Anemia iron deficiency - Causes, symptoms and treatment. MF.

Anemia is a complex clinical and hematological syndrome, manifested by a decrease in the number of red blood cells and hemoglobin of the blood. Anemia is a fairly common disease and according to different data the incidence ranges from 7 to 17% of the population.

Anemias vary in cause, course, symptoms and prognosis. Among all the first place is occupied by iron deficiency anemia, which is up to 80% of cases. According to the World Health Organization, iron deficiency anemia affects every third woman and every sixth man in the world, and up to 50% of young children, which is about 2 billion people.

Iron deficiency anemia is a hypochromic( decrease in hemoglobin in erythrocyte) microcytic( decrease in the size of erythrocytes) anemia, which develops as a result of an absolute deficiency of iron in the body.

The first iron stores the human body receives from the mother through the mother-placenta-fetus system, after birth, iron is supplemented with eating or iron-containing preparations.

Excretion of iron from the body is through the urinary and digestive system, sweat glands and during menstruation in women. A day produces about 2 grams of iron, so in order to prevent the depletion of stocks, it must be replenished in one way or another.

Causes of iron deficiency anemia:

1) Inadequate intake of iron with food

- starvation,
- vegetarianism or iron-protein and protein-poor diet, long-term observable,
- in children breastfed, the cause may be iron deficiency anemia,
- early transfer toartificial feeding,
- later introduction of complementary foods.

2) Increased need for iron

- a period of growth and puberty in adolescents,
- the development of menstrual function in girls,
- frequent ARI( iron intake of infectious agents),
- tumor growth of any site,
- exercise,
-pregnancy,
- breastfeeding.

Despite the fact that during pregnancy, a part of iron is saved due to the absence of menstrual discharge, the need for iron is so increased that it is necessary to replenish it, most often with medications. Almost every pregnancy is accompanied by iron deficiency, expressed in varying degrees. The requirement proportionately increases with multiple pregnancies.

3) Congenital iron deficiency in the body

- prematurity,
- birth from multiple pregnancy,
- severe iron deficiency anemia in the mother,
- pathological bleeding during pregnancy and childbirth,
- fetoplacental insufficiency.

4) Impaired absorption of iron.

In this case, it is not so much the percentage of iron in foods or preparations that matters, but how effective it is in the blood. The violation of iron absorption is due to various diseases of the gastrointestinal tract, absorption is predominantly in the duodenum and is dependent on the mucosa of these parts of the intestine:

- enteritis( inflammation of the small intestine mucosa caused by infection or helminthic invasion),
- gastritis( atrophic,autoimmune) and peptic ulcer of the stomach and duodenum( often caused by the Helicobacter pylori bacterium),
- hereditary diseases: here the paramount importance ofie cystic fibrosis and celiac disease. In addition to impaired absorption of microelements( including iron), they manifest a severe symptom complex, and these children need special nutrition. Therefore, the analysis for these diseases is carried out on day 3-4 in the hospital;
- Crohn's disease( autoimmune lesion of the intestinal mucosa and possibly the stomach),
- condition after removal of the stomach and / or duodenum,
- cancer of the stomach and intestines( here there is a complex mechanism of anemia, mucosal absorption of iron is violated, high risk of bleeding and increasesconsumption due to chronic illness).

5) Increased loss of iron:

- chronic blood loss. This is the largest cause in this group, anemia occurs as a result of regular losses of small blood volumes, this includes losses due to:

~ peptic ulcer of stomach and duodenum, ulcerative colitis, Crohn's disease, hemorrhoids and anal fissures, intestinal polyposis, bleeding from disintegrating tumors of any site and varicose veins of the esophagus;

~ hemorrhagic vasculitis;

~ pulmonary bleeding( bronchiectatic disease, lung cancer, tuberculosis), hemosiderosis of the lungs( chronic lung disease, manifested by repeated haemorrhage into pulmonary vesicles - the alveoli);

~ micro- and macrohematuria( chronic pyelonephritis and glomerulonephritis, polycystosis and kidney cancer, polyposis and bladder tumors), losses in hemodialysis;

~ in women, the frequent causes of chronic iron deficiency anemia are uterine myoma, endometriosis, hyperpolymenorrhea, cervical cancer and other localization;

~ in children and adolescents, a frequent cause is nasal bleeding( Randu-Osler disease and other causes);

- allergic diseases( micronutrient loss in the composition of the sloughing epithelium).

