Causes of iron deficiency anemia in men. Iron deficiency anemia: a common danger. Diagnosis of B12 deficiency anemia

Iron-deficiency anemia- a syndrome caused by iron deficiency and leading to a violation of hemoglobinopoiesis and tissue hypoxia. It occurs, as a rule, with chronic blood loss or insufficient intake of iron in the body. Manifestations of iron deficiency are present in 60% of the adult population after 50 years. Symptoms of iron deficiency anemia in the latent period are often overlooked or mistaken for other diseases.

Causes

Iron deficiency anemia (IDA) used to be better known as anemia. It is the most common pathology of the blood system and the most common.

Code according to the international classification of diseases ICD-10: iron deficiency anemia - D50.

According to the WHO (World Health Organization), more than 2 billion people on the planet have an iron deficiency in the body. Iron is part of most enzymes, is the main component of hemoglobin. Without it, the hematopoietic process and respiration, various vital oxidative and reducing reactions are impossible.

The development of iron deficiency and subsequent anemia can be due to various mechanisms. Most often, iron deficiency anemia is caused by chronic blood loss:

• profuse menstruation,
• dysfunctional uterine bleeding;
• gastrointestinal bleeding from erosions of the mucous membrane of the stomach and intestines,
• gastroduodenal ulcers,
• hemorrhoids,
• anal fissures, etc.

The main causes of deficiency in the body are:

• unbalanced diet (malnutrition can lead to the development of iron deficiency anemia in both children and adults);
• lack of vitamins;
• increased need for iron;
• diseases of the gastrointestinal tract.

The cause of congenital iron deficiency in the body can be:

• severe iron deficiency anemia in the mother;
• multiple pregnancy;
• prematurity.

With prolonged chronic infections (tuberculosis,) iron molecules are captured by immune cells, and a deficiency is found in the blood.

Older people often suffer from a lack of iron in the body, and this is understandable: there is a natural degradation of hematopoietic functions, in addition, various diseases cause blood loss - for example, infections and inflammations, ulcers and erosion.

The role of iron in the human body

Among the trace elements necessary for the life of our body and full health, iron is one of the most important. Without iron, the formation of hemoglobin and myoglobin, red blood cells and muscle pigment, cannot occur.

The function of iron is the transport of oxygen from the lungs through the circulatory system to all organs and tissues of the body. With a lack of this trace element, the body as a whole suffers.

A deficiency of this substance in the body may occur in the event of development of changes in the digestive system, for example, it may be with low acidity or dysbacteriosis.

The main places where iron is found in the body are:

• erythrocyte hemoglobin - 57%;
• muscles - 27%;
• liver - 7 - 8%.

There are many reasons for iron deficiency: strict diets, rejection of meat foods, intense physical activity, sports training, pregnancy and breastfeeding. The body experiences a sharp lack of iron during blood loss, surgical interventions.

The body of an adult contains about 4 grams of iron. This figure varies by gender and age.

The normal level of iron in the blood is:

• in babies up to 24 months - from 7.00 to 18.00 µmol / l;
• in adolescents 14 years old - from 9.00 to 22.00;
• for adult men - from 11.00 to 31.00;
• for adult women - from 9.00 to 30.00.

In order not to provoke iron deficiency anemia, it is enough to ensure the intake of iron with food in the amount of 2 g per day, since just such a volume of iron is excreted from the body every day.

Infants and young children need a lot of iron because they grow quickly. Iron deficiency can lead to anemia.

The causes of iron deficiency in a child can be:

• pathology of pregnancy, in which the supply of iron to the fetus is disturbed (toxicosis, the threat of interruption, illness or anemia of the mother during pregnancy);
• prematurity, multiple pregnancy;
• early artificial feeding, feeding with cow or goat milk, unbalanced nutrition of the baby;
• increased growth rates (in premature babies, children with large body weight at birth, in the second half of the year and in the second year of life);
• bleeding (including some girls in the period of formation menstrual cycle) or malabsorption in the intestine (chronic enteritis, hereditary syndromes).

Symptoms of iron deficiency anemia

The basis of all clinical manifestations of iron deficiency anemia is iron deficiency, which develops in cases where the loss of iron exceeds its intake with food (2 mg / day). Initially, iron stores in the liver, spleen, and bone marrow decrease, which is reflected in a decrease in the level of ferritin in the blood.

According to the time of development of iron deficiency anemia, there are:

• Congenital form, the symptoms of which appear from the first days of life and worsen with age.
• The acquired form, the manifestations of which develop after the action of etiological factors.

During the period of latent iron deficiency, many subjective complaints and clinical signs characteristic of iron deficiency anemia appear. Patients note:

• general weakness,
• malaise,
• decrease in performance.

Already during this period, there may be a perversion of taste, dryness and tingling of the tongue, a violation of swallowing with a sensation of a foreign body in the throat, palpitations, shortness of breath.

If the patient has a moderate decrease in the amount of iron, then he retains his ability to work for a long time and certain symptoms appear only with excessive physical activity.

Apart from common features characteristic of anemia, IDA manifests itself:

• low blood pressure against the background of a rapid pulse;
• pallor and dryness of the skin;
• peculiar taste preferences, expressed in eating raw meat and chalk;
• brittle nails and hair loss.

If you have the above symptoms, you should contact a specialist and pass a general and biochemical analysis s blood.

Stages and degrees

In the formation of iron deficiency states, the rate of development of the process, the stage of the course of the disease and the degree of compensation are of great importance, because IDA has different causes and can come from another disease (for example, repeated bleeding in or 12 duodenal ulcer, gynecological pathology or chronic infections).

Iron deficiency anemia is:

• with a mild degree, the hemoglobin index is reduced, but remains about 90 g / l;
• with an average degree, hemoglobin is kept in the range from 90 to 70 g / l;
• in severe hemoglobin is less than 70 g / l.

