Iron deficiency anemia is a common clinico-hematologic symptom complex due to inadequate percentage of iron in the body and manifested by a decrease in the level of both erythrocytes and hemoglobin in the peripheral blood. In the general structure of all anemia, iron deficiency ranks first in the frequency of occurrence in adults and children and is at least 80%.
Under normal conditions, the body of an average healthy adult contains about 5000 mg of iron, which is part of hemoglobin (2/3 of the total volume), cytochrome oxidase (300 mg), ferritin and hemosiderin, which are deposited in the tissues of the bone marrow, liver and spleen 1000 mg) and so-called serum or transport iron (up to 30.4 mmol / l).
The first necessary stock of iron is stored by the person during the pre-natal period, receiving it from the mother through the placental vascular system. In the postnatal period, iron enters the body solely with food.
The main ways to remove iron from the body are sweat glands, urinary system and digestive tract. In female representatives, after the onset of puberty, there is another way to remove iron - along with menstrual discharge, so iron deficiency anemia in women occurs quite often.
In order not to provoke an iron deficiency anemia, it is enough only to ensure the intake of iron with food in the amount of 2 g per day, since every day this amount of iron is excreted from the body.
Iron deficiency anemia
Among the reasons that can cause the emergence of iron deficiency anemia, the leading position is chronic hemorrhage. Sources of such chronic hemorrhage, which initially causes a latent period, and then obvious signs of iron deficiency anemia, are:
- diseases of the urogenital system in women (fibroids of the uterus, endometriosis, cervical cancer , ovarian dysfunction);
- nosebleed (Rundu-Osler disease).
Another cause of anemia is a violation of the absorption of iron by the organs of the gastrointestinal tract. Iron is absorbed by the mucous membrane of the duodenum, however in this department iron is absorbed only in soluble reduced form. In order to give the iron a soluble form, the action of perchloric acid, which is in the stomach, is necessary. In the initial sections of the small intestine, iron undergoes additional changes, after which it binds to transferrin and is deposited in certain tissues. Thus, any pathology of the upper sections of the gastrointestinal tract causes a violation of iron absorption (total and subtotal resection of the stomach and small intestine, chronic enteritis).
In addition to the iron deficiency in the system, iron deficiency anemia often causes increased consumption of iron, which most often occurs during pregnancy and lactation, and therefore there is even a separate nosological form of "iron deficiency anemia in pregnant women."
An increase in the consumption of iron is also observed during puberty, when there is an accelerated growth of muscle mass, accompanied by a decrease in the iron content in the structure of the bone marrow. There is a clear dependence - if the mother had anemia during pregnancy, then in the child during the onset of menstruation in 100% of cases, anemia is provoked, which is called "early chlorosis".
Not infrequent cause of the emergence of iron deficiency anemia are chronic infectious diseases, in which there is a redistribution of iron and its binding by macrophages involved in the process of immune response ( brucellosis , tuberculosis, bacterial sepsis).
Despite the fact that iron enters the body solely with food, the alimentary type of iron deficiency anemia is a rare occurrence and is more observed in childhood, as well as in vegetarians.
Iron deficiency anemia symptoms
Iron deficiency anemia in adults has a wide range of clinical symptoms, and the degree of their manifestation depends directly on the severity of iron deficiency.
If the patient has a moderate decrease in the amount of iron, then for a long time he remains able to work and those or other symptoms appear only with excessive physical activity.
Clinical manifestations of iron deficiency anemia are quite diverse, but all of them can be attributed to one of the two main syndromes - anemic and syndrome of sideropenia. Symptoms that are part of the anemic syndrome are due to the resulting iron deficiency anemia, hypoxia. Manifestations of syndrome of sideropenia arise as a result of a lack of tissue iron and a decrease in the activity of cytochrome oxidase. In addition to these manifestations, the patient usually presents complaints typical of the underlying disease, against which an iron deficiency anemia arose.
A characteristic sign of the onset of anemic syndrome is the emergence of general weakness, decreased efficiency, drowsiness, dizziness , noise in the ears, a feeling of rapid heartbeat and dyspnea, various degrees of impaired consciousness, chills and increased irritability. A frequent complaint of patients with iron deficiency anemia is a pronounced muscle weakness, the occurrence of which is not associated with physical activity.
Objective signs of iron deficiency anemia, which are noticeable even during the initial examination of the patient are: the appearance of severe pallor of the skin and / or mucous membranes, puffiness of the face, pronounced pastovess of the distal sections of the lower limbs, increased frequency of heart contractions during physical exertion, lowering of arterial pressure and the appearance of auscultatory systolic noise at the point of listening to the top of the heart.
