Low hemoglobin ( anemia) - Causes, Symptoms and Treatment .MF .
anemia - a condition in which a reduced content of functionally full of red cells (erythrocytes) in the blood.Quantitatively it is expressed by the degree of reduction of the concentration of hemoglobin - an iron-containing pigment of red blood cells, giving to blood red.
In order to understand the reasons for reduction of hemoglobin in the blood, it is necessary to know the mechanism of its formation in the body.Hemoglobin is a complex iron compound with a protein located in red blood cells (erythrocytes).
The main function of hemoglobin - participation in the transport of oxygen molecules to organs and tissues of the body, through continuous capture oxygen in the lungs and returns all entities need for further oxidation - reduction reactions, and provide energy for the body's vital functions.
for the formation of hemoglobin following conditions are necessary:
1. Adequate iron content of the food consumed.
2. Average iron absorption in the stomach and small intestine.
3. The presence of animal p
4. Of particular importance is the amount of vitamin B12 and folic acid, which are also absorbed in the upper gastrointestinal tract and have direct relevance to the formation of red blood cells in human bone marrow.With the reduction of the number of erythrocytes, and correspondingly decreases the amount of hemoglobin in the blood, based on the one liter.
5. Absence of pathology in kroveobrazovaniya system.. (Hereditary and acquired blood diseases
Norma hemoglobin in the blood
normal value the amount of hemoglobin in the blood are considered:
Men 130-160 grams per liter of blood
Women 120-147 g / l
for pregnant women lower... limit of normal 110g \ l
for the diagnosis of iron deficiency anemia (low hemoglobin) require submission of the following tests:
complete blood count (taken from the finger) - in modern hematology analyzers find out the amount of hemoglobin in recalculation on one liter of blood,reveal the color index, ie the average content of hemoglobin in the red blood cell (normal 0,81-1,05) .Izmeryaem obbem average diameter and red blood cell (normal 7.0-7.8 microns). the number of reticulocytes (erythrocyte precursors) rate of 4-12% which suggestsregenerative capacity of the bone marrow. The deviation of these indicators may indicate the cause of the low hemoglobin doctor.
iron concentration in serum (taken from a vein norm 12.0 to 26.0 mk.mol \ l).The decline of this index indicates insufficient iron content in food consumption or insufficient intake it in the gastrointestinal tract.
total iron binding capacity of serum (taken from a vein-rate 42,3-66,7mkmol \ l).Increase of this indicator also confirms the lack of iron in foods or poor performance of the digestive system.
receiving test results and finding out that the diagnosis of low hemoglobin confirmed proceed to identify the causes of its decline.By anamnesis exclude vegetarianism.Then we find out the state of the gastrointestinal tract.It fibrogastroscopy (FGS), not very pleasant but necessary procedure allows to judge the state of the gastric mucosa and duodenal ulcers involved in the absorption of iron and vitamin B12.(Eliminates the atrophic gastritis .yazvennuyu gastric ulcer and duodenal ulcer).
necessary to visit a surgeon who with the external examination and manual research will eliminate hemorrhoids.If you suspect other diseases are assigned more complex procedures such as sigmoidoscopy (examination of the rectum using a sigmoidoscopy through the rear through-hole).A survey of the large intestine called fibrocolonoscopy, it is even more time-consuming examination, when colonoscope reached through the rectum distance of more than three meters and actually allows you to explore the entire large intestine. (In these surveys primarily eliminated colitis and cancer. These procedures require preparation, that is, purification. bowel recommendations before their implementation you have to give when recording the survey
Irrigoscopy -. X-ray examination of the small intestine using a contrast agent, eliminates the pathology of the small intestine
In the case where the diagnosis after all of the above examinations is unclear, any clinic is entitled.use their existing quotas on her high-tech help, in this case, computer and magnetic resonance tomography using a contrast agent.
Next to women of course inspection at the gynecologist, who, if necessary, appoint a pelvic ultrasound, which excluded uterine fibroids and ovarian cysts., Itd polimenoreya
In more complex cases, Bole to exclude blood diseases need a specialist consultation - hematologist
reasons for the loss of hemoglobin.
1. Explicit and hidden blood loss.By explicitly include visible bleeding conditions such as polimenoreya (heavy, long-term, more than five days monthly) for women.When hemorrhoids, bleeding gums, as well as blood loss in trauma and operations.Hidden blood loss occur in diseases of the gastrointestinal tract.There is also a concept psevdopoteri blood mainly in female diseases, such as ovarian cysts, uterine fibroids, are diseases in which there is, in the uterine cavity or ovaries are periodically filled with blood hemoglobin with subsequent conversion to another compound and gradual resorption process with sufficient frequency.
2. The processes in the body leading to a reduction in the duration of the life of red blood cells or their destruction.(Autoimmune and infectious diseases, inherited diseases).
3. Staffing donation (when a person donates blood regularly).
One of the causes of low hemoglobin, especially in preschool children is nesballansirovannoe on vitamin and mineral composition of food.
found out the formation and loss of hemoglobin can understand symptoms under reduced hemoglobin.
symptoms of low hemoglobin
1. Asthenic - general weakness, fatigue, drowsiness, dizziness, headaches, heart palpitations, low blood pressure, fainting in severe cases.