In order to more adequately determine the severity of the disease, a classification was adopted:

• Without clinical symptoms;
• Moderate expression;
• Severe anemic syndrome;
• Precoma;
• Coma.

Symptoms of iron deficiency anemia depend on the stage of the disease:

1 stage

There are no clinical manifestations in the first stage of iron deficiency.

Latent stage

The latent stage is observed with a decrease in the concentration of the serum trace element. Laboratory blood tests show in this situation an increase in the level of transferrin with a decrease in the number of sideroblasts in the bone marrow.

The level of hemoglobin in this stage remains quite high, and clinical signs are characterized by a decrease in exercise tolerance.

With the progression of iron deficiency, the symptoms worsen:

• increasing weakness (may develop urinary incontinence);
• morning dizziness up to fainting (fainting can also occur with prolonged mild iron deficiency);
• perversion of taste (the desire to eat chalk, earth, ash, smell paint, gasoline, etc.);
• palpitations, shortness of breath (develop even after minimal exercise).

Stage 3 IDA

Severe clinical manifestations that combine the two previous syndromes. Clinical manifestations are due to oxygen starvation tissues, and are found in the form of:

• tinnitus,
• tachycardia,
• fainting states,
• dizziness,
• asthenic syndrome, etc.

Complications

Complications occur with a long course of anemia without treatment and reduce the quality of life. The following complications may develop:

• lag in growth and development, which is especially characteristic of childhood;
• anemic coma;
• complications of an infectious nature;
• insufficiency of internal organs.

Diagnostics

A doctor of any specialty can suspect the presence of anemia in a person, based on the external manifestations of this disease. However, establishing the type of anemia, identifying its cause and prescribing appropriate treatment should be handled by a hematologist.

General examination (the color of the skin is determined (pallor is possible); the pulse may be rapid, arterial (blood) pressure - reduced).

Diagnosis of iron deficiency anemia is based mainly on laboratory tests.

Blood analysis

A decrease in the number of red blood cells (red blood cells, the norm is 4.0-5.5x10 9 / liter), a decrease in the level of hemoglobin (a special compound inside the red blood cells that carries oxygen, the norm is 130-160 g / l) can be determined.

Blood chemistry

With the development of IDA in a biochemical blood test, the following will be recorded:

• decrease in serum ferritin concentration;
• decrease in serum iron concentration;
• increase in OZhSS;
• decrease in transferrin saturation with iron.

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.

Treatment program for iron deficiency anemia:

• elimination of the cause of the disease;
• medical nutrition;
• ferrotherapy;
• relapse prevention.

The intake of iron with food can only compensate for its normal daily loss. The use of iron preparations is a pathogenetic method for the treatment of iron deficiency anemia. Currently, preparations containing ferrous iron (Fe ++) are used, since it is much better absorbed in the intestine. Iron supplements are usually taken orally.

Mandatory appointment of iron preparations: in the first three months of treatment of anemia - in therapeutic doses, later - in preventive doses. Iron preparations are administered orally between meals, washed down with fresh fruit juices or water, and should not be taken with milk.

Iron preparations should not be taken with milk, tea or coffee - these products bind iron and reduce its flow into the blood. Taking iron supplements can cause:

• nausea,
• vomiting,
• stomach ache,
• constipation,
• blackening of the teeth (if drugs are used in the form of drops).

List of drugs that are used in the treatment of iron deficiency anemia:

• Zhektofer (Jectofer);
• Conferon (Conferon);
• Maltofer (Maltofer);
• Sorbifer durules (Sorbifer durules);
• Tardiferon (Tardiferon);
• Feramid (Ferramidum);
• Ferro-gradumet (Ferro-gradumet);
• Ferroplex (Ferroplex);
• Ferroceron (Ferroceronum);
• Ferrum lek (Ferrum lek).
• Totem (tothema)

Manifestations of side effects from taking drugs are:

• metallic taste in the mouth;
• darkening of teeth and gums;
• pain in the epigastrium;
• dyspeptic disorders due to irritation of the gastrointestinal mucosa (nausea, belching, vomiting, diarrhea, constipation);
• dark staining of the stool;
• allergic reactions (more often by the type of urticaria);
• necrosis of the intestinal mucosa (with overdose or poisoning with saline FP).

Severe iron deficiency anemia, which is treated in a hospital, requires establishing the cause of iron loss. Simultaneously with the elimination of the causes, the pathological symptoms of the disease are eliminated.

Injectable drugs are used exclusively in a hospital (it is necessary to be able to provide anti-shock assistance), they are contraindicated during pregnancy and lactation.

• venofer (the solution is strictly for intravenous administration, the dose and rate of administration are calculated individually).
• kosmofer (solution for intravenous and intramuscular injection, the calculation of the dose and route of administration is made individually).
• ferrinject (solution for intravenous or dialysis system administration).

Nutrition and diet for IDA

The goal pursued by therapeutic nutrition for anemia is to provide the body with all nutrients, vitamins and microelements, in particular, iron, which is necessary to increase the level of hemoglobin.

This diet increases the body's defenses, restores its functions and improves the patient's quality of life.

The body may lack both heme and non-heme iron:

1. Heme iron is found in animal products. Of these products, our body absorbs up to 35% of the desired trace element.
2. Non-heme iron is legumes, seeds and nuts (pumpkin, sesame), dried fruits (raisins, dried apricots), vegetables dark color, iron-enriched breakfast cereals.

