Low hemoglobin( anemia) - Causes, symptoms and treatment. MF.

Anemia is a condition in which the content of functionally full red cells( erythrocytes) is reduced in the blood. Quantitatively, it is expressed by the degree of decrease in the concentration of hemoglobin - the iron-containing pigment of erythrocytes, which gives blood red color.

In order to understand the causes of a decrease in hemoglobin in the blood, you need to know the mechanism of its formation in the body. Hemoglobin is a complex iron compound with a protein found in red blood cells( Erythrocytes).

The main function of hemoglobin is to participate in the transfer of oxygen molecules to the organs and tissues of the body, by constantly capturing oxygen in the lungs and giving it back to all needy structures for further oxidation-reduction reactions and obtaining energy for the vital functions of the body.

To form hemoglobin, the following conditions are necessary: ​​

1. Sufficient iron content in consumed food.
2. Normal absorption of iron in the stomach and small intestine.

3. The presence of animal protein in food.
4. Of particular importance is the content of vitamin B12 and folic acid, which are also absorbed in the upper sections of the gastrointestinal tract and are of direct importance for the formation of red blood cells in the bone marrow of a person. With a decrease in the number of erythrocytes, the amount of hemoglobin in recalculation per one liter of blood decreases accordingly.
5. Absence of pathology in the system of blood formation.(hereditary and acquired blood diseases

Norm of hemoglobin in the blood

The normal values ​​of the hemoglobin in the blood are:

For men 130-160 grams per liter of blood
For women 120-147 g / l
For pregnant women the lower limit of the norm is 110 g

Diagnosis

For the diagnosis of iron deficiency anemia( low hemoglobin), the following tests are required:

Complete blood test( taken from the finger) - on modern hematology analyzers, we determine the amount of hemoglobin in the assayWe measure the average color and the diameter of the erythrocyte( the norm is 7.0-7.8 μm). The number of reticulocytes( precursors of erythrocytes) whose norm is4-12% testifies to the regenerative capacity of the bone marrow. Displacement of these parameters may indicate to the doctor the cause of low hemoglobin.

The concentration of iron in the blood serum( taken from the vein -norm 12.0 to 26.0 μmol / l).A decrease in this indicator indicates a lack of iron in the food consumed or insufficient absorption of it in the gastrointestinal tract.

Total iron binding capacity of blood serum( taken from the vein-norm 42.3-66.7 μmol / l).The increase in this indicator also confirms the lack of iron in foods or the poor performance of the digestive system.

Having obtained the results of the tests and finding out that the diagnosis of low hemoglobin is confirmed, we proceed to find out the reasons for its lowering. By collecting an anamnesis, we rule out vegetarianism. Further we find out the state of the gastrointestinal tract. This fibrogastroskopiya( FGS), not very pleasant but necessary procedure allows you to judge the state of the mucosa of the stomach and duodenum involved in the absorption of iron and vitamin B12.(allows to exclude atrophic gastritis. ulcer disease of the stomach and duodenum).

It is necessary to visit a surgeon who, with an external examination and finger examination, will exclude hemorrhoids. In the event of suspicion of other diseases, more complicated procedures are appointed, such as sigmoidoscopy( examination of the rectum with the help of a sigmoidoscope through the back passage).The examination of the colon is called fibrocolonoscopy, which is an even more laborious examination, when the colonoscope reaches a distance of more than three meters through the rectum and actually allows one to examine the entire large intestine( these examinations primarily exclude colitis and oncological diseases.intestines Recommendations for this should be given to you when you write for the exam.

Irrigoscopy - X-ray examination of the small intestinewith the use of contrast agent, allows to exclude the pathology of the small intestine.

In case the diagnosis after all the above-mentioned examinations remains unclear, any clinic has the right to use its available quotas for high-tech care, in this case it is a computer and magnetic resonance imaging using a contrast medium.

Next, for women, of course examination with a gynecologist, which, if necessary, appoints ultrasound of the pelvic organs, where the uterine myoma and ovarian cysts are excluded., polymenorrhoea, etc.

