- a syndrome caused by iron deficiency and leading to a violation of hemoglobinopoiesis and tissue hypoxia. Clinical manifestations are general weakness, drowsiness, reduced mental performance and physical endurance, tinnitus, dizziness, fainting, shortness of breath on exertion, palpitations, and pallor. Hypochromic anemia is confirmed by laboratory data: a study of a clinical blood test, serum iron, FBC and ferritin. Therapy includes therapeutic diet, taking iron supplements, in some cases - transfusion of red blood cells.

ICD-10

D50

General information

Iron deficiency (microcytic, hypochromic) anemia is an anemia caused by a lack of iron, which is necessary for the normal synthesis of hemoglobin. Its prevalence in the population depends on sex, age and climatic and geographical factors. According to generalized data, about 50% of young children, 15% of women of reproductive age and about 2% of men suffer from hypochromic anemia. Hidden tissue iron deficiency is detected in almost every third inhabitant of the planet. Microcytic anemia in hematology accounts for 80–90% of all anemias. Since iron deficiency can develop under a variety of pathological conditions, this problem is relevant for many clinical disciplines: pediatrics, gynecology, gastroenterology, etc.

Causes

Every day, about 1 mg of iron is lost with sweat, feces, urine, and desquamated skin cells, and about the same amount (2-2.5 mg) enters the body with food. An imbalance between the body's need for iron and its intake or loss contributes to the development of iron deficiency anemia. Iron deficiency can occur both under physiological conditions and as a result of a number of pathological conditions and be due to both endogenous mechanisms and external influences:

Blood loss

Most often, anemia is caused by chronic blood loss: heavy menstruation, dysfunctional uterine bleeding; gastrointestinal bleeding from erosions of the mucous membrane of the stomach and intestines, gastroduodenal ulcers, hemorrhoids, anal fissures, etc. Hidden, but regular blood loss is observed with helminthiases, hemosiderosis of the lungs, exudative diathesis in children, etc.

A special group is made up of people with blood diseases - hemorrhagic diathesis (hemophilia, von Willebrand disease), hemoglobinuria. Perhaps the development of posthemorrhagic anemiacaused by simultaneous, but massive bleeding during injuries and operations. Hypochromic anemia can occur due to iatrogenic causes - in donors who often donate blood; CKD patients on hemodialysis.

Violation of the intake, absorption and transport of iron

Nutritional factors include anorexia, vegetarianism and following diets with restriction of meat products, poor nutrition; in children - artificial feeding, late introduction of complementary foods. A decrease in iron absorption is characteristic of intestinal infections, hypoacid gastritis, chronic enteritis, malabsorption syndrome, conditions after resection of the stomach or small intestine, gastrectomy. Much less often, iron deficiency anemia develops as a result of a violation of the transport of iron from the depot with insufficient protein-synthetic function of the liver - hypotransferrinemia and hypoproteinemia (hepatitis, liver cirrhosis).

Increased iron consumption

The daily need for a trace element depends on gender and age. The need for iron is highest in preterm infants, young children and adolescents (due to high rates of development and growth), women of the reproductive period (due to monthly menstrual losses), pregnant women (due to the formation and growth of the fetus), nursing mothers ( due to consumption in the composition of milk). It is these categories that are most vulnerable to the development of iron deficiency anemia. In addition, an increase in the need and consumption of iron in the body is observed in infectious and tumor diseases.

Pathogenesis

In its role in ensuring the normal functioning of all biological systems, iron is essential element. The supply of oxygen to cells, the course of redox processes, antioxidant protection, the functioning of the immune and nervous systems etc. On average, the iron content in the body is at the level of 3-4 g. More than 60% of iron (> 2 g) is part of hemoglobin, 9% is part of myoglobin, 1% is part of enzymes (heme and non-heme). The rest of the iron in the form of ferritin and hemosiderin is located in the tissue depot - mainly in the liver, muscles, bone marrow, spleen, kidneys, lungs, heart. Approximately 30 mg of iron circulates continuously in plasma, being partially bound by the main plasma iron-binding protein, transferrin.

With the development of a negative balance of iron, the reserves of the microelement contained in tissue depots are mobilized and consumed. At first, this is enough to maintain an adequate level of Hb, Ht, and serum iron. As the tissue reserves are depleted, the erythroid activity of the bone marrow increases compensatory. With the complete depletion of endogenous tissue iron, its concentration begins to decrease in the blood, the morphology of erythrocytes is disturbed, and the synthesis of heme in hemoglobin and iron-containing enzymes decreases. The oxygen transport function of the blood suffers, which is accompanied by tissue hypoxia and degenerative processes in the internal organs (atrophic gastritis, myocardial dystrophy, etc.).

Classification

Iron-deficiency anemia does not occur immediately. Initially, a pre-latent iron deficiency develops, characterized by the depletion of only the reserves of deposited iron while maintaining the transport and hemoglobin pool. At the stage of latent deficiency, a decrease in the transport iron contained in the blood plasma is noted. Actually hypochromic anemia develops with a decrease in all levels of metabolic iron reserves - deposited, transport and erythrocyte. In accordance with the etiology, anemia is distinguished: posthemorrhagic, alimentary, associated with increased consumption, initial deficiency, insufficient resorption and impaired transport of iron. According to the severity of iron deficiency anemia are divided into:

• Lungs(Hb 120-90 g/l). Occur without clinical manifestations or with their minimal severity.
• Medium(Hb 90-70 g/l). Accompanied by circulatory-hypoxic, sideropenic, hematological syndromes of moderate severity.
• Heavy(Hb

Symptoms

Circulatory-hypoxic syndrome is caused by a violation of hemoglobin synthesis, oxygen transport and the development of hypoxia in tissues. This finds its expression in a feeling of constant weakness, increased fatigue, drowsiness. Patients are haunted by tinnitus, flashing "flies" before the eyes, dizziness, turning into fainting. Characterized by complaints of palpitations, shortness of breath that occurs during exercise, hypersensitivity to low temperatures. Circulatory-hypoxic disorders can aggravate the course of concomitant coronary artery disease, chronic heart failure.

The development of sideropenic syndrome is associated with a deficiency of tissue iron-containing enzymes (catalase, peroxidase, cytochromes, etc.). This explains the occurrence of trophic changes in the skin and mucous membranes. Most often they are manifested by dry skin; striated, brittle and deformed nails; increased hair loss. On the part of the mucous membranes, atrophic changes are typical, which is accompanied by the phenomena of glossitis, angular stomatitis, dysphagia, atrophic gastritis. There may be an addiction to pungent odors (gasoline, acetone), a distortion of taste (the desire to eat clay, chalk, tooth powder, etc.). Signs of sideropenia are also paresthesia, muscle weakness, dyspeptic and dysuric disorders. Asthenovegetative disorders are manifested by irritability, emotional instability, decreased mental performance and memory.

Complications

Since IgA loses its activity in conditions of iron deficiency, patients become susceptible to frequent ARVI, intestinal infections. Patients are haunted by chronic fatigue, loss of strength, decreased memory and concentration. The long course of iron deficiency anemia can lead to the development of myocardial dystrophy, recognized by the inversion of the T waves on the ECG. With extremely severe iron deficiency, an anemic precoma develops (drowsiness, shortness of breath, a sharp pallor of the skin with a cyanotic tint, tachycardia, hallucinations), and then a coma with loss of consciousness and lack of reflexes. With massive rapid blood loss, hypovolemic shock occurs.