Foods containing heme iron	Iron (mg/100 g product)	Food containing non-heme iron	Iron (mg/100 g product)
Mutton	10,5	Soya	19,0
Liver	4,0-16,0	Poppy	15,0
kidneys	4,0-16,0	wheat bran	12,0
Liver paste	5,6	Assorted jam	10,0
Rabbit meat	4,0	fresh rosehip	10,0
Turkey meat	4,0	Mushrooms (dried)	10,0
Duck or goose meat	4,0	dry beans	4,0-7,0
Ham	3,7	Cheese	6,0
Beef	1,6	Sorrel	4,6
Fish (trout, salmon, chum salmon)	1,2	Currant	4,5
Pork	1,0	Cereals	4,5
		Chocolate	3,2
		Spinach	3,0
		Cherry	2,9
		"Gray" bread	2,5
		Eggs (yolk)	1,8

Improves the absorption of iron from fruits and cereals ascorbic and lactic acid, so the simultaneous intake of foods such as meat, legumes or cereals, fruits and vegetables is recommended. Sometimes diet is the complete cure primary forms iron deficiency anemia.

The diet of children and adolescents should be varied, healthy and tasty; it is necessary to ensure that it always contains products of animal and vegetable origin, containing a sufficient amount of iron.

Do not attempt to treat iron deficiency anemia in children with diet or supplements.

Phytotherapy is quite acceptable as an addition to treatment, but will not replace iron supplements. The collections are most often used:

• nettle - it increases blood clotting and reduces bleeding;
• strawberries - the microelements included in its composition stimulate hematopoiesis;
• rose hips - contain a large amount of vitamin C, which improves the absorption of iron; for the same purpose, beet juice, pomegranate, black currant juice is used.

Prevention of iron deficiency anemia

Very important point is the prevention of anemia in childhood. It includes: correct mode days, rational feeding, preventive courses of taking iron preparations up to 1.5 years.

- 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 the transport and hemoglobin pool is preserved. 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 decrease in the level of iron in the body, which leads to a drop in the level of hemoglobin in the blood. Hemoglobin is found in erythrocytes, which are red blood cells responsible for transporting oxygen to organs and tissues. Without hemoglobin, this process becomes impossible. Among the people, anemia is better known under the name "anemia", since in past years even doctors called this violation in this way.

The level of erythrocytes in iron deficiency anemia may remain within the normal range. However, they are not able to perform their function if they lack hemoglobin. As a result, organs and tissues begin to suffer from oxygen starvation (this condition is called).

Among other anemias, iron deficiency anemia is the most common. This is easily explained by the fact that a variety of factors and causes, which will be discussed below, can lead to its development.

Iron (Fe) is a trace element without which the human body cannot function normally.

Normally, a healthy adult average male contains about 4-5 g of iron in the body:

Hemoglobin contains 2.5-3.0 g of iron.

In tissues, its level is equal to 1.0-1.5 g. This iron is contained in them as reserves in case of emergency. It comes in the form of a substance called ferritin.

Respiratory enzymes and myoglobin consume about 0.3-0.5 g of iron.

Also, a small amount of iron is found in proteins that transport this trace element. These proteins are called transferrins.

Every day, the body of an adult male removes approximately 1.0-1.2 g of iron through the intestines.

The body of an adult woman contains 2.6-3.2 g of iron. At the same time, only 0.3 g of this microelement is in the reserves of organs and tissues. Every day female body excretes iron through the intestines. During menstruation, the loss of this trace element is also carried out with menstrual blood. During menstruation, 1 g of iron will be excreted daily. Therefore, it is quite logical that it is women who most often suffer from such a disorder as iron deficiency anemia.

In childhood, normal iron levels are equivalent to those for women. This is true for children and adolescents under the age of 14.

Unfortunately, the human body is unable to produce iron on its own. He can only get it from outside (with food or with medicines). Iron absorption occurs in the duodenum and in the small intestine. With the help of the large intestine, this microelement is only excreted.

A person should not be afraid that the active use of iron with food can lead to its excessive accumulation in tissues and organs. The body has a number of mechanisms that simply block excess Fe from food.

On early stages iron deficiency anemia does not manifest itself in any way, that is, a person may not even suspect that there is a hidden lack of iron in his body. Changes at the initial stage of development of this violation are insignificant. Nevertheless, the first signs of IDA are still there, another question that few people think that they are provoked precisely by a drop in the level of iron in the blood.

So, be sure to see a doctor and take a biochemical blood test if a person begins to worry about the following disorders:

Appetite decreases. The person continues to eat food, but does so without much desire.

Perhaps a distortion of taste, the emergence of new food addictions. There may be a desire to eat something unusual, for example, clay, chalk, flour, tooth powder.

In the epigastric region, discomfort often occurs, and there may be violations with the ingestion of food.

• Medium

  The average degree of iron deficiency anemia is characterized by a hemoglobin level in the range of 70-90 g / l. At this time, the patient develops sideropenic syndrome and he begins to present certain complaints to the doctor. Several years (8-10 years) may pass from the moment of manifestation of a mild degree of anemia to the development of anemia of moderate severity.

  Tissue sideropenic syndrome is characterized by symptoms such as: disturbances in the functioning of the digestive system, changes in the skin, deterioration of hair and nails.

  heavy

  A severe degree of iron deficiency anemia is characterized by a decrease in hemoglobin levels to 70 g/l. At the same time, the patient develops the whole complex of syndromes: circular-hypoxic, sideropenic, hematological. It is no longer possible to ignore or ignore their manifestations, a person seeks medical help.

  
  
  
  

  Complaints of the patient who came to the appointment may lead the doctor to the idea that he is developing iron deficiency anemia.

  To confirm this assumption, it is necessary to order a number of laboratory tests, which include:

Anemia is a clinical and hematological syndrome characterized by a decrease in the number of red blood cells and hemoglobin in the blood. A wide variety of pathological processes can serve as the basis for the development of anemic conditions, and therefore anemia should be considered as one of the symptoms of the underlying disease. The prevalence of anemia varies greatly, ranging from 0.7 to 6.9%. Anemia can be caused by one of three factors or a combination of them: blood loss, insufficient production of red blood cells, or increased destruction of red blood cells (hemolysis).

