Miscellaneous

Iron deficiency anemia, symptoms and treatment

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Iron deficiency anemia (anemia) - pathological syndrome characterized by a decrease in the number of erythrocytes and hemoglobin. It is the main hypoxia of tissues and organs, as on the background of lack of erythroid cells delivered little oxygen.

Particularly dangerous this state for the brain. Nerve cells under hypoxia die, which leads to a gradual degradation of the individual. In the initial stages of the disease a person feels constant fatigue and decreased performance. If these symptoms perform laboratory blood test, it is determined by a decrease in hemoglobin and red blood cells.

What it is?

Anemia - a comprehensive clinical and hematological syndrome, manifested by a decrease in the number of red blood cells and hemoglobin. Anemia - a fairly common disease, and according to various sources the incidence ranges from 7 to 17% of the population.

Iron deficiency anemia - a hypochromic (reduction of hemoglobin) microcytic (Decrease erythrocyte size) anemia, which develops due to the absolute iron deficiency body.

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Why the lack of iron causes the disease

It is established that the mechanism of the disease associated with a deficiency of iron minerals in the blood. Its role is difficult to overstate. After the total amount of 70% are directly involved in the construction of hemoglobin. This means that the iron - indispensable material for holding the erythrocytes oxygen molecules and subsequent transfer process from pulmonary bubbles in the tissue.

Any variant of iron deficiency leads to a decrease in the synthesis of hemoglobin and oxygen starvation of the whole organism.

Other mechanisms that influence the level of iron

It is not only the mineral intake from food (the body's iron is not generated), but also the correct process of assimilation and migration.

Molecules for absorption of iron from the duodenum 12 corresponds to a special protein (transferrin). He delivers Fe in the bone marrow, where red blood cells are synthesized. The body forms a "warehouse" in the liver cells to quickly fill in the case of acute shortage. Reserves stored as hemosiderin.

If you put all forms of iron in parts, we get the following:

  • 2/3 of hemoglobin;
  • stocks in the liver, spleen and bone marrow in the form hemosiderin - 1 g;
  • a transport form (serum iron) - 30.4 mmol / l;
  • on the respiratory enzyme cytochrome oxidase - 0.3 g

The accumulation begins during the prenatal period. The fruit takes a part of iron in the maternal organism. Anemia is dangerous for the mother and the formation of a bookmark of the internal organs of the child. And after the birth of the baby should receive it only with food.

Excretion of the mineral surplus occurs in the urine, feces, through the sweat glands. The women from adolescence to menopause there is a way of menstrual bleeding.

  • The daily output of about 2 g of iron, then supplied in the diet should not fewer.

The correct functioning of this mechanism depends on maintaining the right balance for tissue respiration.

Causes of

A necessary condition for the development of disease is the excess prostate tissue consumption over its receipt. Iron deficiency provokes the following states (listed on prevalence):

Blood loss

chronic (daily blood loss of 5-10 ml)

  • frequent nosebleeds;
  • stomach and intestinal bleeding;
  • heavy menstruation;
  • renal pathology with characteristic hematuria.

Acute (massive blood loss)

  • trauma, extensive burns;
  • Uncontrolled donation;
  • abnormal bleeding (e.g., uterine cancer pathology and at al.).

Inadequate iron intake

  • exhausting diets and starving;
  • unbalanced diet;
  • vegetarianism.

Reduction in the absorption of iron

  • Gastrointestinal diseases, parasitic infestation;
  • senile and infancy.

Raising the necessary level of iron

  • active growth (1-2 year and adolescence);
  • pregnancy, lactation (the need for iron is increased to 30 mg twice / day.);
  • the formation of the menstrual cycle;
  • exercise, sport;
  • frequent inflammations (ARI et al.).

Congenital anemia in children

  • preterm pregnancy
  • anemia in pregnant women.

severity

Depending on the depth of iron deficiency distinguish 3 severity IDA:

  1. Light - hemoglobin values ​​are within 110 - 90 g / l;
  2. Medium - Hb content ranges from 90 to 70 g / l;
  3. Heavy - hemoglobin level falls below 70 g / l.