Typical complaints iron deficiency anemia, which are related to sideropenia syndrome, are: lack of appetite, distortion of taste preferences (desire to eat chalk, sand, clay) and smell (desire to breathe fumes of gasoline, acetone and exhaust gases), pain when swallowing as hard, and liquid food (the symptom of Plummer-Vinson). An objective examination of a patient with a sideropenic syndrome reveals trophic disorders of the skin and mucous membranes - dryness, skin peeling , transverse striation of the nail plates, hair loss, seizures in the corners of the mouth, cracks and aphthous changes on the surface of the tongue.
The main options for the course of iron deficiency anemia include: early chlorosis, chronic iron deficiency anemia and iron deficiency anemia during pregnancy.
A feature of early chlorosis is that manifestations of iron deficiency anemia occur during puberty and are more characteristic of girls. Iron deficiency occurs for two reasons - as a result of the increased expenditure on muscle tissue growth and as a result of bleeding during menstruation. Even with a primary examination of a teenager, you can suspect the presence of early chlorosis: the skin is pale, pasty, swelling of the face and lower limbs. A frequent complaint of such patients is a decrease in appetite and frequent constipation .
The chronic course of iron deficiency anemia is more typical for women and is caused by regular menstrual bleeding. In men, the cause of chronic anemia can be gastrointestinal bleeding in excess of 100 ml / day. It should be borne in mind that latent gastric bleeding may be the cause of anemia, therefore, all patients with iron deficiency anemia are shown to have an instrumental examination of the gastrointestinal tract organs (esophagogastroscopy, colonoscopy, sigmoidoscopy, x-rays of the stomach and irrigoscopy). Often the symptoms that testify to hypoxia and sideropenia go into the background and the primary complaints of the patient are manifestations of the underlying disease, which was the primary cause of the onset of anemia.
Iron deficiency anemia in pregnant women is a frequent pathology and is caused by an unbalanced diet of a future mother in conditions of increased consumption of iron. Also, a frequent cause of lowering the iron level in the blood of a pregnant woman is infectious disease, and therefore, it is recommended to sanitize all chronic foci of infection during pregnancy planning. Pregnant women are characterized by complaints that indicate the onset of hypoxia, rather than signs of sideropenic syndrome.
Degrees of iron deficiency anemia
In order to give a qualitative assessment of the state of health of a patient with signs of iron deficiency, it is necessary to take into account not only the clinical, but also the laboratory indicators available to the patient. Evaluation of the severity and severity of iron deficiency anemia is included in the mandatory algorithm of the patient's study before the appointment of treatment.
If we assess the severity of the patient's condition based on existing clinical symptoms, then there are 5 degrees of severity: latent iron deficiency anemia (there are no clinical symptoms), moderately severe iron deficiency anemia (manifestations of anemic and sideropenic symptom complex), expressed degree of iron deficiency anemia (adherence of clinical manifestations of hypoxia and disorders of central hemodynamics), precoma and coma.
When considering laboratory changes characteristic of iron deficiency states, one of the manifestations of which is anemia, it should be taken into account that none of the biochemical indicators of blood can be regarded as an absolute evidentiary criterion and only with the totality of indicators can we judge the severity of anemia.
Thus, for the first degree of iron deficiency anemia is characterized by a decrease in hemosiderin level in macrophages of the bone marrow and a reduced absorption of iron in the intestine.
At the second degree of iron deficiency anemia in erythrocyte, the concentration of protoporphyrin increases, the level of sideroblasts decreases, the morphological changes of erythrocytes in the form of microcytosis and hypochromia, the concentration of hemoglobin decreases, the level of ferritin decreases.
The third degree of iron deficiency anemia is accompanied not only by laboratory, but also clinical signs of anemia.
Iron deficiency anemia in children
The basic composition of iron in the blood of the child is formed during the entire period of the mother's pregnancy, but the most intensive intake of iron through the placental vessels occurs in the third trimester. The norm of iron contained in the body of a full-term newborn is 400 mg, and in children born before the due date, this figure does not exceed 100 mg.
While the positive balance between the consumption of iron and its intake does not break in the body of a newborn child, no changes occur. Neonatologists and pediatricians claim that the stock of iron contained in breastmilk is sufficient to prevent iron deficiency in a child up to the age of 4 months. In this regard, early refusal of breastfeeding can provoke iron deficiency conditions that have serious consequences for the health and early development of the child.