Among various anemic conditions iron deficiency anemia are the most common and account for about 80% of all anemias.

Iron-deficiency anemia- hypochromic microcytic anemia, which develops as a result of an absolute decrease in iron stores in the body. Iron deficiency anemia occurs, as a rule, with chronic blood loss or insufficient intake of iron in the body.

According to the World Health Organization, every 3rd woman and every 6th man in the world (200 million people) suffer from iron deficiency anemia.

iron exchange
Iron is an essential biometal that plays an important role in the functioning of cells in many body systems. biological significance iron is determined by its ability to reversibly oxidize and recover. This property ensures the participation of iron in the processes of tissue respiration. Iron makes up only 0.0065% of body weight. The body of a man weighing 70 kg contains approximately 3.5 g (50 mg/kg body weight) of iron. The iron content in the body of a woman weighing 60 kg is approximately 2.1 g (35 mg/kg of body weight). Iron compounds have a different structure, have a functional activity characteristic only for them, and play an important biological role. The most important iron-containing compounds include: hemoproteins, the structural component of which is heme (hemoglobin, myoglobin, cytochromes, catalase, peroxidase), non-heme group enzymes (succinate dehydrogenase, acetyl-CoA dehydrogenase, xanthine oxidase), ferritin, hemosiderin, transferrin. Iron is part of complex compounds and is distributed in the body as follows:
- heme iron - 70%;
- iron depot - 18% (intracellular accumulation in the form of ferritin and hemosiderin);
- functioning iron - 12% (myoglobin and iron-containing enzymes);
- transported iron - 0.1% (iron associated with transferrin).

There are two types of iron: heme and non-heme. Heme iron is part of hemoglobin. It is found only in a small part of the diet ( meat products), is well absorbed (by 20-30%), its absorption is practically not affected by other food components. Non-heme iron is in free ionic form - ferrous (Fe II) or ferric (Fe III). Most dietary iron is non-heme iron (found primarily in vegetables). The degree of its assimilation is lower than that of heme, and depends on a number of factors. From food, only divalent non-heme iron is absorbed. To “turn” ferric iron into ferrous, a reducing agent is needed, the role of which in most cases is played by ascorbic acid (vitamin C). In the process of absorption in the cells of the intestinal mucosa, ferrous iron Fe2 + turns into oxide Fe3 + and binds to a special carrier protein - transferrin, which transports iron to hematopoietic tissues and iron deposition sites.

The accumulation of iron is carried out by the proteins ferritin and hemosiderin. If necessary, iron can be actively released from ferritin and used for erythropoiesis. Hemosiderin is a ferritin derivative with a higher iron content. From hemosiderin, iron is released slowly. Beginning (prelatent) iron deficiency can be identified by a reduced concentration of ferritin even before the exhaustion of iron stores, while still maintaining normal concentrations of iron and transferrin in the blood serum.

What provokes / Causes of Iron deficiency anemia:

The main etiopathogenetic factor in the development of iron deficiency anemia is iron deficiency. The most common causes of iron deficiency conditions are:
1. iron loss in chronic bleeding (the most common cause, reaching 80%):
- bleeding from the gastrointestinal tract: peptic ulcer, erosive gastritis, esophageal varicose veins, colonic diverticula, hookworm invasions, tumors, UC, hemorrhoids;
- prolonged and heavy menstruation, endometriosis, fibromyoma;
- macro- and microhematuria: chronic glomerulo- and pyelonephritis, urolithiasis, polycystic kidney disease, tumors of the kidneys and bladder;
- nasal, pulmonary bleeding;
- blood loss during hemodialysis;
- uncontrolled donation;
2. insufficient absorption of iron:
- resection of the small intestine;
- chronic enteritis;
- malabsorption syndrome;
- intestinal amyloidosis;
3. increased need for iron:
- intensive growth;
- pregnancy;
- the period of breastfeeding;
- sports activities;
4. insufficient intake of iron from food:
- newborns;
-- Small children;
- Vegetarianism.

Pathogenesis (what happens?) during iron deficiency anemia:

Pathogenetically, the development of an iron deficiency state can be divided into several stages:
1. prelatent iron deficiency (insufficiency of accumulation) - there is a decrease in the level of ferritin and a decrease in the iron content in the bone marrow, iron absorption is increased;
2. latent iron deficiency (iron-deficient erythropoiesis) - the serum iron is additionally reduced, the concentration of transferrin is increased, the content of sideroblasts in the bone marrow is reduced;
3. severe iron deficiency = iron deficiency anemia - the concentration of hemoglobin, red blood cells and hematocrit is additionally reduced.

Symptoms of iron deficiency anemia:

During the period of latent iron deficiency, many subjective complaints and clinical signs characteristic of iron deficiency anemia appear. Patients report general weakness, malaise, decreased performance. Already during this period, there may be a perversion of taste, dryness and tingling of the tongue, a violation of swallowing with a sensation of a foreign body in the throat, palpitations, shortness of breath.
An objective examination of patients reveals "small symptoms of iron deficiency": atrophy of the papillae of the tongue, cheilitis, dry skin and hair, brittle nails, burning and itching of the vulva. All these signs of violation of the trophism of epithelial tissues are associated with tissue sideropenia and hypoxia.

Patients with iron deficiency anemia note general weakness, fatigue, difficulty concentrating, and sometimes drowsiness. There is a headache, dizziness. With severe anemia, fainting is possible. These complaints, as a rule, do not depend on the degree of decrease in hemoglobin, but on the duration of the disease and the age of the patients.