Diagnostics

The appearance of the patient may indicate the presence of iron deficiency anemia: pale skin with an alabaster tint, pastosity of the face, legs and feet, edematous "bags" under the eyes. Auscultation of the heart reveals tachycardia, deafness of tones, a quiet systolic murmur, and sometimes arrhythmia. In order to confirm anemia and determine its causes, a laboratory examination is performed.

• Laboratory tests. In favor of the iron deficiency nature of anemia is evidenced by a decrease in hemoglobin, hypochromia, micro- and poikilocytosis in the general blood test. When evaluating biochemical parameters, there is a decrease in the level of serum iron and ferritin concentration (60 µmol/l), a decrease in transferrin saturation with iron (
• Instrumental techniques. To establish the cause of chronic blood loss, an endoscopic examination of the gastrointestinal tract (EGDS, colonoscopy,), X-ray diagnostics (irrigoscopy, radiography of the stomach) should be carried out. Organ examination reproductive system in women, it includes ultrasound of the small pelvis, examination on the armchair, according to indications - hysteroscopy with WFD.
• Study of bone marrow punctate. A smear microscopy (myelogram) shows a significant decrease in the number of sideroblasts, characteristic of hypochromic anemia. Differential diagnosis is aimed at excluding other types of iron deficiency conditions - sideroblastic anemia, thalassemia.

Treatment

The main principles of the treatment of iron deficiency anemia include the elimination of etiological factors, correction of the diet, replenishment of iron deficiency in the body. Etiotropic treatment is prescribed and carried out by specialists gastroenterologists, gynecologists, proctologists, etc.; pathogenetic - by hematologists. In iron deficiency states good nutrition with the obligatory inclusion in the diet of products containing heme iron (veal, beef, lamb, rabbit meat, liver, tongue). It should be remembered that ascorbic, citric, succinic acid. Iron absorption is inhibited by oxalates and polyphenols (coffee, tea, soy protein, milk, chocolate), calcium, dietary fiber, and other substances.

At the same time, even a balanced diet is not able to eliminate the already developed iron deficiency, therefore, patients with hypochromic anemia are shown replacement therapy ferropreparations. Iron preparations are prescribed for a course of at least 1.5-2 months, and after normalization of the Hb level, maintenance therapy is carried out for 4-6 weeks with a half dose of the drug. For the pharmacological correction of anemia, preparations of ferrous and ferric iron are used. In the presence of vital indications resort to blood transfusion therapy.

Forecast and prevention

In most cases, hypochromic anemia is successfully corrected. However, if the cause is not eliminated, iron deficiency can recur and progress. Iron deficiency anemia in infants and young children can cause a delay in psychomotor and intellectual development (IDD). In order to prevent iron deficiency, annual monitoring of the parameters of a clinical blood test, good nutrition with sufficient iron content, and timely elimination of sources of blood loss in the body are necessary. It should be borne in mind that iron, contained in meat and liver in the form of heme, is best absorbed; non-heme iron from plant foods is practically not absorbed - in this case, it must first be restored to heme iron with the participation of ascorbic acid. Persons at risk may be shown to take iron supplements as prescribed by a specialist.

Iron deficiency anemia is a disease characterized by a decrease in the level of hemoglobin in the blood. According to the results of research in the world, about 2 billion people suffer from this form of anemia of varying severity.

Children and lactating women are most susceptible to this disease: every third child in the world suffers from anemia, and almost all lactating women have anemia of varying degrees.

This anemia was first described in 1554, and drugs for its treatment were first used in 1600. It is a serious problem that threatens the health of society, as it has a significant impact on performance, behavior, mental and physiological development.

This noticeably reduces social activity, but, unfortunately, anemia is often underestimated, because gradually a person gets used to a decrease in iron stores in his body.

Causes of iron deficiency anemia

What it is? There are several causes of iron deficiency anemia. Often there is a combination of causes.

Iron deficiency is often experienced by people whose body requires an increased dose of this trace element. This phenomenon is observed with increased body growth (in children and adolescents), as well as during pregnancy and lactation.

Having adequate levels of iron in the body largely depends on what we eat. If the diet is unbalanced, food intake is irregular, the wrong foods are consumed at all, then in the aggregate all this will cause a lack of iron intake in the body with food. By the way, the main food sources of iron are meat: meat, liver, fish. Relatively a lot of iron in eggs, beans, beans, soybeans, peas, nuts, raisins, spinach, prunes, pomegranate, buckwheat, black bread.

Why does iron deficiency anemia appear, and what is it? The main causes of this disease are as follows:

1. Inadequate dietary iron intake, especially in newborns.
2. Violation of absorption processes.
3. Chronic blood loss.
4. Increased need for iron with intensive growth in adolescents, during pregnancy and lactation.
5. Intravascular hemolysis with hemoglobinuria.
6. Violation of iron transport.

Even minimal bleeding of 5-10 ml/day will result in a loss of 200-250 ml of blood per month, which corresponds to approximately 100 mg of iron. And if the source of occult bleeding is not established, which is quite difficult due to the absence of clinical symptoms, then after 1-2 years the patient may develop iron deficiency anemia.

This process occurs faster in the presence of other predisposing factors (impaired absorption of iron, insufficient intake, etc.).

How does IDA develop?

1. The body mobilizes iron reserves. There is no anemia, no complaints, a ferritin deficiency can be detected during the study.
2. Tissue and transport iron is mobilized, hemoglobin synthesis is preserved. There is no anemia, dry skin, muscle weakness, dizziness, signs of gastritis appear. The examination reveals a deficiency of serum iron and a decrease in transferrin saturation.
3. All funds suffer. Anemia appears, the amount of hemoglobin decreases, and then erythrocytes.

Degrees

Degrees of iron deficiency anemia according to hemoglobin content:

• mild - hemoglobin does not fall below 90 g / l;
• medium - 70-90 g / l;
• severe - hemoglobin below 70 g / l.

The normal level of hemoglobin in the blood is:

• in women - 120-140 g / l;
• in men - 130-160 g / l;
• in newborns - 145-225 g / l;
• in children 1 month. – 100-180 g/l;
• in children 2 months. - 2 years. – 90-140 g/l;
• in children 2-12 years old - 110-150 g / l;
• in children 13-16 years old - 115-155 g / l.

However, the clinical signs of the severity of anemia do not always correspond to the severity of anemia according to laboratory criteria. Therefore, a classification of anemia according to the severity of clinical symptoms has been proposed.

• 1 degree - clinical symptoms are absent;
• Grade 2 - moderate weakness, dizziness;
• Grade 3 - there are all clinical symptoms of anemia, disability;
• 4 degree - represents a serious condition of precoma;
• Grade 5 - is called "anemic coma", lasts several hours and leads to death.

Signs of the latent stage

Latent (hidden) iron deficiency in the body can lead to symptoms of sideropenic (iron deficiency) syndrome. They have the following character:

• muscle weakness, fatigue;
• decreased attention, headaches after mental stress;
• craving for salty and spicy, spicy foods;
• sore throat;
• dry pale skin, pallor of mucous membranes;
• fragility and pallor of the nail plates;
• dullness of hair.

A little later, an anemic syndrome develops, the severity of which is also determined by the erythrocytes in the body, as well as the rate of development of anemia (the faster it develops, the more pronounced the clinical manifestations), the compensatory capabilities of the body (they are less developed in children and the elderly) and the presence of concomitant diseases.