In the development of the iron deficiency state, the child has 3 pathogenetic stages: prelalentic (iron level reduction due to a decrease in its accumulation in tissues with safe red blood formula indices), latent (lower values not only of iron content in tissues, but also of iron level contained in serum blood) and anemia (decrease in the levels of all indicators of the red blood formula).
Based on these indicators, all the causes that cause the occurrence of iron deficiency in the child's body can be divided into several groups:
♦ Intrauterine period: pathological conditions accompanied by placental insufficiency (early and late toxicosis, hypoxia syndrome, infectious diseases of the pregnant woman), utero-placenta bleeding, multiple pregnancy with fetal transfusion syndrome, chronic iron-deficiency anemia of severe degree during pregnancy.
♦ Intranatal period: premature bandaging of the umbilical cord, massive bleeding during delivery.
♦ Postpartum period: nutritional reasons (early interruption of breastfeeding, early lactation with whole cow milk, vegetarian type of diet), reasons based on the accelerated growth rate of the child (prematurity, the birth of a child who has a large weight, the period of pubertal development), diseases accompanied by a violation of the absorption function of the intestine (malabsorption syndrome, developmental abnormalities, hereditary diseases of the gastrointestinal tract).
In childhood, it is difficult to establish a diagnosis of iron deficiency anemia according to clinical signs, since the symptoms of anemia are non-specific and can be represented by one of the following symptom-complexes:
- asthenovegetative manifestations (their appearance is caused by a disruption in the functioning of the basic structures of the brain and manifests itself as a backwardness in psychomotor development, irritability, a decrease in intellectual capabilities, a tendency to hypotension and enuresis);
- trophic changes in the skin, mucous membranes are caused by the so-called epithelial syndrome;
- Immunodeficiency syndrome (a tendency to infectious diseases that affect the upper respiratory tract and intestines);
Recent centralized, randomized studies have shown that children with signs of iron deficiency anemia living in large cities are more likely to suffer from lead intoxication, which has severe complications in the form of mental and neurological disorders, hepatic renal insufficiency, and absolute refractoriness to the use of iron-containing drugs.
Among the clinical forms of iron deficiency anemia that occur in childhood, distinguish:
- Anemia in a premature baby, the first signs of which appear already in the first month of life, and accompanied by a marked decrease in the hemoglobin in the blood to 80 g / l. As a drug of choice in this situation is Erythropoietin, which is administered subcutaneously 3 times a week at a dose of 200 units per kg of weight by a course of at least 10 injections;
- Infectious and alimentary anemia, which manifests itself in the second half of the child's life and is caused by insufficient intake of useful iron along with breast milk in cases of breastfeeding disorders, as well as infectious diseases;
- Chlorosis caused by endocrine dysfunction during puberty and having all the signs of a lack of iron in the blood, but not requiring specialized medication correction and passing independently after the establishment of a regular menstrual cycle.
In order to prevent the development of iron deficiency conditions in a child in this or that period, it is necessary to use preventive measures: the rational nutrition of the pregnant woman and the use of prolonged forms of iron-containing preparations with the available signs of anemia, prolonged and regular breastfeeding with a rational approach to the introduction of lures, periodic analysis of laboratory parameters of peripheral blood.
Iron deficiency anemia treatment
When choosing methods for the therapy of iron deficiency anemia, many factors should be considered, since the treatment should be individual, consistent and pathogenetically justified.
The main directions in the treatment of iron deficiency states are the obligatory effect on the etiologic factor provoking the onset of anemia, as well as the medical correction of iron deficiency.
As an etiopathogenetic treatment, one should consider the treatment of diseases accompanied by chronic bleeding even in small amounts, the sanation of chronic foci of infection in the body.
As the pathogenetically justified medicines used to treat iron deficiency anemia, preparations containing iron ions are used. Treatment with iron preparations should be strictly individual and performed only under the control of laboratory blood indicators, as these drugs are not always well tolerated in patients.
Side effects from the use of iron-containing medications arise as a result of the irritating effect of iron salts on the mucous membranes of the upper parts of the digestive tract. There are side reactions in the form of belching gastric contents, metallic taste in the mouth, bloating and difficult exhaustion of gases, as well as disorders of stool.
It should be taken into account that with oral administration of iron preparations, the absorption capacity of the mucosa of the small intestine is only 10% and only at a pronounced degree of iron deficiency anemia can reach 20%, therefore it is recommended to use large doses of preparations that make up not less than 100 mg per day. It is believed that to improve the absorption capacity of the intestine positively affects ascorbic acid, so it is recommended that it be combined with iron preparations at a daily dose of 50 mg for children and 100 mg for adults.