Iron deficiency anemia is also characterized by changes in the skin, nails, and hair. The skin is usually pale, sometimes with a slight greenish tint (chlorosis) and with an easy blush of the cheeks, it becomes dry, flabby, flaky, cracks easily. Hair loses its luster, becomes gray, thinner, breaks easily, thins and turns gray early. Nail changes are specific: they become thin, dull, flatten, easily exfoliate and break, striation appears. With pronounced changes, the nails acquire a concave, spoon-shaped shape (koilonychia). In patients with iron deficiency anemia, muscle weakness occurs, which is not observed in other types of anemia. It is referred to as a manifestation of tissue sideropenia. Atrophic changes occur in the mucous membranes of the digestive canal, respiratory organs, and genital organs. Damage to the mucous membrane of the digestive canal is a typical sign of iron deficiency conditions.
There is a decrease in appetite. There is a need for sour, spicy, salty foods. In more severe cases, there are perversions of smell, taste (pica chlorotica): eating chalk, lime, raw cereals, pogophagy (an attraction to eating ice). Signs of tissue sideropenia quickly disappear after taking iron supplements.

Diagnosis of iron deficiency anemia:

Main landmarks in laboratory diagnostics iron deficiency anemia the following:
1. The average content of hemoglobin in an erythrocyte in picograms (norm 27-35 pg) is reduced. To calculate it, the color index is multiplied by 33.3. For example, with a color index of 0.7 x 33.3, the hemoglobin content is 23.3 pg.
2. The average concentration of hemoglobin in the erythrocyte is reduced; normally, it is 31-36 g / dl.
3. Hypochromia of erythrocytes is determined by microscopy of a smear of peripheral blood and is characterized by an increase in the zone of central enlightenment in the erythrocyte; Normally, the ratio of central enlightenment to peripheral darkening is 1:1; with iron deficiency anemia - 2 + 3: 1.
4. Microcytosis of erythrocytes - a decrease in their size.
5. Coloring of erythrocytes of different intensity - anisochromia; the presence of both hypo- and normochromic erythrocytes.
6. Different form of erythrocytes - poikilocytosis.
7. The number of reticulocytes (in the absence of blood loss and the period of ferrotherapy) with iron deficiency anemia remains normal.
8. The content of leukocytes is also within the normal range (with the exception of cases of blood loss or oncopathology).
9. The content of platelets often remains within the normal range; moderate thrombocytosis is possible with blood loss at the time of examination, and the platelet count decreases when blood loss due to thrombocytopenia is the basis of iron deficiency anemia (for example, with DIC, Werlhof's disease).
10. Reducing the number of siderocytes up to their disappearance (siderocyte is an erythrocyte containing iron granules). In order to standardize the production of peripheral blood smears, it is recommended to use special automatic devices; the resulting monolayer of cells improves the quality of their identification.

Blood chemistry:
1. Decreased iron content in the blood serum (normal in men 13-30 µmol/l, in women 12-25 µmol/l).
2. TIBC is increased (reflects the amount of iron that can be bound by free transferrin; TIBC is normal - 30-86 µmol / l).
3. Study of transferrin receptors by enzyme immunoassay; their level is increased in patients with iron deficiency anemia (in patients with anemia of chronic diseases - normal or reduced, despite similar indicators of iron metabolism.
4. The latent iron-binding capacity of the blood serum is increased (determined by subtracting the serum iron content from the FIA ​​values).
5. The percentage of saturation of transferrin with iron (the ratio of the serum iron index to the total body fat; normally 16-50%) is reduced.
6. The level of serum ferritin is also reduced (normally 15-150 mcg/l).

At the same time, in patients with iron deficiency anemia, the number of transferrin receptors is increased and the level of erythropoietin in the blood serum is increased (compensatory reactions of hematopoiesis). The volume of erythropoietin secretion is inversely proportional to the oxygen transport capacity of the blood and is directly proportional to the oxygen demand of the blood. It should be borne in mind that the level of serum iron is higher in the morning; before and during menstruation, it is higher than after menstruation. The content of iron in the blood serum in the first weeks of pregnancy is higher than in its last trimester. The level of serum iron increases on the 2nd-4th day after treatment with iron-containing drugs, and then decreases. Significant consumption of meat products on the eve of the study is accompanied by hypersideremia. These data must be taken into account when evaluating the results of a serum iron study. It is equally important to observe the technique of laboratory research, the rules of blood sampling. Thus, the test tubes in which blood is collected must first be washed with hydrochloric acid and bidistilled water.

Myelogram study reveals a moderate normoblastic reaction and a sharp decrease in the content of sideroblasts (erythrocaryocytes containing iron granules).

The iron stores in the body are judged by the results of the desferal test. At healthy person after intravenous administration of 500 mg of desferal, 0.8 to 1.2 mg of iron is excreted in the urine, while in a patient with iron deficiency anemia, iron excretion decreases to 0.2 mg. The new domestic drug defericolixam is identical to desferal, but circulates in the blood longer and therefore more accurately reflects the level of iron stores in the body.

Based on the level of hemoglobin, iron deficiency anemia, like other forms of anemia, is divided into severe, moderate and mild anemia. With mild iron deficiency anemia, the hemoglobin concentration is below normal, but more than 90 g / l; with moderate iron deficiency anemia, the hemoglobin content is less than 90 g / l, but more than 70 g / l; with severe iron deficiency anemia, the hemoglobin concentration is less than 70 g / l. However, clinical signs of the severity of anemia (symptoms of a hypoxic nature) 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.

According to clinical manifestations, 5 degrees of severity of anemia are distinguished:
1. anemia without clinical manifestations;
2. anemic syndrome of moderate severity;
3. severe anemic syndrome;
4. anemic precoma;
5. anemic coma.

Moderate severity of anemia is characterized by general weakness, specific signs (for example, sideropenic or signs of vitamin B12 deficiency); with a pronounced degree of severity of anemia, palpitations, shortness of breath, dizziness, etc. appear. Precomatous and comatose states can develop in a matter of hours, which is especially characteristic of megaloblastic anemia.

