
- Skin lesions with signs of peeling, cracking and loss, due to pronounced dryness, elasticity of the skin.
- Structural disorder of hair and nail plates, which is a characteristic symptom of iron deficiency anemia in women. The structure of the hair becomes thinner, hair is prone to fragility and loses its shine, falls out and turns gray quickly. The nail plates become cloudy, covered with striations, exfoliate and become brittle. A long process of iron deficiency, appears as signs of koilonychia - a dystrophic spoon-shaped curvature of the nail plates.
- Pathologies of mucous tissues. The mucous membrane of the mouth dries up, turns pale and becomes covered with atrophic foci. Cracks and bumps appear on the lips in the corners. The enamel on the teeth loses its strength.
- Pathological damage to the mucous lining of the gastrointestinal tract, which appears as atrophic areas that disrupt the digestive processes, provoking constipation or diarrhea, pain in the abdomen. The absorption of nutrient components is impaired.
- Disorders in the mucous tissues of the respiratory tract, causing cough and sore throat. Atrophy of the mucous membranes is manifested by ENT diseases and frequent infections.
- Pathological processes in the mucous membrane of the urinary system, causing pain during urination and intimacy, involuntary discharge of urine and the development of various infectious diseases.
- Atrophy in the mucous tissue of the tongue with the manifestation of bursting burning pains, smooth surface and relief cracks, redness and changes in the configuration of the tongue.
- Problems with smell and taste - appetite decreases, intolerance to many products is noted, taste is perverted and addictions to the use of completely inedible things (earth, clay, raw meat and fish mince) appear. Such symptoms are characteristic of chronic iron deficiency anemia in women.
- Smelling problems are manifested by gustatory hallucinations when the patient senses non-existent aromas or shows interest in unusual pungent odors.
- Intellectual disabilities - decreased concentration, memory and general development.
IDA treatment - drugs and nutrition
Iron preparations and "helpers"
With obvious symptoms of iron deficiency anemia, treatment is aimed at eliminating the deficiency of trace elements of iron, replenishing its reserves in the body and eliminating the very cause that provoked the disease.
Drug therapy provides for a course of treatment with preparations containing iron. If the full absorption of medications in a natural way is impossible, or when supplies need to be replenished urgently, the drugs are administered intramuscularly or intravenously.
For this purpose, medications are prescribed that compensate for the deficiency and improve the absorption of the microelement - "Hemofer prolongatum", "Sorbifer Durules" and "Ferro foilgamma", intravenous administration of "Ferrum Leka".
In the serious condition of patients with anemia, with upcoming surgical interventions or before childbirth, they are assigned a procedure for transfusion of donor erythrocytes.
Diet
Balanced nutrition is an important link in IDA therapy. When composing a diet for iron deficiency anemia, the fact that good absorption of iron by the body comes from meat dishes and "animal" food is taken into account. It is recommended to include in the diet:
- chicken, pork and beef liver;
- egg yolks;
- beef and lamb, rabbit and chicken;
- cow's milk and cottage cheese;
- buckwheat and seaweed dishes;
- rosehip, prune and currant drinks;
- peaches, apples, almonds and sunflower seeds.
With timely and comprehensive therapy of the disease, the cause of iron deficiency is quickly eliminated without causing any consequences. Undesirable consequences can be caused by untimely diagnosis, not established in time the root cause, late treatment, violation of prescribed drugs and not adhering to the diet.
We are used to thinking about our health last. Often people endure colds “on their feet”, prescribe vitamins and pain relievers to themselves, and medical examination has not yet become a habit among Russians.
At first glance, “trivial” symptoms can signal a serious illness, so it is very important to listen to your body. Signs of anemia in women are often attributed to work overload and stress. However, diagnosis and timely treatment can significantly improve the condition of patients.
What is anemia?
This is a clinical and hematological syndrome, in which the level of hemoglobin in the blood decreases and the number of red blood cells decreases. In itself, anemia is not a disease, therefore, in medicine, there are seven classifications of it for various reasons.
Most often, experts diagnose iron deficiency anemia, in which there is an imbalance in one of the most important elements. It is iron that is in the composition of many enzymes involved in the life of the body.
The causes and symptoms of anemia in women require special attention. At first, the fair sex may not even be aware of their illness. Increased fatigue or drowsiness, bad mood and even hair loss are often attributed to vitamin deficiency.
Unfortunately, multivitamin complexes can only temporarily weaken the signs of anemia in adult women, but an independent solution to the problem is impossible.
Hemolytic, iron deficiency, aplastic, or B12 deficiency - it is impossible to determine the type of anemia based on patient complaints alone, so do not delay your visit to the doctor.
Diagnostics
Even if you read all the literature and learn all the signs of anemia in women, only a specialist can diagnose and prescribe the appropriate treatment. Diagnostics is carried out on the basis of the following studies:
Biochemical blood test (determination of the level of TIBC, iron, hemoglobin, bilirubin and ferritin);
Complete blood count (determination of the number of reticulocytes and platelets, study of the morphology of erythrocytes).