In even more complicated cases, to exclude blood diseases, consultation of a narrow specialist - hematologist

is required. Causes of loss of hemoglobin by the body.

1. Explicit and hidden blood loss. To the apparent can be attributed visible bleeding in conditions such as polymentorrhea( profuse, prolonged, more than five days a month) in women. With hemorrhoids, bleeding gums, as well as blood loss in injuries and operations. Hidden are blood loss in diseases of the gastrointestinal tract. There is also the concept of pseudo blood loss in women with diseases such as the ovarian cyst, uterine fibroids, diseases in which there are, cavities in the myomium or ovaries periodically filled with blood, with further conversion of hemoglobin into another compound and gradual resorption with sufficient periodicity of the process.

2. Processes in the body leading to a reduction in the lifespan of erythrocytes or to their destruction.(autoimmune and infectious diseases, hereditary pathologies).

3. Personnel donation( when a person regularly surrenders blood).

One of the causes of low hemoglobin, especially in preschool children, is unbalanced by vitamin-mineral composition nutrition.

Having ascertained the process of formation and loss of hemoglobin, one can understand the symptoms manifested with reduced hemoglobin.

Symptoms with low hemoglobin

1. Asthenic - general weakness, fatigue, drowsiness, dizziness, headaches, heart palpitations, low blood pressure, in severe cases fainting.

2. Dystrophic - a decrease in hemoglobin in the blood in most cases is an indirect sign of a lack of iron in the organs and tissues of the body. Consequently, the following manifestations occur:
a.changes in nail plates, they become brittle, thinner, delaminated, striated.
b. Dryness of the skin, painful cracks in the corners of the mouth.
c. Hair loss or slow growth.
. Disorders of taste and smell, up to eating inedible substances( chalk, dental powder, coal, earth, clay, sand, matchheads) and raw products( cereals, dry pasta, dough, forcemeat, it.t.).As the most pleasant patients note the smell of acetone, nail polish, paints, rubber, naphthalene, car exhausts.
d. Unreasonable subfebrile condition( a slight increase in body temperature in the range 37-37.5 gr. C).

The appearance of the patient with the unfolded picture of hemoglobin deficiency in the blood is characteristic.

This is primarily the pallor of the skin and visible mucous membranes. With a decrease in hemoglobin caused by a lack of vitamin B12, typically a change in the mucous tongue, the so-called glossitis is "polished," a bright red, painful tongue. In some forms of anemia with a decrease in the level of hemoglobin, due to increased destruction of red blood cells, the skin can take an icteric tinge.

It should be borne in mind that in the initial stages of iron deficiency anemia, clinical manifestations may be mild, and in some cases, in general, asymptomatic.

Anemia accompanies a variety of diseases and is often only their symptom.

Disease is one of the signs of which is decreased hemoglobin:

1. Chronic post-hemorrhagic iron-deficiency anemia( IDA)( various blood loss, described above).

2. Allied iron deficiency anemia( IDA) is the cause of iron deficiency in food.

3. IDA with increased iron consumption( pregnancy, lactation, growth and maturation period).

4. Diseases associated with impaired absorption of iron and vitamin B12 in the gastrointestinal tract:
a. Chronic atrophic gastritis( thinned gastric mucosa).
b Chronic enteritis( inflammation of the small intestine is one of the reasons that can be dysbacteriosis or irritable bowel syndrome arising from a background of frequent stresses).
c. Postrezektsionnaya IDA( with the removed part of the stomach or small intestine).

5. Diseases associated with a violation in the human immune system characterized by pathological formation of immune complexes with the participation of erythrocytes, as a result of which premature death of erythrocytes occurs. These include:
glomerulonephritis, rheumatoid arthritis, lupus erythematosus and other systemic vasculitis.

6. Reduction of hemoglobin can occur with long-term infectious diseases( gastroenterocolitis in folk speech called dysentery and salmonellosis, chronic hepatitis C and B, long-term pneumonia, tuberculosis, pyelonephritis, etc.).The reason is also in the early destruction of red blood cells and the increased need for iron in the body to restore homeostasis.