Modern clinical researches show that among patients with iron deficiency anemia, laboratory and clinical heterogeneity is observed. So, in some patients with signs of iron deficiency anemia and concomitant inflammatory and infectious diseases, the level of serum and erythrocyte ferritin does not decrease, however, after the elimination of the exacerbation of the underlying disease, their content drops, which indicates the activation of macrophages in the processes of iron consumption. In some patients, the level of erythrocyte ferritin even increases, especially in patients with a long course of iron deficiency anemia, which leads to ineffective erythropoiesis. Sometimes there is an increase in the level of serum iron and erythrocyte ferritin, a decrease in serum transferrin. It is assumed that in these cases, the process of iron transfer to hemosynthetic cells is disrupted. In some cases, a deficiency of iron, vitamin B12 and folic acid is determined simultaneously.

Thus, even the level of serum iron does not always reflect the degree of iron deficiency in the body in the presence of other signs of iron deficiency anemia. Only the level of TIBC in iron deficiency anemia is always elevated. Therefore, not a single biochemical indicator, incl. TIA cannot be considered as an absolute diagnostic criterion for iron deficiency anemia. At the same time, the morphological characteristics of peripheral blood erythrocytes and computer analysis of the main parameters of erythrocytes are decisive in the screening diagnosis of iron deficiency anemia.

Diagnosis of iron deficiency conditions is difficult in cases where the hemoglobin content remains normal. Iron deficiency anemia develops in the presence of the same risk factors as in iron deficiency anemia, as well as in individuals with an increased physiological need for iron, especially in premature babies at an early age, in adolescents with a rapid increase in body height and weight, in blood donors, with nutritional dystrophy. At the first stage of iron deficiency, there are no clinical manifestations, and iron deficiency is determined by the content of hemosiderin in bone marrow macrophages and by the absorption of radioactive iron in the gastrointestinal tract. At the second stage (latent iron deficiency), there is an increase in the concentration of protoporphyrin in erythrocytes, a decrease in the number of sideroblasts, morphological signs appear (microcytosis, hypochromia of erythrocytes), a decrease in the average content and concentration of hemoglobin in erythrocytes, a decrease in the level of serum and erythrocyte ferritin, saturation of transferrin with iron. The level of hemoglobin in this stage remains quite high, and clinical signs are characterized by a decrease in exercise tolerance. The third stage is manifested by clear clinical and laboratory signs of anemia.

Examination of patients with iron deficiency anemia
To exclude anemia that has common features with iron deficiency anemia, and to identify the cause of iron deficiency, a complete clinical examination of the patient is necessary:

General blood analysis with the obligatory determination of the number of platelets, reticulocytes, the study of the morphology of erythrocytes.

Blood chemistry: determination of the level of iron, OZhSS, ferritin, bilirubin (bound and free), hemoglobin.

In all cases it is necessary examine bone marrow punctate before the appointment of vitamin B12 (primarily for differential diagnosis with megaloblastic anemia).

To identify the cause of iron deficiency anemia in women, a preliminary consultation with a gynecologist is required to exclude diseases of the uterus and its appendages, and in men, an examination by a proctologist to exclude bleeding hemorrhoids and a urologist to exclude prostate pathology.

There are cases of extragenital endometriosis, for example in the respiratory tract. In these cases, hemoptysis is observed; fibrobronchoscopy with histological examination of the biopsy of the bronchial mucosa allows you to establish a diagnosis.

The examination plan also includes X-ray and endoscopic examination of the stomach and intestines in order to exclude ulcers, tumors, incl. glomic, as well as polyps, diverticulum, Crohn's disease, ulcerative colitis, etc. If pulmonary siderosis is suspected, radiography and tomography of the lungs are performed, sputum examination for alveolar macrophages containing hemosiderin; in rare cases, a histological examination of a lung biopsy is necessary. If a kidney pathology is suspected, a general urinalysis, a blood serum test for urea and creatinine are necessary, and, if indicated, an ultrasound and X-ray examination of the kidneys. In some cases it is necessary to exclude endocrine pathology: myxedema, in which iron deficiency can develop secondarily due to damage to the small intestine; polymyalgia rheumatica is a rare disease connective tissue in older women (less often in men), it is characterized by pain in the muscles of the shoulder or pelvic girdle without any objective changes in them, and in the blood test - anemia and an increase in ESR.

Differential diagnosis of iron deficiency anemia
When making a diagnosis of iron deficiency anemia, it is necessary to make a differential diagnosis with other hypochromic anemias.

Iron-redistributive anemia is a fairly common pathology and, in terms of frequency of development, ranks second among all anemias (after iron deficiency anemia). It develops in acute and chronic infectious and inflammatory diseases, sepsis, tuberculosis, rheumatoid arthritis, liver diseases, oncological diseases, IHD, etc. The mechanism of development of hypochromic anemia in these conditions is associated with the redistribution of iron in the body (it is located mainly in the depot) and the violation of the mechanism of iron recycling from the depot. In the above diseases, the activation of the macrophage system occurs, when macrophages, under conditions of activation, firmly retain iron, thereby disrupting the process of its reutilization. In the general blood test, a moderate decrease in hemoglobin is noted (
The main differences from iron deficiency anemia are:
- elevated level serum ferritin, which indicates an increased iron content in the depot;
- the level of serum iron may remain within normal limits or be moderately reduced;
- TIBC remains within normal limits or decreases, which indicates the absence of serum Fe-starvation.