6) Disruption of transferrin synthesis. Transferrin is a transport protein of iron, which is synthesized in the liver.

- congenital defect of transferrin synthesis( often traced to heredity)
- the presence of antibodies( protective proteins blocking its action) to the 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) Application of medicines.

- non-steroidal anti-inflammatory drugs( diclofenac, ibuprofen, aspirin) reduce the viscosity of the blood and may contribute to the occurrence of bleeding, in addition, these drugs can trigger the occurrence of stomach and duodenal ulcers.

- antacids( Almagel, Gastalum, Renni) reduce the production of hydrochloric acid, which is necessary for the effective absorption of iron

- iron-binding drugs( desferal), these drugs bind and release free iron and iron in ferritin and transferrin, and with an overdose can lead toiron deficiency states.

9) Donation.300 ml of donor blood contain about 150 mg of iron, with donations more often 4 times a year, an iron deficiency state develops.

Symptoms of iron deficiency anemia

1) Anemia syndrome
2) Sideropenic syndrome
3) Non -hematological manifestations of anemia

The anemia syndrome is formed due to a decrease in red blood cells and hemoglobin of the blood, which causes a decrease in the saturation of cells and tissues with oxygen. Symptoms of anemic syndrome are not specific, but help to suspect the presence of anemia and, in conjunction with data from other examinations, diagnose.

Subjective signs first manifest at a load greater than usual, and then( with progression of the disease) and at rest:

- general weakness
- increased fatigue and decreased performance
- dizziness
- tinnitus and flickering before the eyes
- episodesheart palpitations
- exertional dyspnea
- syncope

Objective examination reveals:

- pallor of the skin and visible mucous membranes( for example, the inner surface
- tachycardia, various variants of arrhythmia
- moderate heart murmurs, muffled heart tones

Sideropenic syndrome is caused by an iron deficiency in the tissues thatcauses 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, and raw minced meat, uncooked dough, dry cereals), more often expressed in women and adolescents

- propensity to consume spicy, salty, spicy food

- distortion of the sense of smell( attract odors, perceived by most as unpleasant: petrol, acetone, odor of varnishes, paints, lime)

- muscle strength and muscle atrophy due to myoglobin deficiency( oxygen binding protein in skeletal muscles) and tissue respiration enzymes

-dystrophic changes of the skin( dryness up to the formation of cracks, peeling), hair( brittle, falling out, dimness, early graying), nails( dullness, transverse striation, coilonichia - spoon-like concavity of the nails).Reduces the regenerative function of the skin( for a long time minor injuries, abrasions do not heal).

- 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 raspiraniya in the area of ​​the tongue, reddening and atrophy of the papillae( the so-called "lacquered tongue", the surface of the tonguethis case is not velvety as normal, but smooth and even shiny), frequent periodonts and caries

- atrophic changes in the mucous membrane of the gastrointestinal tract( dryness of the mucosa of the esophagus, which causes pain when swallowing and difficulty in swallowing solid food - sideropeniathe development of atrophic gastritis and enteritis

- dystrophic changes in the muscles of the sphincter of the bladder( urgent urination, inability to retain urine during coughing, laughing, sneezing, episodes of bedwetting)

- the symptom of the "blue sclera" is characterized by bluish coloring of the sclera(due to deficiency of iron and insufficient function of some enzymes, the collagen synthesis is broken, and it becomes thinner and through it the small vessels shine)

- "sideropenic subfebrile- prolonged body temperature increase to low-grade figures( 37.0-37.9 ° C) for no apparent reason.

- predisposition to infectious and inflammatory diseases( frequent ARI and other infections), tendency to chronic infection

- decreased resistance to heavy metals poisoning

Non-hematologicalconsequences of anemia:

- fetal growth retardation in pregnant women with anemia,
- menstrual cycle disorder,
- impotence,
- behavioral changes, decreased motivation, intellectual abilities, these simstoms are more pronounced in children and adolescents and disappear in the reduction of iron stores.