Symptoms of iron deficiency anemia

Iron deficiency anemia develops slowly, so its symptoms are not always pronounced. With anemia, nails often exfoliate, deform and break, hair splits, the skin becomes dry and pale, appear, there is weakness, malaise, dizziness, headache, flies before the eyes, fainting.

Very often in patients with anemia there is a change in taste, there is an irresistible craving for non-food products such as chalk, clay, raw meat. Many begin to attract pungent odors, for example, gasoline, enamel paint, acetone. A complete picture of the disease opens only after the general.

Diagnosis of IDA

In typical cases, the diagnosis of iron deficiency anemia is not difficult. Often, the disease is detected in analyzes taken for a completely different reason.

In a manual, blood color index, and hematocrit are detected. When performing OAC on the analyzer, changes are detected in erythrocyte indices characterizing the hemoglobin content in erythrocytes and the size of erythrocytes.

Identification of such changes is the reason for the study of iron metabolism. More details of the assessment of iron metabolism are disclosed in the article on iron deficiency.

Treatment of iron deficiency anemia

In all cases of iron deficiency anemia, before starting treatment, it is necessary to establish the immediate cause of this condition and, if possible, eliminate it (most often, eliminate the source of blood loss or treat the underlying disease complicated by sideropenia).

Treatment of iron deficiency anemia in children and adults should be pathogenetically substantiated, comprehensive and aimed not only at eliminating anemia as a symptom, but also at eliminating iron deficiency and replenishing its reserves in the body.

The classic treatment regimen for anemia:

• elimination of the etiological factor;
• organization of proper nutrition;
• taking iron supplements;
• prevention of complications and relapses of the disease.

At proper organization The above procedures can be expected to get rid of the pathology within a few months.

Iron preparations

In most cases, iron deficiency is eliminated with the help of iron salts. The most affordable drug that is used to treat iron deficiency anemia today is ferrous sulfate tablets, it contains 60 mg of iron, and is taken 2-3 times a day.

Other iron salts, such as gluconate, fumarate, lactate, also have good absorption properties. Considering that the absorption of inorganic iron with food decreases by 20-60%, it is better to take such medicines before meals.

Possible side effects from iron preparations:

• metallic taste in the mouth;
• abdominal discomfort;
• constipation;
• diarrhea;
• nausea and/or vomiting.

The duration of treatment depends on the patient's ability to absorb iron and continues until laboratory blood parameters (erythrocyte, hemoglobin, color index, serum iron level and iron-binding ability) are normalized.

After eliminating the signs of iron deficiency anemia, it is recommended to use the same drug, but at a reduced prophylactic dose, since the main focus of treatment is not so much to eliminate the signs of anemia, but to replenish iron deficiency in the body.

Diet

The diet for iron deficiency anemia is the consumption of foods rich in iron.

A complete diet is shown with the obligatory inclusion in the diet of products containing heme iron (veal, beef, lamb, rabbit meat, liver, tongue). It should be remembered that ascorbic, citric, succinic acid contribute to the strengthening of ferrosorption in the gastrointestinal tract. Iron absorption is inhibited by oxalates and polyphenols (coffee, tea, soy protein, milk, chocolate), calcium, dietary fiber, and other substances.

However, no matter how much meat we eat, only 2.5 mg of iron will enter the blood from it per day - this is how much the body can absorb. And iron-containing complexes are absorbed 15-20 times more - that's why with the help of diet alone, the problem of anemia cannot always be solved.

Conclusion

Iron deficiency anemia is a dangerous condition that requires an adequate approach to treatment. Only long-term use of iron supplements and elimination of the cause of bleeding will lead to getting rid of the pathology.

To avoid serious complications from treatment, laboratory blood tests should be constantly monitored throughout the course of therapy for the disease.

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Iron deficiency anemia (IDA)

Iron deficiency anemia (IDA) is one of the most commonly diagnosed pathological conditions of the circulatory system, and indeed the most common type.

Statistical studies have shown that about 2.5 billion patients worldwide have this diagnosis.

In order to stop the progression of the disease and avoid complications, it is necessary to identify the root causes of its occurrence and start treatment in a timely manner.

What is iron deficiency anemia?

Anemia is characterized by a reduced content of red blood cells in the human circulatory system - erythrocytes, and, as a result, a drop in hemoglobin.

If the low level of these elements is associated with a lack of iron in the body, then in this case we are talking about iron deficiency anemia (IDA).

As a rule, pathology is not an independent disease. In most cases, iron deficiency anemia occurs after some other negative changes in the human body.

FOR REFERENCE! The norm in the body in adults is on average about 4 grams. In men and women at different ages, this indicator may have a different value. So, for example, iron deficiency anemia in adults is much more often manifested in the fairer sex. First of all, this is due to the regular blood loss that occurs during menstruation. And the strongest concentration of iron is observed in newborn babies, since they have an increased supply of this microelement in the womb.

Iron deficiency adversely affects the viability of a person as a whole. In addition, the development of this deficiency is fraught with failures in the formation of red blood cells, as well as a violation of the oxidation and reduction reactions, the mechanism of cell division and the normal course of some other reactions.

Iron is the basis of hemoglobin, which performs the functions of supplying oxygen to all tissues and organs in the human body, and also plays an important role in protein and hormone synthesis. If iron deficiency is not replenished for a long time, the patient begins to develop anemic syndrome.

Causes of iron deficiency anemia

The reasons for the development of iron deficiency anemia may be a lack of iron entering the body from the outside, or failures of processes consuming it, because the human body cannot produce this trace element on its own. They can become:

• unbalanced diet: not well-chosen diet, refusal to eat meat (vegetarianism);
• regular significant blood loss . In addition to menstruation in women, chronic blood loss can be associated with the presence of various diseases: decaying tumors and others. It also includes blood donation, which occurs more often than 3-4 times in one year;
• congenital factors that have arisen during intrauterine development: the presence of IDA in the mother, multiple pregnancy, prematurity;
• malfunctions of the gastrointestinal tract, as a result of which the process of iron absorption in the duodenum is disrupted. This may be due to the presence of various (enteritis, stomach cancer, etc.);
• leading to disturbances in the production of transferrin - a protein that performs transport functions: microelements supplied with food are not distributed throughout the body, which causes iron deficiency. Synthesis of transferrin occurs in liver cells;
• reception medicines that affect the absorption and processing of iron in excess doses. Among them may be:, antacids, iron-binding drugs. People with a predisposition to iron deficiency anemia should consult their doctor before using these types of medications.

Iron deficiency anemia in children can develop as a result of various pathologies during pregnancy, an early transition to artificial feeding, an accelerated growth rate (in case of prematurity).

Provocative factors of IDA

The increased need of the body for iron is the main provoking factor for the development of iron deficiency anemia. It can be associated with such life processes as:

• pregnancy. During pregnancy, for the normal development of the fetus, a woman needs almost twice as much iron as in ordinary life;
• breast-feeding. As in pregnancy, while breastfeeding female body consumes much more iron than it can get.

Stages of development of IDA

The pathogenesis of this type of anemia is expressed in two main periods:

1. Latent (hidden) period It is characterized by a decrease in iron stores in the body, as a result of which, the level of ferritin falls. At the same time, other laboratory parameters may remain within the normal range. The body tries to compensate for the lack of a microelement by more active absorption in the intestines and the production of a transport protein. Due to this, IDA does not yet occur at this stage, although the prerequisites for it are already present.
2. Immediate iron deficiency anemia occurs at a time when the level of red blood cells decreases so much that they can no longer adequately provide their functions. At this stage, the main symptoms begin to appear more clearly and character traits diseases.