Additionally, the doctor may prescribe an endoscopic and X-ray examination of the intestines and stomach, tomography of the lungs or ultrasound examination of the kidneys - all measures are carried out to exclude various diseases.
Iron-deficiency anemia
Iron deficiency is observed in the following diseases or physiological conditions:
- Blood loss of various origins. Most often, increased consumption of iron occurs with bleeding from the alimentary canal (peptic ulcer, gastritis) and uterine (uterine fibroma). Less commonly, trauma, pulmonary, renal, or nosebleeds are the cause.
- Unbalanced diet. In adults and children, iron deficiency occurs with starvation, chronic malnutrition, and a monotonous diet high in sugars and fats. Babies may not be getting enough of this essential nutrient for iron deficiency anemia during pregnancy.
- Impaired absorption of iron. Iron absorption is impaired due to scarring, atrophic and inflammatory processes in the small intestine. In addition, experts also remind about physiological conditions, due to which the need for iron increases sharply. These include pregnancy and lactation - at this moment the first signs of anemia appear in women. The supply in the body is not enough for the placenta, the needs of the fetus or blood loss during childbirth.
During the first two years of life, due to rapid growth, the baby also needs iron. The next stage of accelerated development occurs during puberty, in girls this is associated with the onset of menstruation.
At risk
Why are we talking specifically about women? Experts have calculated that latent iron deficiency is observed in women of childbearing age (20-30%), and every third woman suffers from iron deficiency anemia.
Main reasons:
Pregnancy;
Uterine bleeding;
Pathological menstruation.
among women
The main signs of anemia can cause a lot of inconvenience. General malaise and weakness, decreased performance and drowsiness are the most common complaints of the fair sex. Additionally, there is dry mouth, shortness of breath, palpitations and impaired swallowing. In severe anemia, dizziness and headache accompany fainting.
Unfortunately, an imbalance in iron is certainly reflected in the appearance:
Decreased appetite, the need for salty, spicy or sour food, a perversion of taste and smell - all these are signs of iron deficiency anemia in women, which quickly disappear with proper treatment.
Treatment
The tactics for treating anemia depends on the severity of the condition and the type of anemia. First of all, it is necessary to establish the cause of its occurrence and, if possible, eliminate it.
An integrated approach will not only help eliminate the signs of anemia in women, but also replenish the reserves of essential substances in the body. Compliance with a therapeutic diet becomes an important step.
With iron deficiency anemia, the attending physician prescribes iron supplements. According to the WHO recommendations, preference is given to drugs with ferrous iron. The duration of treatment should not be less than three months.
Presented on the pharmaceutical market in large numbers:
- "Ferrum Lek".
- "Sorbifer durules".
- "Jectofer".
- "Totem".
- "Conferon".
- "Ferroceron".
- "Maltofer".
- "Ferroplex".
- "Tardiferon".
- "Feramide".
"Iron" products
Iron supplements are prescribed based on laboratory findings and may help relieve the signs and symptoms of anemia.
Treatment tips for women also include a balanced diet that includes foods high in iron:
- Vegetables: mushrooms, green radish, sun-dried tomatoes, spinach, beans, parsley, carrots, broccoli, green peas, and Brussels sprouts.
- Fruits: apricots (dried apricots), watermelon, persimmons, raisins, currants, dates, pomegranates and prunes.
- Red meat. You should not abuse this product, it is enough to eat a small amount of lean meat 2-3 times a week. Offal, such as beef liver, are also incredibly useful.
- Cereals: wild rice, bulgur, oatmeal, barley and corn.
A special diet rich in foods with iron is an effective way to increase the level of hemoglobin in the blood. However, in an emergency, when the hemoglobin level tends to critically low, the attending physician takes more effective measures.
ethnoscience
In folk medicine, there is sure to be a cure for any ailment. It turns out that the signs of anemia in women, according to the old recipes of healers and healers, can be removed with the help of ordinary products.
Tip # 1. Radish - This vegetable has already been on our list. During the day, eat a teaspoon of grated radish (6 receptions). The course of treatment is one month.
Council number 2. To normalize blood pressure, as well as get rid of drowsiness, weakness, lack of appetite and vitality will help Boil a glass of milk and add 2-3 crushed cloves of garlic. Drink 30 ml three times a day.
Council number 3. Elderly patients suffering from anemia, it is useful to drink kefir with honey. A glass of fermented milk drink requires a tablespoon of honey.
Tip # 4. For cooking, you need dried strawberry leaves. Pour a tablespoon with boiling water and leave for twenty minutes. Replace tea with a drink, with the addition of milk and honey, drink twice a day.
Prophylaxis
We know that the fair sex is prone to self-improvement. However, experiments with appearance do not always end well.
The main danger is posed by diets based on the use of a single product or severely restricting the diet. If, for weight loss, a woman refuses for a while from iron-containing products, then her well-being should be under control.
Coffee lovers should reconsider their habits, because excessive consumption of the aromatic drink accelerates the leaching of iron from the body.