Anemia (anemia) - a decrease in the total amount of hemoglobin in the blood, red blood cell count and hematocrit.How to cure this disease folk remedies.
generally accepted classification of anemias does not exist.Anemia is defined as a number of clinical conditions in which the concentration of hemoglobin in the peripheral blood is less than 120 g / l, and the hematocrit value - less than 36%.Besides these hematologic parameters in diagnosing anemia are important embodiments morphology of erythrocytes and bone marrow regeneration ability.Hypoxic syndrome - the main pathogenic factor of this heterogeneous group of diseases.
According to the classification MPKonchalovsky, subsequently modified GAAlexeyev and IAKassirski all anemia etiology and pathogenesis is divided into three main groups:
Lake erythroblastic ratio myelogram patients creates a picture of the functional state of the bone marrow with anemia.Normally, it is 1: 4;anemias with sufficient bone marrow function is reduced to 1: 1, or even
By saturation of red blood cells by hemoglobin deficiency anemia are:
Depending on the diameter of anemia, red blood cells can be:
allocated to these laboratory parameters of anemia are classified into:
Additionally, the nature of the flow recovered anemia:
In mild cases of anemia clinical symptoms may be absentsincecompensatory mechanisms (increased erythropoiesis, the activation of the cardiovascular and respiratory systems) satisfy the physiological tissue oxygen demand.Severe anemia is accompanied by weakness, dizziness, tinnitus, "flickering flies" before the eyes, fatigue, irritation.This may occur amenorrhea, gastrointestinal disorders and jaundice.Laboratory examination quantifies the severity of anemia and helps to establish the cause.To neglect the laboratory examination of the patient, even in the mild form of anemia is impossible, sinceSymptoms of the disease indicate only a violation of the hidden and give too little information about the origin and the clinical severity of anemia.
Hemolytic anemia develops when circulating red blood cells are destroyed prematurely.Often, bone marrow can not produce red blood cells fast enough to compensate for their rapid destruction (despite the fact that the bone marrow may increase the rate of production to six times).The disease is rarely life threatening, but it is difficult to cure.
aplastic anemia occurs when the bone marrow stem cells are damaged and can not produce enough red blood cells, white blood cells and platelets.The disease may begin gradually or suddenly (acute form).The low content of red blood cells causes weakness, tiredness, paleness and shortness of breath.The lack of white blood cells makes a person vulnerable to infectious diseases, and the lack of platelets increases the risk of bleeding.Therefore, aplastic anemia is a potentially life-threatening.In fact, in the absence of treatment, more than 80% of patients die within a year.This relatively rare disease is more common in men.
Insufficient or defective synthesis of heme and globin, breaking erythropoiesis, is the cause of the appearance in the peripheral blood and hypochromic microcytic erythrocyte population.At the same time changing the shape of erythrocytes caused by the interaction of the structural components of the membrane with hemoglobin.The differential diagnosis in this group of anemia - iron deficiency anemia (iron deficiency due to insufficient tissue Fund) atransferrinemii (disorders of iron transport), anemia in chronic somatic diseases (disorders of recycling and iron reutilization) and thalassemia (a hereditary defect of the synthesis of polypeptide chains of globin) -primarily based on laboratory studies.
Iron deficiency anemia develops when the normal iron stores are depleted so that the bone marrow can not produce enough hemoglobin protein found in red blood cells that contains iron and carries oxygen in the blood stream.The most common cause of anemia is iron deficiency;the disease is rarely severe and usually easily treated.In the case of a weak chronic form virtually no symptoms and can be detected only if the doctor has the results of a clinical blood test.More severe anemia leads to a noticeable fatigue and other symptoms.
Iron deficiency anemia (IDA) - the most common form of anemia, is 70-80% of all patients with anemia.Women suffer significantly more often than men: 11.7% versus 0.5-1.5%.In women, a high percentage (20-25%) of latent iron deficiency.15-30 ml of blood loss during menstruation 7,5- leads to loss of 15.0 mg of iron, while during suction the body receives only 1-2 mg per day.Moreover, in the III trimester iron deficiency is found in almost 90% of women and the gap remains after childbirth and lactation in 55% of them.Parallel to this, iron deficiency anemia can develop in children due to insufficient iron production from the mother suffering from iron deficiency anemia of prematurity, as well as the child's refusal to eat.The possibility of development of iron deficiency anemia in girls above.The most common in children 2-3 years of relative compensation occurs, hemoglobin may be normal, but during puberty newly developed iron deficiency.According to LLEremenko (1994) extreme habitat (short daylight hours, low temperature), the inhabitants of the northern regions of Russia affects the red blood parameters.Long stay in the northern regions contributes to the significant increase in the incidence of iron deficiency anemia.Iron deficiency in cold climates found twice as often as in central Russia.