Types of iron deficiency anemia

The classification of the disease according to the causes of occurrence distinguishes the following types:

• anemia resulting from excessive blood loss;
• iron deficiency anemia, which appeared as a result of malfunctions in the work of red blood cells;
• chronic iron deficiency anemia;
• hemolytic anemia (elevates with a high degree of destruction of red blood cells).

Classification according to the level of hemoglobin divides the disease into types depending on the severity:

• mild severity (hemoglobin content over 90 g/l);
• moderate severity (70-90 g/l);
• high severity (below 70 g/l).

Symptoms of iron deficiency anemia

The degree of IDA increases in the body gradually and at first it may practically not make itself felt. The latent period of the disease is characterized by the manifestation of sideropenic syndrome.

Later, a general anemic syndrome begins to appear, the clarity of which is determined by the severity of anemia and the body's ability to resist. The presence of the following symptoms in a patient may indicate a disease of iron deficiency anemia:

• fatigue and chronic muscle fatigue. With iron deficiency in the body, human muscles become weaker. A lot of energy is expended on their daily work, which ceases to be produced in the right amount due to a decrease in the level of red blood cells. As a result, a person gets tired much faster even with small daily loads. Iron deficiency anemia in children can manifest itself in the child's desire for less active games, lethargic behavior and drowsiness;
• the appearance of shortness of breath. With IDA, it is difficult to supply oxygen to the heart due to poor blood circulation. For this reason, the patient may experience a lack of air;
• deterioration of the skin, nails and hair. Iron deficiency becomes noticeable externally (see photo above), when the skin becomes dry and cracked, pallor appears. The nails weaken, break and become covered with specific transverse cracks. In some cases, bending of the nail plate in reverse side. The hairline is thinning. Hair changes its structure ahead of time gray hair appears;
• mucosal damage. One of early symptoms IDA is a lesion of the mucous membranes, because these tissues most acutely feel the lack of iron due to disruption of various cellular processes:
  • the most pronounced damage to the mucous membranes is noticeable in changes appearance language. It becomes smooth, covered with cracks and areas of redness. Added pain, burning. In some cases, there are sharp;
  • dryness and areas of atrophy appear in the oral cavity. There is discomfort when eating and pain when swallowing. Cracks form on the lips;
  • atrophy of the intestinal mucosa caused by iron deficiency anemia is accompanied by the appearance of pain syndromes in the abdomen, constipation, diarrhea. The ability of the gastrointestinal tract to absorb nutrients is deteriorating;
  • damage to the mucous membranes of the genitourinary system is characterized by pain during urination and (usually in childhood). The risk of contracting various infections increases;
• susceptibility to various infections. The lack of iron in the body is also reflected in the work of leukocytes - blood cells responsible for releasing the body from pathogens of various infections. As a result, the patient has a general weakening of immunity, increased susceptibility to bacterial and viral infections;
• difficulties of intellectual activity. Insufficient supply of brain cells with iron leads to memory impairment, absent-mindedness and weakening of the intellect in general.

Diagnosis of IDA

Iron deficiency anemia in children and adults can be established by any specialist, however, detailed diagnosis aimed at identifying the causes and treatment should be carried out by a hematologist. Patient examinations include:

• visual examination of the patient is the first stage in the diagnosis of IDA. The specialist needs, according to the patient, to determine the overall picture of the development of the pathology and conduct an examination that will help draw conclusions about the degree of the disease and identify complications, if any;
• from a finger or from a vein - a generalized picture of the patient's health, with the help of which the doctor can unequivocally establish the presence or absence of IDA in the patient. This analysis is carried out in the laboratory using special equipment - a hematological analyzer. The diagnosis of iron deficiency anemia is established in a patient if:
  • a decrease in the number of red blood cells (in men - less than 4.0 x 1012 / l, in women - less than 3.5 x 1012 / l), when the number of platelets and leukocytes is normal or increased;
  • the predominance of erythrocytes in the patient's blood, in which the value is less than normal (a deviation is considered to be less than 70 μm3);
  • color index (CPI) less than 0.8;
• a biochemical blood test allows you to study the patient's condition in more detail, taking into account indicators related to the area under study. The following deviations indicate the presence of iron deficiency anemia:
  • serum iron (SF): in men - less than 17.9 μmol / l, in women - less than 14.3 μmol / l;
  • total iron-binding capacity of serum (OZHSS): significantly exceeds the level of 77 μmol / l;
  • ferritin (a complex protein complex that acts as the main intracellular iron depot in humans) is below normal: in men - below 15 ng / ml, in women - less than 12 ng / ml;
  • (less than 120 g/l);

Iron deficiency anemia in children is characterized by the following blood test results:

• serum iron (SF) below 14 µmol/l;
• total iron-binding capacity of serum (OZHSS) more than 63 µmol/l;
• ferritin in the blood below 12 ng / ml;
• hemoglobin level (less than 110 g/l).

• bone marrow puncture is a diagnostic method based on taking samples of the bone marrow by taking it with a special tool from the sternum. With IDA disease, an increase in the erythroid germ of hematopoiesis is observed;
• radiography is performed to determine intestinal pathologies that can cause chronic bleeding, thereby becoming the cause of anemia;
• endoscopic examinations of human mucous membranes are also carried out to identify various pathologies of organs abdominal cavity. It can be:
  • fibroesophagogastroduodenoscopy (FEGDS);
  • sigmoidoscopy;
  • colonoscopy;
  • laparoscopy and others.

Treatment of iron deficiency anemia

According to doctors, the treatment of iron deficiency anemia in adults and children should not be limited to medications alone. Filling the deficiency of an important micronutrient is best and easiest with the help of healthy food and a well-chosen diet.

The daily rate of iron that the diet should contain is at least 20 mg. It should be noted that the treatment of this disease will be ineffective if measures are not taken to eliminate the primary pathology that caused iron deficiency.

To prevent the disease, each person should conduct a laboratory analysis of blood parameters every year, eat a comprehensive diet and, if necessary, eliminate possible causes of significant blood loss in time.

People with a predisposition to iron deficiency should see a doctor for a course of iron-rich medications.

Nutrition and supplements

A balanced diet plays a major role in the prevention and treatment of IDA. When compiling a diet, it should be borne in mind that iron is better absorbed if it is taken in combination with vitamin C.

At the same time, this microelement is best absorbed by the intestines if it is contained in products of animal origin (up to 3 times more compared to plant products).

• white beans (72 mg);
• nuts of all kinds (51 mg);
• buckwheat (31 mg);
• pork liver (28 mg);
• molasses (20 mg);
• brewer's yeast (18 mg);
• seaweed and algae (16 mg);
• pumpkin seeds (15 mg);
• lentils (12 mg);
• blueberries (9 mg);
• beef liver (9 mg);
• heart (6 mg);
• beef tongue (5 mg);
• dried apricots (4 mg).

• ascorbic acid;
• succinic acid;
• fructose;
• nicotinamide.

FOR REFERENCE! Seafood is also rich in iron, but it is not recommended to include them in the diet with a deficiency of this trace element. The fact is that their composition, among other things, includes a large amount of phosphates, which impede the process of absorption of iron in the body.

Despite the fact that iron deficiency anemia in infants develops quite rarely (except when the mother has this disease), it should be noted that in this case the disease is especially dangerous.