Diagnosis of iron deficiency anemia

I. General examination of ( skin color and mucous type of body type), patient questioning( chronic diseases, attitude to alcohol, heredity, for a woman's character of menstruation and date of last menstruation), palpation( soreness of belly and waist,volumetric formation of the abdomen and mammary glands, the size and mobility of the lymph nodes), percussion( tapping to determine the boundaries of the heart and liver, the soreness of flat and tubular bones), auscultation( listening to possible wheezingin the lungs, the noises and the rhythm of the heart).

II. UAC( general blood test) or CRAC( clinical expanded blood test) is the main study in the primary diagnosis of anemia.

Here we give the most important indicators so that you can be guided by the analysis:

Hb( hemoglobin) - the norm in women is 120-150 g / l, for men 130-170 g / l.

RBC( erythrocytes) - the norm of 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 elderly people the concentration of erythrocytes can also be increased to 6.0 * 1012 / l. In both cases, such indicators are considered the norm.

RET( reticulocytes) - norm from 0,8 - 1,3 to 0,2 - 2%.

Hct( hematocrit, ie the ratio of blood cells to the liquid part of it) - in men it reaches 40-48%, in women it is somewhat lower - 36-42%.

MCV( mean erythrocyte volume) is the norm of 75-95 μm3.

MCH( average content of hemoglobin in erythrocytes) is 24-33 pg.

MCHC( mean hemoglobin concentration in erythrocytes) is a norm of 30-38%.

WBC( leukocytes) - 3.6-10.2 * 10 9 / l.

PLT( platelets) - 152-343 * 10 9 / l.

III. OAM( general urine test) , the loss of protein in the urine and the presence of blood in the urine

are of paramount importance

IV. General biochemical studies ( total protein, glucose, bilirubin total and direct, ALAT, ASAT, SHF, creatinine, urea, LDH, CRP)

V. Specific biochemical studies of

1. determination of serum iron

norm: children up to1 year - 7.16-17.90 μmol / l;
children from 1 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 serum( norm in women: 38.0-64.0 μm / L, in men 45.0 - 75.0 μm / l)

3. iron saturation of transferrin( normal about 30%)

4. Transferrin content( norm 2.0-4.0 g / l)

5. Serum ferritin content( μg / L = ng / ml)

newborns 25 - 200
1 month 200 - 600
6 months - 15 years 30 -140

males 20 - 350
females 10 - 150

Pregnancy:

1st trimester 56 - 90
2nd trimester 25 - 74
3rd trimester 10 - 15

6. Desferase test( after intravenous administration of 500 mgesferala a healthy person in the urine is released from 0.8 to 1.2 mg iron in patients with iron deficiency anemia is lower).

VI.Further in terms of pre-examination you can be assigned:

- blood test for HIV and hepatitis B and C
- lung X-ray, if necessary, bronchoscopy with biopsy( taking a piece of tissue for analysis), computed tomography of the lungs
- parasitic feces analysis and occult blood
- ECG and acidity of gastric juice
- ultrasound of internal organs and kidneys
- intestinal examination( irrigoscopy, sigmoidoscopy, colonoscopy)
- consultation of urologist, gynecologist, proctologist, gastroenterologist
- sternal pu(sampling of red bone marrow from sternum for examination)
- ultrasound of uterus and appendages
- sputum examination for alveolar macrophages containing hemosiderin
- consultation of endocrinologist, rheumatologist
- analysis for oncom markers

Treatment of iron deficiency anemia

1. Diet
2 Oral iron preparations
3. Injectable iron preparations
4. Blood transfusion

Diet in the treatment of iron deficiency anemia

Diet in complex treatment of iron deficiencyth anemia can be effective in the normal assimilation 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 meat, turkey, liver, sea fish, heart, buckwheat and millet, eggs, greens, peas, nuts, cocoa, apricots, apples, peaches, persimmons,quince, blueberry, pumpkin seeds), ascorbic acid, which improves the absorption of iron( bell pepper, cabbage, dogrose, currant, citrus, sorrel).

Limit foods that interfere with iron absorption: black tea, all dairy products.

Medications for iron deficiency anemia

Oral iron preparations( in tablets, drops, syrup, solution) are the starting treatment for anemia of mild and moderate severity, in the presence of pregnancy, the admission is consistent with the obstetrician-gynecologist.