IDA - a group of poly etiology of hypochromic-microcytic anemia due to impaired bone marrow production of red blood cells as a result of reducing the total amount of iron in the body, and heme synthesis defects.Anemia in peripheral blood of patients appears hypochromia, microcytosis, and poikilocytosis anisotropy and a significant decrease in erythrocyte hemoglobin: number of erythrocytes within 4,8h1012 / L Hemoglobin 100 g / l, the color index is less than 0,6, MCY - 65 fl,MCH - 24 pg, ICSU 290 g / l, serum iron has been reduced to 5 mmol / l, serum ferritin - 25 g / l and the transferrin saturation is only 16%.Regenerative changes of erythrocytes (yield in peripheral blood normoblasts and reticulocytes) in IDA are mild.
Anemia of this kind may develop as a result of chronic blood loss (bleeding from the gastrointestinal tract and rectum, menometrorrhagias, kidney bleeding, etc.), idiopathic pulmonary hemosiderosis, increase demand and reduce the deposit of iron (with accelerated cell growth, pregnancy, lactation, infection and intoxication).Iron deficiency may be related to increased demand for it, and often, especially in children and the elderly, have alimentary nature or due to decreased absorbability of iron due to inflammatory processes in the course of the gastrointestinal tract (upper section of the small intestine), achlorhydria, gastrectomy.Often associated with a perverse appetite.The main risk factors for iron deficiency anemia in young children may be smoking mothers and toxicosis first half of pregnancy.All of these reasons, however, are not comparable in the incidence of anemia from blood loss.
disease develops slowly, the gradual decrease in hemoglobin level contributes to adaptation to apoksemii, resulting in clinical symptoms manifest later, when anemia becomes very deep (hemoglobin is reduced to 50-30 g / l). The clinical picture is diverse and is due both to the presence of anemic hypoxia, soand tissue iron deficiency.Typically, patients complain of general weakness, sometimes quite sharp, despite the moderately severe anemia, frequent dizziness, sometimes a headache, "flickering flies" before their eyes, in some cases there are fainting and shortness of breath with little exertion.There are chest pain, edema.Observe the expansion boundaries of cardiac dullness left anemic systolic murmur at the apex, and the pulmonary artery, "the noise of the top" in the jugular vein, tachycardia and hypotension.The ECG changes are seen, indicating the repolarization phase.In elderly patients severe iron deficiency anemia can cause cardiovascular disease.In addition, patients have muscle weakness (sideropenia manifestation of tissue), which is not observed in other types of anemia.Atrophic changes occur in the mucous membranes of the digestive tract, respiratory system, reproductive organs.Patients are cut and drop the hair, the nails become brittle, there is the longitudinal and transverse striations, sometimes concave nails down to the spoon-shaped form (koilonychia).In 25% of cases the changes in the oral cavity.Reduced sense of taste, there are tingling, burning and bloating in the language.On examination revealed atrophic changes in the mucous membrane of language, sometimes cracks on the tip and on the edges, in more severe cases - areas of reddening of irregular shape ( "geographic tongue") and aphthous changes.Atrophic process also captures the mucous membrane of the lips.There are cracked lips and corners of the mouth Zayed (cheilosis), changes in tooth enamel.Characteristic cider sideropenic dysphagia (Plummer-Vinson syndrome), which is manifested difficulty in swallowing dry and solid food, and tickling feeling of having a foreign body sensation in the throat.Some patients in relation to these manifestations take only liquid food.There are signs of changes in gastric functions: belching, feeling of heaviness in the stomach after eating, nausea.They are caused by the presence of atrophic gastritis and ahilii, which are determined by morphological (gastrobiopsy mucosa) and functional (gastric secretion) studies.Noteworthy dysgeusia (pica chlorotica) - craving for chalk, coal, tooth powder.Patients eat clay, earth, pastry, ice.They are attracted by odors of damp, gasoline, acetone, kerosene, naphthalene, acetone, paints, etc.The defeat of the lining of the digestive tract - as a typical sign of iron deficiency states that there was a misconception of his primacy in the pathogenesis of iron deficiency anemia.However, the disease develops as a result sideropenia, and only then progresses to development of atrophic forms.Signs of tissue sideropenia disappear quickly after taking iron supplements.Iron deficiency anemia is a chronic course with periodic exacerbations and remissions.As a rule, there is a slight over or for medium gravity;severe anemia is less common.Mild to moderate degree of iron-deficiency anemia is characterized by decreased erythrocyte, serum ferritin and tissue pool of iron at a constant transport fund.In the absence of proper pathogenetic therapy of partial remission and are accompanied by constant tissue iron deficiency.