Parenteral routes of administration of iron preparations are advisable to apply under conditions of pronounced impairment of the intestinal absorption function. Replaced transfusion of whole blood or its components is performed only in the case of severe hemodynamic disorders, and also as a preparatory manipulation before the surgical intervention for urgent indications.
Iron-containing preparations for oral administration with proven efficacy include: Ferroplex in a daily dose of 150 mg, Tardiferon at 80 mg 2 times per day, Ferrogradumet at 105 mg per day, Sorbifer durules at 100 mg per day, Aktiferrin 1 capsule 2 rub. / Day.
When taking tableted and encapsulated iron preparations, it is necessary to drink them with a large amount of liquid, since they are capable of provoking a carious lesion of the teeth. The drug for parenteral administration is Ferrum-lek 100 mg 1 dose / day. For the therapy of iron deficiency conditions in children, drugs in liquid form are used: Aktiferrin in a daily dose of 5 drops per kg of body weight divided into 3 doses, Maltofer 5 ml 2 r. per day.
When appointing patients iron preparations as a treatment for iron deficiency, it should be borne in mind that some drugs at one-time administration can inhibit the absorption capacity of the intestine. These drugs include Almagel, Tetracycline and magnesium salts.
The duration of treatment depends on the ability of the patient's body to absorb iron and continues until the laboratory blood indicators (red blood cells, hemoglobin, color index, serum iron level and iron binding capacity) normalize.
After eliminating the signs of iron deficiency anemia, the use of the same drug is recommended, but in a reduced prophylactic dose, since the main focus of treatment is not so much the elimination of signs of anemia, but the replenishment of iron deficiency in the body.
As a rule, the improvement of the patient's condition, provided adequate selection of the therapy scheme is observed on the 6-7th day. If efficiency is not observed, this is the reason for dose adjustment or drug change, as well as stimulation to further diagnostic search.
The reasons for the lack of a positive effect can be: unprotected bleeding, irregular intake of the drug, a combination of iron deficiency and a lack of vitamin B12, as well as a violation of the absorption capacity of the intestine.
The prognosis for the patient's life and health is favorable provided that all the doctor's recommendations for correcting the eating behavior and taking medications are followed.
In addition to drugs used to eliminate iron deficiency in the body, patients are recommended to use non-specific recipes of traditional medicine, which are based on their preparation solely from natural ingredients. These funds can be used as additional measures to the main treatment and for the prevention of possible complications (satiety therapy) under the supervision of a doctor.
The best blood-healing properties, according to experts of alternative medicine, is garlic tincture, for the preparation of which it is necessary to grind 100 g of young garlic and mix it with the chopped leaves of a golden mustache, then add 0.5 liters of 70% alcohol to the prepared mixture and insist for 1 month. Apply this tincture to 20 drops of 3 r. per day. It should be borne in mind that during pregnancy and during lactation this medication is contraindicated.
For pregnant women and children is more suitable rowan infusion, for the preparation of which should be mixed 1 tablespoon. crushed berries of mountain ash with 1 tbsp. chopped leaves of a golden mustache and pour this mixture of 0.5 liters of boiling water. In the infusion, you can add 1 tsp. honey (in the absence of an allergic reaction) and use it 3 r. per day in small sips of 50 ml.
Iron deficiency anemia
The International Association of Hematologists says that when normalizing the eating behavior of a patient with signs of mild iron deficiency anemia, it is possible to substantially normalize blood counts and not resort to the use of iron preparations to eliminate iron deficiency. Patients with severe anemia show the use of a specialized diet as a supplement to the main treatment.
The basic principles of therapeutic nutrition in iron deficiency anemia is a sharp restriction of the consumption of fats of both plant and animal origin, as well as enrichment with products containing large amounts of protein. It is proved that carbohydrates do not influence the digestion of iron by the body, so their consumption should not be limited.
In order to fill the level of iron necessary for normal blood formation, it is necessary to include a large number of products containing iron in the patient's diet (liver, beef tongue, lean turkey meat, red sea fish, buckwheat and millet, blueberries and peach). A large percentage of iron is also found in all types of greens, beef and eggs. Among the fruits should be preferred persimmon, quince and apples in a raw or baked form.
From the diet of patients with iron deficiency anemia it is recommended to completely exclude milk products and black tea, so they contain substances that interfere with the absorption of iron. And, on the contrary, products that are synergistic, which should be consumed in large quantities together with iron-containing products, are those that contain a high percentage of vitamin C (sorrel, currant, sauerkraut, freshly squeezed fruit and citrus juices with pulp).