- sorbifer durules / phenyulses 100 1-2 tablets 1-2 times a day until the recovery of hemoglobin( in pregnant women for prevention 1 tablet 1 time per day for 1 tablet 2 times a day).

- ferretab 1 capsule per day, up to 2-3 capsules per day in 2 divided doses, the minimum duration of admission is 4 weeks, then according to the indications.

- maltofer occurs in three dosage forms( drops, syrup, tablets), reception for iron deficiency anemia of 40-120 drops / 10-30 ml of syrup / 1-3 tablets per day in 1-2 divided doses. Children under 1 year 10-20 drops, 2.5-5 ml syrup in 1-2 divided doses, children from 1 year to 12 years 20-40 drops, 5-10 ml syrup in 1-2 divided doses;reception for 3-5 months under the control of the level of hemoglobin.

- tardiferron / ferrogradumet for 1-2 tablets per day until the recovery of hemoglobin, pregnant women 1 tablet per day II-III trimester.

- activiferin 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, preschool children 25-35 drops 3 times a day.

- totem( combined preparation of iron, copper and manganese) for 2-4 ampoules per day, the solution is diluted in 1 glass of water, taken for 3-6 months, children 5-7 mg / kg of weight in 3-4 hours.

Injection preparations are used exclusively in the hospital( it is necessary to be able to provide anti-shock care), contraindicated in pregnancy and lactation.

- venofer( solution strictly for intravenous administration, calculation of dose and speed of administration is done individually).

- Cosmosfer( solution for iv and / m administration, calculation of dose and method of administration is done individually).

- ferrinject( solution for intravenous administration or in the dialysis system).

Transfusion( transfusion of blood components) is performed in severe anemia, according to strict indications and in a hospital.

Features of the course and treatment of iron deficiency anemia in children

Anemia in children manifests common symptoms( pallor of the skin and mucous membranes, general lethargy, tearfulness, sweating, decreased appetite, sleep disturbances), infants often have regurgitation and vomiting after feeding, in children afteryear, there may be a regression of motor skills, reduced vision, dystrophic changes in the skin, hair and nails, tooth decay.

With the progression of the disease, it is possible to observe the development of functional noise in the heart, tachycardia, headaches, fainting, it is possible to increase the size of the liver and spleen, the appearance of unusual taste inclinations - the desire to eat chalk, clay, earth.

Treatment of anemia in children includes 4 principles: normalization of diet and nutrition, possible elimination of the cause of iron deficiency, iron therapy, concomitant therapy.

Recommended:

- priority of breastfeeding,
- long walks in the air, prevention of acute respiratory infections,
- introduction of meat complementary foods from 6 months,
- exclude lure of manna, rice, porridge, preference for buckwheat, barley, millet,
preparations of iron( maltofer, activiferin, totem) under the control of the pediatrician.

The effectiveness of treatment can be judged after 7-10 days( the increase in reticulocytes by 2 times in comparison with the initial, the increase in hemoglobin by 10 g / l and more per week), treatment lasts at least 3 months. If the prescribed treatment is ineffective, then other drugs should be considered, possibly increasing the dose to the maximum therapeutic dose, sources of chronic blood loss, foci of chronic infections, the presence of neoplasms and helminthic invasions, concomitant vitamin B12 deficiency should be excluded.

Subject to the principles of complex therapy, the symptoms of anemia quickly regress.

Complications of iron deficiency anemia

Complications occur with prolonged anemia without treatment and reduce quality of life.

- decreased immunity,
- increased heart rate, which leads to a greater heart strain and eventually to heart failure,
- in pregnant women, the risk of premature birth and fetal growth retardation increases,
- in children the lack of iron causes growth and development retardation,
- a rare and severe complication is a hypoxic coma,
- hypoxia due to lack of iron complicates the course of already existing cardiopulmonary diseases( IHD, bronchial asthma, bronchiectatic disease and others).

Forecast

In most cases, iron deficiency anemia is successfully amenable to correction, signs and symptoms of anemia recede. However, in the absence of treatment, complications develop and the disease progresses.

If you have a reduced level of hemoglobin, then you need to undergo a complete clinical and laboratory examination and identify the cause of anemia. Correctly diagnosed is the key to successful treatment.

Doctor therapist Petrova A.V.