Iron deficiency in children can result in serious disorders in physical development, therefore, it requires prompt replenishment.

Treatment of iron deficiency anemia at this age is carried out by a strict diet and careful monitoring of the daily, as well as the revision of the baby's complementary foods, if one is already available.

Medical treatment (drugs)

Proper nutrition is necessary step in the treatment and prevention of IDA, however, it cannot compensate for the lack of the necessary microelement in the body on its own, and therefore doctors recommend patients to take medications.

Most often, drugs are prescribed in the form of tablets, less often, in cases of malfunctioning of the intestines, parenteral administration.

Medicines for iron deficiency anemia should be used for a long course (over several weeks or months).

All of them are designed to normalize the main indicators in the analysis of blood and eliminate the symptoms of the disease. The most commonly used ones are:

• Hemofer prolongatum;
• Sorbifer Durules;
• Ferroceron;
• Ferroplex;
• Tardiferon.

Before using medicines, it is necessary to consult a doctor; illiterate use can lead to an excess of iron, which is also fraught with negative consequences and complications.

RBC transfusion

In severe cases of anemia, it may be necessary to perform an operation to transfuse red blood cells. This procedure may be necessary in the presence of a serious threat to the life of the patient and should be carried out in the shortest possible period of time. Indications for the appointment of erythrocyte transfusion may be:

• significant blood loss
• a sharp decrease in hemoglobin levels;
• preparation for surgery or early childbirth.

For the success of this procedure and the absence of complications, it is very important that the donor's blood ideally matches the patient in all laboratory parameters.

Prognosis and complications

The degree of complexity of such a disease as iron deficiency anemia today is quite low.

With timely detection of symptoms and a qualitative diagnosis, this ailment can be completely eliminated without any consequences.

In some cases, the development of complications in the treatment of IDA can occur. The reasons for this may be the following factors:

• illiterate diagnostic procedures and, as a result, the establishment of a false diagnosis;
• not identifying the first cause;
• untimely adoption of measures for treatment;
• incorrect dosage of prescribed medications;
• non-compliance with the regularity of treatment.

Possible complications of this disease are:

• in children - growth retardation and intellectual development. Children's iron deficiency is very dangerous, since in advanced cases of the disease, disruptions in the child's body can become irreversible;
• anemic coma, which develops against the background of poor-quality oxygen circulation in the body, in particular, due to insufficient oxygen supply to the brain. Characteristic features this complication - fainting, weakened and zamelennye reflexes. If timely qualified medical assistance is not provided, a strong threat to the life of the patient is created;
• appearance - a frequent occurrence with a long lack of iron in the body;
• infectious diseases with anemia can cause development.

These types of complications pose the greatest threat to pediatric and elderly patients.

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Interesting

Depends on hemoglobin the supply of oxygen to cells, the rate of energy production and metabolic processes, protection from destructive free radicals, the functioning of the immune system, brain neurons. The highest need in the regular intake of iron is noted in such periods: newborns (especially premature); children under 3 years old and teenagers; women of reproductive age due to menstruation; pregnant and lactating.

Anemia is called decrease in hemoglobin and erythrocytes in the blood. Reasons for development iron deficiency anemia is associated with regular blood loss, impaired absorption of iron in diseases of the stomach and intestines.

For normal operation the body needs a daily intake of 2-2.5 mg of the trace element. At the same time, it is important that the iron is in an absorbable form, the so-called heme. This type contains meat products and liver. From plant foods, it can also enter the blood, but only if there is a sufficient content of ascorbic acid. With an unbalanced diet, as well as vegetarians and vegans, it is necessary to take iron in the composition of vitamin complexes or iron-containing preparations.

can be divided into hypoxic (oxygen deficiency), metabolic (absorption disorders) and asthenic ( general weakness). With asthenia, patients with anemia are prone to irritability, fatigue, mood swings. Often, memory, learning ability, and the ability to concentrate are reduced.

The severity of the symptoms does not always reflect the degree of iron deficiency, but rather depends on age features organism and the duration of the disease. Chronic iron deficiency anemia appears in the presence of a constant focus of bleeding.

According to statistics, every third person has a hidden iron deficiency.. A laboratory sign is a decrease in the concentration of blood ferritin with normal values ​​of hemoglobin and erythrocytes, serum iron content. That's why for patients at risk, it is not enough to conduct a general blood test and a complete hematological examination is required.

It is necessary to conduct a general and biochemical blood test. The diagnosis is considered confirmed with such changes: reduced hemoglobin and color index; low level of red blood cells, there are reduced cells and different shapes; serum iron, and saturation of transferrin with iron below normal; the total iron-binding capacity of serum is above 60 µmol/l.

The source of the bleeding must be found. To do this, appoint: X-ray of the stomach; gastroscopy, colonoscopy and sigmoidoscopy; analysis of feces for occult blood and worm eggs; Ultrasound of the abdominal cavity; gynecological examination; bone marrow puncture.

Treatment directed to increase its intake with food (red meat, tongue and liver, vegetables and herbs, citrus fruits, currants, rose hips, cranberries; coffee, milk, tea, cocoa, chocolate, white flour products, rice inhibit the penetration of iron) and eliminate the cause diseases.

After the onset of symptoms, drug therapy is most often required.- iron preparations for 2-2.5 months, and then for another 1-1.5 months the dose is reduced for a maintenance course. Most used medicines: Sorbifer durules, Totema, Aktiferrin, Tardiferon Gino-tardiferon, Ferrum lek, Maltofer.

Read more in our article on iron deficiency anemia, its symptoms, treatment and prevention.

Anemia is a decrease in hemoglobin and red blood cells in the blood. It is caused by various factors - congenital or acquired disorders in the formation of red blood cells or hemoglobin, destruction (hemolysis) of cell membranes under the influence of poisons, blood loss.

The vast majority of cases are due to iron deficiency.. Clinical manifestations of anemia are caused by insufficient oxygen supply to the tissues. Symptoms are not always obvious - general weakness, dizziness, pale skin. Therefore, blood tests are necessary for diagnosis.

Treatment includes iron-rich dietary intake, medications, and, in special cases, intravenous administration of red blood cells.

What does iron deficiency affect?

This microelement can be classified as vital, since the supply of oxygen to cells, the rate of energy production and metabolic processes, protection from destructive free radicals, the functioning of the immune system, brain neurons depend on its presence.

The human body contains approximately 3.5 g of iron. More than half is associated with hemoglobin, 10% contain enzymes and protein structures, and the rest (almost a third) is in the form of reserves in the liver, bone marrow, spleen cells, muscles, kidneys and lungs.

The highest need for a regular intake of iron is observed during such periods:

• newborns (especially premature);
• children under 3 years old and adolescents;
• women in their childbearing period due to monthly losses;
• pregnant and lactating.

Therefore, iron deficiency is most often felt in this category of patients. For the normal functioning of the body you need a daily intake of 2-2.5 mg of the microelement. At the same time, it is important that the iron is in an absorbable form, the so-called heme. This type contains meat products and liver.

From plant foods, it can also enter the blood, but only if there is a sufficient content of ascorbic acid, which converts non-heme iron into heme iron. With an unbalanced diet, also in vegetarians and vegans, in a period of increased need, it becomes necessary to take iron in the composition of vitamin complexes or iron-containing preparations.