Man begins to feel bad already at the stage of latency deficiency, but the symptoms will become clearly visible only when sideropenic syndrome. Before the appearance of the clinical picture of iron deficiency anemia in full it will take years 8 - 10 and only if person who is not interested in their health, learns that he has anemia, that is, when the noticeable decline hemoglobin.

Symptoms of iron deficiency anemia

The main symptoms of iron deficiency anemia in women and men:

  • dyspnea;
  • the taste and smell;
  • tendency to infections;
  • language loss;
  • fatigue;
  • changes in skin (peeling and redness) and nails / hair (separation, loss);
  • mucous membranes (e.g., oral ulcers may appear on stomatitnyh type);
  • violations of intellectual development - reduced concentration of attention, the child begins to absorb bad teaching material, loss of memory;
  • muscle weakness.

In the clinical picture of iron deficiency anemia allocate 2 main syndrome:

  • giposideroz;
  • anemic syndrome.

anemic syndrome

This syndrome is manifested by nonspecific symptoms, characteristic of all anemias:

  • dyspnea which appears with minimal exertion;
  • disruptions in heart;
  • dizziness when changing position of the body;
  • tinnitus.

Intensity of the above symptoms depends on the rate of hemoglobin decline. Iron deficiency anemia is a chronic nature of the flow, so patients are able to adapt to its manifestations.

In some cases, the first complaint in iron deficiency anemia can be:

  • fainting;
  • angina;
  • decompensation of cerebral vascular lesions.

Giposideroz

Giposideroza symptoms associated with a lack of iron in the tissues. This is followed by:

  • deterioration of the hair structure with the tips of delamination;
  • symptoms of asthenia;
  • excessive skin dryness, yielding minimal correction using moisturizing cosmetics;
  • pathological changes in the nails, transverse striation of the nail plate, change its form;
  • violation of the protective properties of the organism with frequent viral diseases;
  • advent angular stomatitis, cracks manifested with inflammation of portions of the corners of the mouth;
  • signs of inflammatory lesions of language;
  • change in skin color to a pale greenish hue;
  • unusual eating habits (like eating chalk, ash and other substances);
  • predilection for unusual odors;
  • blue sclera due to degenerative changes in the cornea against iron deficiency.

According to recent research conducted by pediatricians and hematologists in children with tissue iron deficiency observed mental retardation. This is associated with impaired myelination of nerve fibers with a reduction in electrical brain activity. Also in young patients have a higher risk of developing heart failure, however, clear mechanisms of myocardial damage is not revealed when giposideroze.

Diagnostics

Fault state and its severity determination carried out on laboratory results. For iron deficiency anemia is characterized by the following changes:

  • decrease of blood hemoglobin (normal women - 120-140 g / l for men - 130-150 g / l);
  • poikilocytosis (changing the shape of red blood cells);
  • reducing the concentration of ferritin (norm for women - 22-180 g / l for men - 30-310 g / l);
  • microcytosis (the presence of abnormally small in size of red blood cells);
  • hypochromia (color index - less than 0.8);
  • decrease in serum iron concentration (normal women - 8,95-30,43 mol / l for men - 11,64-30,43 mol / l);
  • reduction of iron saturation of transferrin (norm - 30%).

Effective treatment of iron deficiency anemia is important to establish the cause, caused it. In order to detect the source of chronic blood loss shown holding:

  • FEGDS;
  • barium enema;
  • ultrasound of the pelvic organs;
  • X-ray of the stomach with contrast;
  • colonoscopy;
  • study fecal occult blood.

In complex cases perform diagnostic puncture bone marrow with subsequent histological and cytological examination punctate obtained. A significant reduction in the sideroblasts it indicates the presence of iron deficiency anemia.

Differential diagnosis with other types of hypochromic anemia (thalassemia, sideroblastic anemia).