Average iron intake of barely compensates for the current demand for it.Therefore, unexpected loss of iron in chronic bleeding or heavy menstruation easily lead to its deficiency.Depletion of iron stores begin without clinical manifestations, reveal the hidden deficit is possible only by special studies, including the determination of the amount of hemosiderin in the bone marrow macrophages and absorption of radioactive iron in the gastrointestinal tract.In its development, the WDN are 2 stages:
Initially, the iron level in the serum and the concentration of hemoglobin in the red blood cells are normal, but below 25 mg / l is reduced only to the content of serum ferritin.Number of transferrin, as well as the value of the total iron binding capacity of serum increased.Then depleted iron stores (iron levels below 5 mmol / l and the transferrin saturation - below 16%) does not provide an effective erythropoiesis (Hb below 109 g / l, the content of erythrocyte ferritin falls).
Thus, pathogenetic essence of iron deficiency is expressed exhaustion of his organ and transportation stocks, which leads to iron-and zhelezozavisimymi enzymes depletion of cells and tissues to disruption of redox processes and metabolism in the red blood cells to the development of tissue hypoxia, activation of peroxidationand reducing antioxidant activity.This is especially pronounced in IDA, which is the extreme degree of J. in the body.
Diagnosis IDA consists of clinical manifestations, the presence of the reasons for the development of J., laboratory data in the study and ferrokinetiki general analysis of peripheral blood.Currently, in order to more accurate diagnosis of monitor parameters such erythrocytes as the MCV, MCH, MCHC and the RDW, obtained on hematological counters.The blood smears dominated by small hypochromic erythrocytes annulotsity (red blood cells with hemoglobin in the absence of the center ring-shaped), red blood cells of unequal size and shape (anisocytosis, poikilocytosis).In severe anemia erythroblasts individual may appear.The number of reticulocytes is not changed and increases only for anemia, which developed against the backdrop of blood loss, which is an important sign of bleeding.Osmotic resistance of erythrocytes little changed or slightly increased.The number of leukocytes is not a pronounced downward trend.WBC little changed.Leykopoeza is characterized by a slight increase in the number of immature granulocytes.The platelet count usually remains normal;some increased bleeding.In the bone marrow at iron deficiency anemia can be found erythroblastic reaction delayed maturation and gemoglobinizatsii erythroblasts.The bone marrow in most cases hyperplastic.Increasing the ratio of white and red cell series, last number prevails.Erythroblasts make up 40-60% of all cells, in many of them there are degenerative changes in the form of vacuolization of cytoplasm, nucleus pyknosis absent cytoplasm (naked nuclei).
usually iron metabolism changes enough to make the diagnosis "latent iron deficiency," as preliminary stages of IDA, and the detection of a reduced level of H b (women below 120.0 g / l in men and less than 130.0 g / l)- J. apparent or true IDA.With all of this anemia is hypochromic character with a color index of less than 0.9 with the presence of anisotropy and poikilocytosis, anizohromii polihromazii and red blood cells in the peripheral blood.
Treatment WDN, regardless of severity, should be started immediately after the verification of the diagnosis and determine the cause of J. okonnatelnogo.
Table.Some oral iron preparations
J. Compensation in the blood and tissues is possible with the help of pharmaceuticals.Among them, there are currently more than 30 oral medications and 70 of integrated multivitamins that contain iron.Parenteral iron therapy does not increase the effectiveness of treatment and is shown only in severe and extensive lesions of the mucous membrane of the stomach and small intestine, reducing the absorption of iron.For a correct choice of the drug should take into account the amount of the trace element in each tablet or other dosage form.