Reasons for development

The most common factors leading to iron deficiency anemia are associated with regular blood loss:

• bleeding with peptic ulcer of the stomach and intestines;
• hemorrhoids, rectal fissures;
• heavy menstruation;
• uterine bleeding due to hormonal failure;
• increased bleeding in violation of blood coagulation (hemophilia, congenital hemorrhagic diathesis, thrombocytopenia);
• hidden bleeding in the presence of worms;
• , operations, injuries;
• childbirth, abortion, diagnostic curettage of the uterus;
• renal failure with regular hemodialysis (artificial blood purification).

The second cause of anemia is iron malabsorption. in diseases of the stomach and intestines:

• gastritis with low acidity;
• intestinal infections;
• removal of part of the stomach or small intestine;
• chronic inflammatory processes of the digestive system.

Dietary factors include elimination of meat from the diet, monotonous protein-restricted diets, poor nutrition, use of infant formula, introduction of complementary foods late.

Rarer causes of iron deficiency anemia:

• violation of the formation of proteins by the liver in severe hepatitis or cirrhosis;
• prolonged infections;
• inflammatory processes in the body;
• tumor neoplasms.

Symptoms of iron deficiency anemia

All manifestations of the disease can be divided into hypoxic (oxygen deficiency), metabolic and asthenic (general weakness).

hypoxia

With anemia, the formation of hemoglobin is disrupted, and hence the delivery of oxygen. Clinical manifestations include:

• shortness of breath with little exertion and palpitations;
• constant weakness, rapid fatigue;
• daytime sleepiness;
• noise in the head;
• the appearance of "flies" before the eyes;
• dizziness;
• pre-fainting and fainting states;
• constant chilliness, poor tolerance to low temperatures.

Exchange

Iron is necessary for the work of a number of enzymes that provide redox reactions in tissues. With its deficiency, sideropenia is formed - iron deficiency syndrome at the cellular level.. Symptoms of this condition include:

• dry skin;
• hair loss;
• brittle and thin nails with a deformed nail plate, with severe anemia, they become spoon-shaped;
• atrophy of the mucous membranes in the form of a violation of swallowing, gastritis, inflammation of the tongue and oral cavity, the appearance of cracks in the corners of the mouth, burning and itching in the perineum;
• muscle weakness;
• numbness and tingling in the limbs;
• addiction to unusual smells (paint, gasoline, thinner);
• change in taste desires - eating chalk, tooth powder;
• bowel dysfunction (constipation, diarrhea, bloating).

Asthenia

Patients with anemia are prone to irritability, fatigue, mood swings.. Often, memory, learning ability, and the ability to concentrate are reduced. The severity of these signs does not always reflect the degree of iron deficiency, but rather depends on the age characteristics of the organism and the duration of the disease.

Latent and chronic in women, men

According to statistics, every third person has a hidden iron deficiency. This is due to the fact that vivid manifestations occur with a significant decrease in its reserves in the body, and the initial stages or a slight deviation from the norm are asymptomatic. Initially, only the depot of the trace element decreases, and the amount circulating in the blood does not change. At the stage of latent anemia, the level of transport iron also decreases.

A laboratory sign is a decrease in the concentration of blood ferritin with normal values ​​of hemoglobin and erythrocytes, serum iron content. Therefore, it is not enough for patients from risk groups to conduct a complete blood count, but a complete hematological examination is required.

Chronic iron deficiency anemia occurs when there is a persistent focus of bleeding. Most often, it is caused by gastrointestinal blood loss, hemorrhoids, in women, heavy menstruation comes first. In such cases, the course of anemia depends entirely on the time of detection of the underlying disease and the success of its treatment.

The body gradually adapts to small hemorrhages, increasing the production of red blood cells, so the symptoms in such patients are erased or absent.

Watch the video about the causes and treatment of anemia:

Diagnostics

To establish anemia associated with iron deficiency, it is necessary to conduct a general and biochemical blood test. The diagnosis is considered confirmed with the following changes:

• reduced hemoglobin and color index;
• low level of red blood cells, there are reduced cells and different shapes;
• serum iron, ferritin, and transferrin iron saturation below normal;
• the total iron-binding capacity of serum is above 60 µmol/l.

The source of the bleeding must be found. For this, appoint:

• radiography of the stomach;
• gastroscopy, colonoscopy and sigmoidoscopy;
• analysis of feces for occult blood and worm eggs;
• Ultrasound of the abdominal organs;
• gynecological examination for women;
• bone marrow puncture.

Health implications

In conditions of iron deficiency, the functional activity of the body decreases, as well as its protection against infections. This is due to the fact that immunoglobulin A, which protects the mucous membranes of the respiratory, genitourinary and digestive systems, loses its activity. Patients with anemia often suffer from colds, viral and intestinal infections, and are prone to inflammation of the kidneys and genital organs. In them, more often than in other patients, pathologies acquire a chronic course.

Prolonged anemia causes dystrophic changes in the organs. The most noticeable effect on the heart muscle. In it, over time, the function of contractility and excitability decreases, which is reflected in the form of a change in polarity on the ECG, progressive circulatory disorders.

In young children, iron deficiency leads to:

• delayed psychomotor development;
• low activity;
• reduced ability to develop skills;
• hyperactivity or lethargy;
• rapid fatigue during physical and mental stress.

Treatment of iron deficiency anemia

Therapy for iron deficiency is aimed at increasing its intake with food and eliminating the cause of the disease. All patients are advised to eat a nutritious diet. Its basic rules are:

• sufficient intake of red meat (beef, veal, rabbit, lean lamb), tongue and liver. It is important that meat products contain as little fat as possible, as it inhibits the absorption of iron;
• increased absorption is facilitated by fresh vegetables and herbs, citrus fruits, currants, rose hips, cranberries;
• inhibit the penetration of iron coffee, milk, tea, cocoa, chocolate, products made from white flour, rice.

A balanced diet can be sufficient only if the body has an adequate supply of iron in the depot (latent, latent anemia). After the onset of symptoms, drug therapy is most often required. Patients are recommended iron preparations for 2-2.5 months until the hemoglobin content in the blood is normalized, and then for another 1-1.5 months the dose is reduced for a maintenance course.

The most used medicines:

• sorbifer durules,
• totem,
• Aktiferrin,
• Tardyferon
• Gyno-tardiferon,
• ferrum lek,
• Maltofer.

In severe cases, a red blood cell transfusion is performed.

Prevention

Prevention of iron deficiency anemia includes the following areas:

• • proper nutrition with sufficient content of heme iron;
  • vegetarians are shown a blood test and preventive intake of iron and vitamin B12 preparations;
  • timely examination by a therapist, and, if necessary, by a hematologist in case of bleeding, conditions with a high need for iron (athletes who increase muscle mass, children and adolescents in a period of intensive growth, pregnant women).

Iron deficiency anemia occurs when there is insufficient intake or absorption of iron from food, as well as diseases accompanied by bleeding. It can be hidden or manifested by oxygen starvation of tissues, metabolic disorders and asthenic syndrome.

To establish the diagnosis, a blood test is performed for the content of hemoglobin, erythrocytes, transferrin, ferritin, and serum iron. Treatment begins with the normalization of nutrition and the elimination of the underlying disease, then iron preparations are prescribed.

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Symptoms of iron deficiency anemia, treatment and causes

Iron deficiency anemia (anemia) is a pathological syndrome characterized by a decrease in the number of red blood cells and hemoglobin in the blood. It is the main hypoxia of tissues and organs, since against the background of a lack of an erythroid germ, little oxygen is delivered to the cells.