Treatment of iron deficiency anemia

Provides treatment of iron deficiency anemia only lengthy reception ferric iron preparations inwardly moderate doses, with a significant increase in hemoglobin, in contrast to the improvement of well-being, will not be soon - through 4-6 weeks.

Usually given any drug ferrous - ferric sulfate is usually - better than his prolonged dosage form, in high therapeutic doses for several months, then the dose is reduced to a minimum for a few more months, and then (if the cause of anemia is not resolved), continued receiving supporting minimum dose for a week, a month, many years.

Thus, this practice is well justified in the treatment of women with chronic tardiferon post hemorrhagic iron deficiency anemia due to long-term giperpolimenorrei - one tablet in the morning and evening of 6 consecutive months, followed by one tablet per day, 6 more months, and then a few years for a week each day monthly days. This provides iron load when a heavy menstruation tightened during menopause. Is meaningless anachronism hemoglobin levels before and after menstruation.

When agastralnoy (gastrectomy for tumors) anemia good effect gives reception minimum dose of the drug is constantly many years and the introduction of vitamin B12 for 200 micrograms per day, intramuscularly or subcutaneously for four weeks each year life.

Pregnant women with iron deficiency and anemia (a slight decrease in hemoglobin and red blood cell count due to physiological and moderate polyplasmia requires treatment) is assigned the average dose of iron sulphate inwardly before delivery and during lactation, if the child does not arise diarrhea, which is usually rarely happens.

Popular products of iron

Currently the attention of doctors and patients a wide range of drugs to increase the iron content in the body.

The most effective drugs for increasing the concentration of iron include:

  • Ferrum Lek;
  • Maltofer;
  • Ferropleks;
  • gemofer;
  • Ferrotseron; (Urine stains in pink);
  • tardiferon;
  • Ferrogradumet;
  • Heferol;
  • Ferograd;
  • Sorbifer-durules.

Preparations for parenteral administration appointed in violation of iron absorption in the gastrointestinal tract (Gastrectomy, gastric ulcer and 12 duodenal ulcer exacerbation, resection of large areas of thin intestine).

When prescribing drugs for intravenous and intramuscular injection in the first place need to be aware of allergic reactions (Hot flashes, palpitations, chest pain in the lower back and calf muscles, a metallic taste in the mouth), and the possible development of anaphylactic shock.

Ferrumsoderzhaschih list of drugs is not a guide to action, assign and calculate the dose - it is the treating physician. Therapeutic doses are assigned to normalize the hemoglobin level, then the patient is transferred to preventive dose.

How long should I take iron supplements?

  1. If the treatment is effective, the 10-12 day dramatically increased the number of young red blood cells - reticulocytes.
  2. After 3-4 weeks increased hemoglobin.
  3. 1,5-2 months complaints disappear.
  4. Deficiency of iron in the tissues persists only after 3 months of continuous oral iron - that is how much and should continue the course of treatment.

Thus, iron deficiency anemia - a frequent and well studied, but rather offensive disease. Low levels of hemoglobin - is just the tip of the iceberg, revealing significant changes in tissues associated with iron deficiency. Fortunately, modern drugs can fix these problems - with the proviso that the treatment will be brought to an end, and the reasons why, eliminated the possibility.

side effects

Most often in the treatment of iron preparations observed following side effects: metallic taste, darkening of tooth enamel, allergic skin rashes, digestive disorders as a result of irritation to the mucous membrane of the digestive tract, particularly the intestine (diarrhea, nausea, vomiting). Therefore, the initial dose of drug must be 1 / 3-1 / 2, followed by treatment to increase their total dose over several days in order to avoid pronounced side effects.

Intramuscular administration of iron preparations is carried out only on strict because of pronounced local and systemic side effects. Indications for intramuscular administration of iron preparations are: digestive diseases (impaired intestinal absorption syndrome, ulcerative colitis, chronic enterocolitis, gastro-intestinal bleeding) and iron preparations intolerance when receiving through the mouth.

Contraindications to anemia iron preparations are not due to iron deficiency (haemolytic, aplastic), hemosiderosis, hemochromatosis.