7. Glistovye invasions - a wide ribbon that absorbs from the body a large amount of vitamin B12.

8. Blastomatous( malignant) blood diseases.

9. Malignant neoplasms, especially the gastrointestinal tract with them, the decrease in hemoglobin occurs due to impaired absorption of iron, as well as due to latent blood loss. With all other tumor localizations, the decrease in hemoglobin occurs to a lesser extent, apparently due to changes in metabolic processes in the body occurring under these diseases. But this is considered a very important sign requiring attention, especially in men who have had high hemoglobin values ​​throughout their life and suddenly decreased even within normal limits.

It should be noted that the first four groups of diseases are the cause of decreased hemoglobin in more than 90% of the cases.

Treatment and prevention of iron deficiency anemia with a deficiency of hemoglobin.

Therapeutic tactics for IDA should be aimed not only at normalization of hematological parameters( hemoglobin, erythrocytes, color index), but also restoration of serum iron concentration, adequate stores in the depot organs( primarily the spleen and liver, as well as muscle tissue).

Treatment should be started as soon as possible with measures to eliminate the cause of its development, primarily micro and macro-circulation( removal of fibroids of the uterus, excision of hemorrhoids, hormonal correction of dysfunctional uterine bleeding, treatment of gastroduodenal ulcers, gastroduodenitis, enteritis, etc.).

The main pathogenetic method of treatment of IDA( reduced hemoglobin) is the appointment of iron preparations, and the reception of the latter inside, preferably before the parenteral administration.(administration of drugs intramuscularly and intravenously).Injections of iron preparations should preferably be performed in a hospital, since there is a high percentage of allergic reactions to iron preparations.

The dose of iron preparations should be sufficient to obtain a therapeutic effect, but also not excessive, not causing the phenomenon of intolerance.

This dose usually ranges from 100 to 300 mg of elemental iron per day. With good tolerability should be used at the maximum dose to restore the level of hemoglobin and erythrocytes. When normal hemoglobin figures are reached, treatment does not stop, but continues usually within 2-3 months, under the control of the quantity of iron in red blood cells and serum. So, that you need to adjust for long-term treatment, at least 2-6 months. After reaching the normal parameters of peripheral blood, the medication is taken in a daily dose of 2-3 times less than that with which the hemoglobin is normalized. Therapy is carried out before replenishment of iron stores in iron depot organs. This is controlled by blood indicators such as serum iron, the total iron binding ability of blood serum. Antiretroviral therapy for chronic IDA is performed in patients with unresolved etiologic factors( profuse and prolonged menstruation and uterine bleeding, blood loss associated with hemorrhoids, intestinal diseases).Therapy is carried out individually selected by small doses of iron preparations( 30-60 mg of iron per day) in the form of one-month repeated( 2-3 times a year) courses, or the appointment of such iron therapy for 7-10 days monthly( usually during and after menstruation), under the control of hemoglobin and iron metabolism.

If low hemoglobin is associated with insufficient intake of vitamin B12( megaloblastic anemia), subcutaneous injections of vitamin B12( cyanocobalamin) are prescribed. Enter a dose of 200-500 mcg once a day, for four to six weeks. After normalization of hemopoiesis and blood composition, which usually occurs after 1.5-2 months, the introduction of the vitamin once a week continues for another 2-3 months.

In the process of treatment with iron preparations, it is not worth waiting for an increase in the amount of hemoglobin earlier than in a month of treatment. The doctor judges the effectiveness of treatment by changing the number of reticulocytes( the precursors of erythrocytes) in a general blood test. After 8-10 days after the initiation of therapy with vitamin B12 and iron preparations, the amount of reticulocytes rises several times, a so-called "reticulocyte crisis" is observed. That speaks about the success of the therapy. Often, B12 deficiency anemia is accompanied by a deficiency in the body also folic acid. In this case, folic acid is added to the treatment, in a dose of 5-15 mg per day, with a course of 20-30 days.