Iron-saturated anemia develops as a result of impaired heme synthesis, which is due to heredity or can be acquired. Heme is formed from protoporphyrin and iron in erythrokaryocytes. With iron-saturated anemia, there is a violation of the activity of enzymes involved in the synthesis of protoporphyrin. The consequence of this is a violation of heme synthesis. Iron that has not been used for heme synthesis is deposited as ferritin in bone marrow macrophages, as well as in the form of hemosiderin in the skin, liver, pancreas, and myocardium, resulting in secondary hemosiderosis. Anemia, erythropenia, and a decrease in color index will be recorded in the general blood test.

The indicators of iron metabolism in the body are characterized by an increase in the concentration of ferritin and the level of serum iron, normal indicators of TIBC, and an increase in the saturation of transferrin with iron (in some cases it reaches 100%). Thus, the main biochemical indicators that allow assessing the state of iron metabolism in the body are ferritin, serum iron, TIBC, and % saturation of transferrin with iron.

The use of indicators of iron metabolism in the body allows the clinician to:
- to identify the presence and nature of violations of iron metabolism in the body;
- identify the presence of iron deficiency in the body at the preclinical stage;
- to carry out differential diagnostics of hypochromic anemias;
- evaluate the effectiveness of the therapy.

Treatment for iron deficiency anemia:

In all cases of iron deficiency anemia, 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 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.

Treatment program for iron deficiency anemia:
- elimination of the cause of iron deficiency anemia;
- medical nutrition;
- ferrotherapy;
- prevention of relapses.

Patients with iron deficiency anemia are recommended a varied diet, including meat products (veal, liver) and vegetable products (beans, soybeans, parsley, peas, spinach, dried apricots, prunes, pomegranates, raisins, rice, buckwheat, bread). However, it is impossible to achieve an antianemic effect with diet alone. Even if the patient eats high-calorie foods containing animal protein, iron salts, vitamins, microelements, iron absorption can be achieved no more than 3-5 mg per day. It is necessary to use iron preparations. Currently, the doctor has a large arsenal of iron preparations, characterized by different composition and properties, the amount of iron contained in them, the presence of additional components that affect the pharmacokinetics of the drug, various dosage forms.

According to the recommendations developed by WHO, when prescribing iron preparations, preference is given to preparations containing ferrous iron. The daily dose should reach 2 mg/kg of elemental iron in adults. The total duration of treatment is at least three months (sometimes up to 4-6 months). An ideal iron-containing preparation should have a minimum number of side effects, have a simple regimen of administration, the best ratio of effectiveness / price, optimal iron content, preferably the presence of factors that enhance absorption and stimulate hematopoiesis.

Indications for parenteral administration of iron preparations occur with intolerance to all oral preparations, malabsorption (ulcerative colitis, enteritis), peptic ulcer of the stomach and duodenum during an exacerbation, with severe anemia and the vital need for rapid replenishment of iron deficiency. The effectiveness of iron preparations is judged by changes in laboratory parameters over time. By the 5th-7th day of treatment, the number of reticulocytes increases by 1.5-2 times compared with the initial data. Starting from the 10th day of therapy, the hemoglobin content increases.

Taking into account the prooxidant and lysosomotropic effect of iron preparations, their parenteral administration can be combined with intravenous drip administration of rheopolyglucin (400 ml once a week), which allows protecting the cell and avoiding overload of macrophages with iron. Taking into account significant changes in the functional state of the erythrocyte membrane, activation of lipid peroxidation and a decrease in the antioxidant protection of erythrocytes in iron deficiency anemia, it is necessary to introduce antioxidants, membrane stabilizers, cytoprotectors, antihypoxants, such as a-tocopherol up to 100-150 mg per day (or ascorutin, vitamin A, vitamin C, lipostabil, methionine, mildronate, etc.), and also combined with vitamins B1, B2, B6, B15, lipoic acid. In some cases, it is advisable to use ceruloplasmin.

List of drugs that are used in the treatment of iron deficiency anemia:
- Zhektofer (Jectofer);
- Conferon (Conferon);
- Maltofer (Maltofer);
- Sorbifer durules (Sorbifer durules);
- Tardiferon (Tardiferon);
- Feramid (Ferramidum);
- Ferro-gradumet (Ferro-gradumet);
- Ferroplex (Ferroplex);
- Ferroceron (Ferroceronum);
- Ferrum lek.
- Totem (tothema)

Prevention of iron deficiency anemia:

Periodic monitoring of the blood picture;
- eating foods high in iron (meat, liver, etc.);
- preventive intake of iron preparations in risk groups.
- prompt elimination of sources of blood loss.

Which doctors should you contact if you have iron deficiency anemia:

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Other diseases from the group Diseases of the blood, hematopoietic organs and individual disorders involving the immune mechanism:

B12 deficiency anemia

Anemia due to impaired synthesis by utilization of porphyrins

Anemia due to a violation of the structure of globin chains

Anemia characterized by the carriage of pathologically unstable hemoglobins

Anemia Fanconi

Anemia associated with lead poisoning

aplastic anemia

Autoimmune hemolytic anemia

Autoimmune hemolytic anemia

Autoimmune hemolytic anemia with incomplete heat agglutinins

Autoimmune hemolytic anemia with complete cold agglutinins

Autoimmune hemolytic anemia with warm hemolysins

Heavy chain diseases

Werlhof's disease

von Willebrand disease

Di Guglielmo's disease

Christmas disease

Marchiafava-Micheli disease

Rendu-Osler disease

Alpha heavy chain disease

gamma heavy chain disease

Shenlein-Henoch disease

Extramedullary lesions

Hairy cell leukemia

Hemoblastoses

Hemolytic uremic syndrome

Hemolytic uremic syndrome

Hemolytic anemia associated with vitamin E deficiency

Hemolytic anemia associated with deficiency of glucose-6-phosphate dehydrogenase (G-6-PDH)