This condition is especially dangerous for the brain. Nerve cells die during hypoxia, which leads to a gradual degradation of the personality. On early stages disease, a person feels constant fatigue and decreased performance. If, with these symptoms, a laboratory blood test is performed, it determines a decrease in the level of hemoglobin and red blood cells.

What it is?

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

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

Why Iron Deficiency Causes Disease

It has been established that the mechanism of the disease is associated with a deficiency of the mineral iron in the blood. Its role is difficult to exaggerate. Indeed, of the total amount, 70% are directly involved in the construction of hemoglobin. This means that iron is an indispensable material for the retention of oxygen molecules by erythrocytes and the subsequent process of transfer from pulmonary vesicles to tissues.

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

Other Mechanisms Affecting Iron Levels

It is important not only to supply the mineral with food (iron is not produced in the body), but also the right process its absorption and transfer.

A special protein (transferrin) is responsible for the absorption of iron molecules from the duodenum. It delivers Fe to the bone marrow, where red blood cells are synthesized. The body forms a "storehouse" in the liver cells for rapid replenishment in the event of an acute deficiency. Stocks are stored in the form of hemosiderin.

If we decompose all iron-containing forms in parts, we get the following:

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

Accumulation begins in the prenatal period. The fetus takes some of the iron from the mother's body. Maternal anemia is dangerous for the formation and laying of internal organs in a child. And after birth, the baby should receive it only with food.

The excretion of excess minerals occurs with urine, feces, through the sweat glands. In women with adolescence before menopause there is still a path of menstrual bleeding.

• About 2 g of iron is excreted per day, which means that no less amount should be supplied with food.

Maintaining the right balance to ensure tissue respiration depends on the correct functioning of this mechanism.

Causes

A necessary condition for the development of insufficiency is the excess of iron consumption by tissues over its intake. Iron deficiency is provoked by the following conditions (listed by prevalence):

blood loss

chronic (daily blood loss 5-10 ml)

• frequent nosebleeds;
• stomach and intestinal bleeding;
• profuse menstruation;
• pathology of the kidneys with characteristic hematuria.

Acute (massive blood loss)

• injuries, extensive burns;
• uncontrolled donation;
• pathological bleeding (for example, uterine bleeding in oncopathology, etc.).

Insufficient supply of iron

• debilitating diets and starvation;
• unbalanced diet;
• vegetarianism.

Decreased levels of absorbed iron

• diseases of the gastrointestinal tract, helminthic invasion;
• old age and infancy.

Increasing the level of essential iron

• active growth (1-2 years and adolescence);
• pregnancy, lactation (the need for iron doubles to 30 mg / day);
• the formation of the menstrual cycle;
• physical activity, sports;
• frequent inflammation (ARVI, etc.).

Congenital anemia in children

• premature pregnancy
• anemia in pregnancy.

Severity

Depending on the depth of iron deficiency, there are 3 degrees of severity of IDA:

1. Light - hemoglobin values ​​​​are in the range of 110 - 90 g / l;
2. Average - the content of Hb ranges from 90 to 70 g / l;
3. Severe - the hemoglobin level falls below 70 g / l.

A person begins to feel bad already at the stage of latent deficiency, but the symptoms will become clearly visible only with sideropenic syndrome. Before the appearance of a clinical picture of iron deficiency anemia in full, it will take another 8-10 years, and only then a person who is little interested in his health will know that he has anemia, that is, when hemoglobin decreases markedly.

Symptoms of iron deficiency anemia

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

• dyspnea;
• violation of taste and smell;
• susceptibility to infectious diseases;
• language loss;
• increased fatigue;
• changes in the skin (flaking and redness) and nails / hair (stratification, loss);
• damage to the mucous membranes (for example, sores of the type of stomatitis may appear in the oral cavity);
• intellectual development disorders - concentration of attention decreases, the child begins to learn poorly educational material, memory decreases;
• muscle weakness.

At the same time, in the clinical picture of iron deficiency anemia, 2 main syndromes are distinguished:

• hyposiderosis;
• anemic syndrome.

Anemia syndrome

This syndrome is manifested by nonspecific signs characteristic of all anemias:

• shortness of breath that appears with minimal physical exertion;
• interruptions in the work of the heart;
• dizziness when changing body position;
• tinnitus.

The severity of the above symptoms depends on the rate of decrease in hemoglobin. Iron deficiency anemia has a chronic course, so patients are able to adapt to its manifestations.

In some cases, the first complaints with iron deficiency anemia may be:

• fainting states;
• angina attacks;
• decompensation of vascular lesions of the brain.

Hyposiderosis

Symptoms of hyposiderosis are associated with a lack of iron in the tissues. This is accompanied by:

• deterioration of the hair structure with delamination of the tips;
• signs of asthenia;
• excessive dryness of the skin, amenable to minimal correction with moisturizing cosmetics;
• pathological changes in the nails, transverse striation of the nail plate, a change in its shape;
• violation protective properties organisms with frequent viral diseases;
• the appearance of angular stomatitis, manifested by cracks with areas of inflammation in the corners of the mouth;
• signs of inflammatory lesions of the tongue;
• a change in the color of the skin to a pale greenish tint;
• unusual eating habits (desire to eat chalk, ashes and other substances);
• addiction to unusual smells;
• blue sclera due to degenerative changes in the cornea of ​​the eye against the background of iron deficiency.

According to recent studies conducted by pediatricians and hematologists, children with tissue iron deficiency experience mental retardation. This is due to a violation of the processes of myelination of nerve fibers with a decrease electrical activity brain. Also, in young patients there is high risk development of heart failure, however, clear mechanisms of myocardial damage in hyposiderosis have not been identified.

Diagnostics

Diagnosis of the condition, as well as determining the degree of its severity, are carried out according to the results of laboratory tests. Iron deficiency anemia is characterized by the following changes:

• a decrease in the content of hemoglobin in the blood (the norm for women is 120-140 g / l, for men - 130-150 g / l);
• poikilocytosis (change in the shape of red blood cells);
• a decrease in the concentration of ferritin (the norm for women is 22-180 mcg / l, for men - 30-310 mcg / l);
• microcytosis (the presence in the blood of abnormally small red blood cells);
• hypochromia (color index - less than 0.8);
• a decrease in the concentration of serum iron (the norm for women is 8.95–30.43 µmol / l, for men - 11.64–30.43 µmol / l);
• decrease in saturation of transferrin with iron (norm - 30%).

For effective treatment of iron deficiency anemia, it is important to establish the cause that caused it. In order to detect the source of chronic blood loss, the following is indicated:

• FEGDS;
• irrigoscopy;
• ultrasound examination of the pelvic organs;
• radiography of the stomach with contrast;
• colonoscopy;
• stool examination for occult blood.

In difficult diagnostic cases, a puncture of the red bone marrow is performed, followed by a histological and cytological examination of the resulting punctate. A significant decrease in sideroblasts in it indicates the presence of iron deficiency anemia.

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

Treatment of iron deficiency anemia

Treatment of iron deficiency anemia is carried out only by long-term use of ferric iron preparations orally in moderate doses, and a significant increase in hemoglobin, in contrast to improving well-being, will not be fast - after 4-6 weeks.

Usually any preparation of ferrous iron is prescribed - more often it is ferrous sulfate - its better is prolonged dosage form, at an average therapeutic dose for several months, then the dose is reduced to the minimum for a few more months, and then (if the cause of anemia is not eliminated), the maintenance minimum dose continues for a week, monthly, for many years.