Diet

International Hematology Association states that for normalization of eating a patient with mild symptoms of iron anemia, can be largely normalize the blood and does not resort to the use of iron supplements to correct iron deficiency state. Patients with severe anemia shows the use of specialized diet as a supplement to the basic treatment.

The fundamental principles of nutritional therapy in iron deficiency anemia is a sharp restriction of the use of Fat of both vegetable and animal origin, as well as enriched foods containing a large number of squirrel. It is proved that the absorption of iron by the body in any way not affect carbohydrates, so they should not limit consumption.

To fill necessary for normal hematopoiesis iron levels, you must include in the diet of the patient supply large the number of products that contain iron (liver, beef tongue, lean turkey meat, red species of marine fish, buckwheat and millet cereal, blueberries and peach). A large percentage of iron is also found in all kinds of greens, beef and eggs. Among the fruits should be preferred persimmon, quince and apples raw or baked form.

From the diet with iron deficiency anemia patients is recommended to completely eliminate foods milk and a number of black tea because they contain in their composition substances that prevent the absorption of gland. In contrast, products, synergists, which should be in a lot of use in conjunction with the iron-containing products are those that contain a high percentage of vitamin C (sorrel, currants, sauerkraut, fresh fruit and citrus juices with pulp).

Features of anemia in pregnancy

The grounds for the development of iron deficiency anemia in women consider periods of heavy menstruation, as well as the processes of pregnancy and childbirth. However, iron deficiency during the gestation of the child are not always there, that there are special conditions:

  • Chronic anemia in women;
  • diseases of internal organs;
  • frequent pregnancy and childbirth;
  • vynashivanie twins or triplets;
  • acute toxicosis or improper diet.

Iron deficiency anemia in pregnant women is expressed in symptoms that are easily confused with toxicity and only in patients with severe deficiency symptoms become apparent.

In asymptomatic disease, help identify anemia a blood test, and in severe stages of its symptoms They are: dizziness, shortness of breath, pale and dry skin, changes in taste sensations and hair loss. Anemia does not always goes away after delivery, often it has to be treated as early as during pregnancy. Treatment for pregnant woman doctor prescribes a given reasons for the deficit. Women assigned rate of ferrous iron preparations in combination with folic acid.

Complications of iron deficiency anemia

Complications arise with prolonged duration of treatment without anemia and reduced quality of life.

  • decreased immunity,
  • rare and serious complication is hypoxic coma,
  • increased heart rate, which leads to more stress on the heart and eventually to heart failure,
  • in pregnant women increases the risk of preterm delivery and fetal growth retardation,
  • Iron deficiency in children causes a delay in growth and development,
  • hypoxia due to iron deficiency complicates existing cardio-pulmonary disease (ischemic heart disease, bronchial asthma, bronchiectasis, and others).

prevention

WHO experts have formulated the basic dogma of preventive measures aimed at reducing the prevalence of iron deficiency anemia among the population. The main ways of achieving this goal are:

  • Eating diet foods rich in easily digestible form of iron;
  • use of means that improve iron absorption (various vitamins mentioned above);
  • Treatment of chronic infection foci.

Preventive maintenance should be carried out, according to experts of the World Health Organization, at the population level, as early signs of iron deficiency anemia observed in almost 25% of the world world. And this is not a small figure, and the effects of the disease is very unpleasant.

Furthermore, prevention of iron-deficiency anemia is divided into primary, secondary and tertiary, respectively. The purpose of the primary - to eliminate the main factor contributing to the body of anemia, secondary - quickly identify the signs in time competently diagnose and treat disease. The purpose of the tertiary prevention - minimizing possible complications.

Forecast

In the majority of cases, iron deficiency anemia can be corrected successfully, the signs and symptoms of anemia are retreating. However, if untreated, develop complications and the disease progresses.

If you have identified a low hemoglobin level, it is necessary to undergo a full clinical and laboratory examination and determine the cause of anemia. Correct diagnosis - the key to successful treatment.

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