Hemolytic disease of the fetus and newborn

Hemolytic anemia associated with mechanical damage to red blood cells

Hemorrhagic disease of the newborn

Histiocytosis malignant

Histological classification of Hodgkin's disease

DIC

Deficiency of K-vitamin-dependent factors

Factor I deficiency

Factor II deficiency

Factor V deficiency

Factor VII deficiency

Factor XI deficiency

Factor XII deficiency

Factor XIII deficiency

Patterns of tumor progression

Immune hemolytic anemias

Bedbug origin of hemoblastoses

Leukopenia and agranulocytosis

Lymphosarcomas

Lymphocytoma of the skin (Caesari disease)

Lymph node lymphocytoma

Lymphocytoma of the spleen

Radiation sickness

Marching hemoglobinuria

Mastocytosis (mast cell leukemia)

Megakaryoblastic leukemia

The mechanism of inhibition of normal hematopoiesis in hemoblastoses

Mechanical jaundice

Anemia is a condition of the body in which it lacks red blood cells. A change in their norm in the blood causes weakness, dizziness, and a general weakening of the immune system. In this state, a person cannot fight the exacerbation of chronic diseases or a viral infection.

Chronic iron deficiency anemia (ICD-10 code D50) develops against the background of a chronic lack of iron in the human body. This leads to a sharp decrease in the size and number of red blood cells - erythrocytes in the blood. This type of anemia accounts for 90% of all reported cases of the disease. The daily human need for iron is about 4 g.

There are three stages of iron deficiency anemia:

• prelatent iron deficiency is mild anemia;
• latent microelement deficiency - moderate anemia;
• iron deficiency anemia is a severe disease.

Latent iron deficiency is caused by a decrease in its content in various organs. human body: liver, bone marrow or spleen. A sharp decrease in this element reduces the level of ferritin in the blood, which leads to a decrease in hemoglobin. Thus, low hemoglobin values ​​in this case are a secondary phenomenon. A general blood test can show the norm for hemoglobin in the blood. In clinical practice, additional tests for the level of ferritin and transferrin are used.

With iron deficiency anemia, there is a decrease in serum iron in the blood, which leads to a sharp decrease in hemoglobin and the development of anemia, as a result of which there is a disruption in the work of other organs. Three conditions are distinguished depending on the degree of iron deficiency.

Etiology

The factors of the etiology of the occurrence of iron deficiency anemia are united by one thing - a decrease in the background of iron in tissues and blood.

Reasons for reducing the amount of iron in the body:

• Wrong nutrition. With food, the body does not receive the necessary amount of iron for normal functioning.
• Decreased appetite and associated decrease in food intake.
• Diseases gastrointestinal a path which lead to disturbance of normal absorption of iron through mucous fabrics.
• An imbalance between the intake and use of iron due to a sharp increase in demand.
• Overt blood loss due to trauma or hidden internal bleeding as a result of other diseases.

Patients with iron deficiency anemia report general weakness, problems concentrating and drowsiness. Significantly reduced level of vitality. Iron deficiency manifests itself in abnormal pallor of the skin, nails, lips and tongue. characteristic feature anemia is the fragility of nails, their ability to exfoliate.

Forms of iron deficiency anemia

IDA - iron deficiency anemia - is classified according to several indicators:

By etiology:

• chronic form of posthemorrhagic anemia;
• IDA as a result of overexpenditure of iron by the body;
• IDA as a result of congenital iron deficiency in newborns;
• alimentary IDA;
• IDA due to a violation of the absorption process in the intestine;
• in violation of iron transport.

According to the stage of development of the disease:

• latent anemia;
• iron deficiency anemia with an obvious clinic.

According to the severity of the course of the disease:

• mild form (hemoglobin 90-120 g/l);
• moderate (hemoglobin 70-90 g/l);
• severe form of anemia (hemoglobin less than 70 g/l).

Severe iron deficiency anemia

The most difficult case in clinical practice is the restoration of iron balance in latent iron deficiency anemia. In this case, it is imperative to establish the cause of anemia. Without its elimination, with a constant loss of iron, it is impossible to restore balance even medicines. Hemoglobin values ​​in the general blood test are less than 70 g/l.

In the treatment of iron deficiency anemia of this severity, in combination with a diet, intravenous administration of iron preparations is prescribed. The level of hemoglobin is monitored with a certain frequency, until the problem of iron deficiency is completely eliminated.

Iron deficiency anemia of moderate severity

This stage of the course of the disease is difficult to diagnose. Iron deficiency anemia of moderate severity can show the norm of hemoglobin in the blood, but the presence of iron in other organs and tissues is insufficient. This degree can be established with the help of additional blood tests for ferritin and transferrin. Hemoglobin indicators in the general blood test are 70-90 g / l.

Treatment at this stage is carried out with the help of a diet and the introduction of multivitamin complexes into the diet. For adults, doctors recommend taking dietary supplements containing iron with food. But for children and pregnant women, it is possible to prescribe medications: iron preparations in tablets or capsules. The medication is taken one hour before a meal or at least two hours after a meal.

Mild iron deficiency anemia

This degree of the disease is called latent iron deficiency anemia. The level of iron in blood is normal (80-120 g / l), but its intake per day is less than consumption. The process of formation of iron deficiency begins.

Mild iron deficiency anemia can be treated with food. It is enough to review the daily diet. Introduce products containing this microelement into it:

• seaweed - 20 mg;
• dried apricots - 16 mg;
• parsley - 11 mg;
• beets - 8 mg;
• white poultry meat - 5 mg.

In addition to nutrition, decoctions of herbs are used in complex therapy: angelica, yarrow and blueberries.

When determining the diagnosis of "chronic iron deficiency anemia", you should not count on a quick recovery, since the process of occurrence of each type of iron deficiency anemia took long time. You can achieve a quick disappearance of obvious symptoms of the disease, but it will take up to 2-3 months to restore the balance of iron in the blood and other organs.