So, this practice has justified itself well in the treatment of women with chronic posthemorrhagic iron deficiency anemia due to long-term hyperpolymenorrhea with tardiferon - one tablet in the morning and evening for 6 months without a break, then one tablet a day for another 6 months, then for several years every day for a week on menstruation days . This provides an iron load when prolonged heavy periods appear during menopause. A meaningless anachronism is to determine the level of hemoglobin before and after menstruation.

With agastral (gastrectomy for a tumor) anemia, a good effect is given by taking the minimum dose of the drug constantly for many years and administering vitamin B12 at 200 micrograms per day intramuscularly or subcutaneously for four consecutive weeks every year for life.

Pregnant women with iron deficiency and anemia (a slight decrease in hemoglobin and the number of red blood cells is physiological due to moderate hydremia and does not require treatment) are given an average dose of ferrous sulfate by mouth before delivery and during lactation, if the child does not develop diarrhea, which usually happens rarely.

Popular iron preparations

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

To the most effective medicines to increase the concentration of iron include:

• Ferrum Lek;
• Maltofer;
• Ferroplex;
• Hemopher;
• Ferroceron; (colors urine pink)
• Tardiferon;
• Ferrogradumet;
• Heferol;
• Ferograd;
• Sorbifer-durules.

Preparations for parenteral administration are prescribed for violation of iron absorption in the gastrointestinal tract (gastric resection, peptic ulcer of the stomach and 12 duodenal ulcer in the acute phase, resection of large areas of the small intestine).

When prescribing drugs for intravenous and intramuscular administration, first of all, you need to remember about allergic reactions (feeling hot, palpitations, pain behind the sternum, in the lower back and calf muscles, metallic taste in the mouth) and the possible development of anaphylactic shock.

The list of ferrum-containing drugs is not a guide to action; it is up to the attending physician to prescribe and calculate the dose. Therapeutic doses are prescribed until the hemoglobin level normalizes, then the patient is transferred to prophylactic doses.

How long do I need to take iron supplements?

1. If the treatment is effective, then on the 10-12th day the number of young erythrocytes - reticulocytes - sharply increases in the blood.
2. After 3-4 weeks, hemoglobin rises.
3. Complaints disappear after 1.5-2 months.
4. Iron deficiency in tissues can be eliminated only after 3 months of continuous intake of iron preparations - this is how long the course of treatment should continue.

Thus, iron deficiency anemia is a common and well-studied, but not harmless disease. A low hemoglobin level is just the tip of the iceberg, under which serious tissue changes associated with iron deficiency are hidden. Fortunately, modern drugs can eliminate these problems - provided that the treatment is carried out to the end, and the causes, if possible, are eliminated.

Side effects

The most common symptoms observed during treatment with iron preparations are: side effects: metallic taste in the mouth, darkening of tooth enamel, allergic skin rashes, digestive disorders as a result of an irritant effect on the mucous membrane of the digestive tract, especially the intestines (loose stools, nausea, vomiting). Therefore, the initial doses of drugs should be 1/3-1/2 of the therapeutic dose, followed by their increase to the full dose within a few days to avoid the occurrence of pronounced side effects.

Intramuscular administration of iron preparations is carried out only according to strict indications due to the development of pronounced local and systemic side effects. Indications for intramuscular administration of iron preparations are as follows: diseases of the digestive tract (syndrome of impaired intestinal absorption, ulcerative colitis, chronic enterocolitis, gastrointestinal bleeding) and intolerance to iron-containing preparations when taken by mouth.

Contraindications to the appointment of iron preparations are anemia not caused by iron deficiency (hemolytic, aplastic), hemosiderosis, hemochromatosis.

Diet

The International Association of Hematology claims that by normalizing the eating behavior of a patient with signs of mild iron deficiency anemia, it is possible to largely normalize blood counts and not resort to the use of iron supplements to eliminate iron deficiency. Patients with severe anemia are shown to use a specialized diet as an addition to the main treatment.

The fundamental principles of therapeutic nutrition for iron deficiency anemia are a sharp restriction in the use of fats of both vegetable and animal origin, as well as enrichment with foods containing a large amount of protein. It has been proven that carbohydrates do not affect the absorption of iron by the body, so their consumption should not be limited.

In order to replenish the level of iron necessary for normal hematopoiesis, it is necessary to include in the patient's diet a large number of foods containing iron (liver, beef tongue, lean turkey meat, red types of sea fish, buckwheat and millet cereals, blueberries and peach). A large percentage of iron is also found in all types of greens, beef and eggs. Among fruits, preference should be given to persimmons, quince and apples in raw or baked form.

From the diet of patients with iron deficiency anemia, it is recommended to completely exclude dairy products and black tea, as they contain substances that prevent the absorption of iron. Conversely, synergistic foods that should be consumed in large quantities with iron-containing foods are those that contain a large percentage of vitamin C (sorrel, currants, sauerkraut, freshly squeezed fruit and citrus juices with pulp).

Features of anemia during pregnancy

The reasons for the development of iron deficiency anemia in women are periods of heavy menstruation, as well as the processes of pregnancy and childbirth. However, iron deficiency during the period of bearing a child does not always occur, there are special prerequisites for this:

• chronic anemia in a woman;
• diseases of internal organs;
• frequent pregnancies and childbirth;
• carrying twins or triplets;
• acute toxicosis or malnutrition.

Iron deficiency anemia in pregnant women is expressed by symptoms that are easily confused with toxicosis, and only with severe deficiency do the signs become apparent.

With an asymptomatic course of the disease, a blood test will help identify anemia, and in severe stages, its symptoms are: dizziness, shortness of breath, pallor and dry skin, changes in taste sensations and hair loss. Anemia does not always go away on its own after childbirth, it often has to be treated during pregnancy. Treatment for a pregnant woman is prescribed by a doctor, taking into account the causes of the deficiency. Women are prescribed a course of ferrous iron preparations in combination with folic acid.

Complications of iron deficiency anemia

Complications occur with a long course of anemia without treatment and reduce the quality of life.

• decreased immunity,
• a rare and severe complication is hypoxic coma,
• increased heart rate, which puts more stress on the heart and eventually leads to heart failure
• pregnant women have an increased risk of preterm birth and fetal growth retardation,
• in children, iron deficiency causes a delay in growth and development,
• hypoxia due to iron deficiency complicates the course of existing cardiopulmonary diseases (CHD, bronchial asthma, bronchiectasis, and others).

Prevention

WHO experts formulated the main dogmas of preventive measures aimed at reducing the spread of iron deficiency anemia among the population. The main ways to achieve this goal are:

• the use in the diet of food enriched with an easily digestible form of iron;
• the use of agents that improve iron absorption (the various vitamins mentioned above);
• treatment of chronic foci of infections.

Prevention should be carried out, according to experts from the World Health Organization, at the population level, since early signs of iron deficiency anemia are observed in almost 25% of the world's population. And this is far from a small figure, and the consequences of the disease are very unpleasant.

In addition, the prevention of iron deficiency anemia is divided into primary, secondary and, accordingly, tertiary. The purpose of the primary is to eliminate the main factor contributing to the anemization of the body, the secondary is to identify signs in a timely manner, correctly diagnose and treat the disease in time. The goal of tertiary prevention is to minimize possible complications.

Forecast

In the vast majority of cases, iron deficiency anemia can be successfully corrected, 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 anemia. A correct diagnosis is the key to successful treatment.