The iron deficiency anemia is divided according to the degree of decrease in hemoglobin:

Latent iron deficiency anemia is when the hemoglobin content in erythrocytes is normal and serum iron is lowered, but symptoms of decreased hemoglobin can already be observed. In these cases, the condition correction is achieved by low doses of iron( 30-40mg per day) within 1-1.5 months according to indications 2 - 3 times a year. This condition is also characteristic during pregnancy. Over-the-counter drug in this case ferretab composite containing 0.154 g iron fumarate and folic acid 0.005 g. Depending on the parameters of serum iron and total iron-binding capacity of blood serum, 1-3 capsules per day are prescribed for at least 4 weeks.

Light degree( hemoglobin 110-90 g / l).
Medium degree( hemoglobin 90-70 g / l).
Severe degree( hemoglobin below 70 g / l).

OTC drugs are the most commonly used for correcting iron deficiency states.

Ferretab composite ( 0154g fumarate of iron and 0.0005g of folic acid).In addition, the intake of ascorbic acid in a daily dose of 0.2-0.3 g is desirable).

Sorbifer durules ( 0.32 g of ferrous sulfate and 0.06 g of vitamin C) is produced in a pellet daily dosage, depending on the degree of anemia 2-3 times a day.

Totem - is available in vials of 10 milliliters, the content of elements is the same as in sorbipers. It is applied orally, it can be diluted with water, it is possible to administer it with intolerance to tabletted forms of iron. The daily dose of 1 to 2 admission.

FENYULS ( 0.15g, ferrous sulphate, 0.05g vitamin C, vitamins B2, B6.0.005g calcium pantothenate

Vitamin B12 in ampoules of 1 ml 0.02% and 0.05%

Folic acid intablets of 1 mg

Ampoule preparations of iron, for intramuscular and intravenous injection, are sold only by prescription and require injections only in hospital due to the high incidence of allergic reactions to these drugs.

Given the best absorption, iron preparations are prescribed before meals, if there is no vitamin C in the medicine, additional intake of ascorbic acid in a daily dose of 0.2-0.3 g is required. In some patients, signs of iron intolerance are observed during treatment, especially if it is used for a long time: loss of appetite, nausea, vomiting, abdominal pain, intestinal dysfunction in the form of diarrhea or constipation, etc., which disappear after lowering the initial doses of the drug and prescribing iton time or after eating. In some cases, patients with a predilection for intestinal disorders iron preparations are appointed together with enzymes( mezim forte, festal, panzinorm).When exacerbation against the background of treatment, gastritis, peptic ulcer of the stomach or duodenal ulcers, at the same time, antiretroviral drugs( almogel, ranitidine, omez) are prescribed.

How to increase hemoglobin folk remedies

Treatment of iron deficiency anemia should be conducted against a background of a diet rich in iron and animal proteins, the main sources of which are meat and meat products, especially beef. The commonly recommended vegetables and fruits are useful mainly as a source of large amounts of vitamins, especially ascorbic acid, which promotes better absorption of iron. The dishes containing blackcurrant, citrus, kiwi, dog rose, strawberry, etc. will be useful here. In cases of anemia with unresolved risk factors( hyperpolymenorrhea - profuse monthly, microhematuria with hemorrhoids, frequent nasal bleeding), it is advisable to use the following infusion from the phytospora containing nettle leaves, yarrow herb, hips and mountain ash. Apply 1/3 or 1/2 cup 2-3 times a day. Courses for two weeks during profuse menstrual periods, also in the period of exacerbation of diseases accompanied by micro bleeding.

Naturally, it is necessary to eliminate the causes of low hemoglobin as soon as possible by timely treatment of all diseases contributing to its reduction( see "causes of hemoglobin loss", "diseases of which one of the signs is lower hemoglobin", set forth above).

Which doctors should be treated with low hemoglobin.

Doctors may need help:

- Gynecologist
- Infectionist
- Nephrologist
- Oncologist
- Gastroenterologist

Therapist Shutov A.I.