2. Dystrophic - decrease in hemoglobin in the blood in most cases is an indirect sign of a lack of iron in the organs and tissues of the body.Therefore you experience the following symptoms:
well.changes in the nail plate, they become brittle, thinning, delaminate, streaked.
b.Dry skin, painful cracks at the corners of the mouth.
in.Hair loss or slow their growth.
Violations of taste and smell, until eating inedible substances (chalk, tooth powder, charcoal, earth, clay, sand, match heads) and products in raw form (cereal, dry pasta, pastry, mince, i.t.d.).As most patients notice a pleasant smell of acetone, nail polish, paint, shoe polish, naphthalene, exhaust gas of cars.
d.Besprichinny low-grade fever (slight increase in body temperature in the range 37-37,5 oC).
Characteristic appearance of the patient with a comprehensive picture of the lack of hemoglobin in the blood.
Above all pale skin and visible mucous.At decrease in hemoglobin which is caused by a lack of vitamin B12, typical changes in the mucous language, the so-called glossitis - "polished", bright red, painful tongue.In some forms of anemia with decreased hemoglobin level, as a result of increased destruction of red blood cells can make skin jaundiced.
should be borne in mind that in the early stages of iron deficiency anemia clinical manifestations can be mild, but in some cases, and generally asymptomatic.
Anemia is accompanied by a variety of diseases and is often the only symptom of them.
Diseases one sign of which is the reduced hemoglobin:
1. Chronic hemorrhagic iron deficiency anemia (IDA) (various blood loss as described above).
2. alimentary iron deficiency anemia (IDA) - the reason for the lack of iron in the diet.
3. IDA with increased consumption of iron (pregnancy, lactation, period of growth and maturation).
4. Diseases associated with impaired absorption of iron and vitamin B12 in the gastrointestinal tract:
well.Chronic atrophic gastritis (thinning of the gastric mucosa).
b Chronic enteritis (inflammation of the small intestine which is one of the reasons may be goiter or irritable bowel syndrome occurs against the backdrop of frequent stress).
in.IDA post-resection (with remote part of the stomach or small intestine).
5. Diseases associated with the violation to the human immune system is characterized by abnormal formation of immune complexes involving red blood cells, which occurs as a result of the premature death of red blood cells.These include:
glomerulonephritis, rheumatoid arthritis, lupus erythematosus and other systemic vasculitides.
6. Reduction in hemoglobin may occur during prolonged infectious diseases (gastroenterokolity in popular speech nazyvamye dysentery, salmonellosis, chronic hepatitis C and B, long flowing pneumonia, tuberculosis, pyelonephritis, etc.).Reason in the early destruction of red blood cells and increased the body's need for iron to restore homeostasis.
7. worm infestation - a tapeworm from the body absorbs a large amount of vitamin B12.
8. blastomatous (malignant) diseases of the blood.
9. Malignant neoplasms, particularly of the gastrointestinal tract in which hemoglobin reduction occurs due to impaired iron absorption, and also due to hidden bleeding.For all other localizations of tumor reduction of hemoglobin occurs to a lesser extent, apparently due to changes in metabolic processes occurring in these diseases.But it is considered a very important feature requires attention, especially in men who throughout their lives had high numbers of hemoglobin and suddenly there was a decrease, even within the normal range.
It should be understood that the first four groups of diseases are the cause of reduced hemoglobin in more than 90% percent of cases.
Treatment and prevention of iron deficiency anemia with a hemoglobin deficiency.
Medical tactic is at IDA should aim not only at normalization of hematological parameters (hemoglobin, erythrocytes, color index), but also the reduction of the iron concentration in the blood serum, the adequacy of its reserves in the depot organs (especially spleen and liver, and muscle tissue).
treatment possible should begin with measures to eliminate the causes of its development, primarily micro and makrokrovotecheniya (removal of uterine fibroids, excision of hemorrhoids, hormonal correction of dysfunctional uterine bleeding, treatment of gastroduodenal ulcer, gastroduodenitis, enteritis itd).
main pathogenetic treatment of IDA (decreased hemoglobin) is the appointment of preparations of iron, with the latter receiving inside predpodchitelnee prior to parenteral administration.(Administration of drugs intravenously and intramuscularly).Injections of iron preparations is preferably carried out in a hospital environment, as there is a large percentage of allergic reactions to iron supplementation.
dose iron supplements should be sufficient to produce a therapeutic effect, but not excessive, does not cause the phenomenon of intolerance.
Usually the dose ranges from 100 to 300 mg of elemental iron per day.With good tolerance should be applied to the maximum dose to restore the level of hemoglobin and red blood cells.Upon reaching normal values of hemoglobin treatment is not terminated, but continues even usually within 2-3 months, under the control of the amount of iron in the red blood cells and indicators in the blood serum.So, you need to tune in to long-term treatment, for at least 2-6 months.After reaching the normal values of peripheral blood preparations reception carried out in a daily dose 2-3 times less than that with which the normalization is achieved hemoglobin.Therapy is conducted to fill the iron reserves in the depot iron bodies.This is controlled by indicators of blood as serum iron, total iron binding capacity of serum.Preventive treatment of chronic iron deficiency anemia carried out in patients with no elimination of etiological factors (heavy and prolonged menstruation and uterine bleeding, blood loss associated with hemorrhoids, bowel disease).Therapy is individually matched with small doses of iron (30-60 mg of iron per day) in the form of a one-month repeated (2-3 times a year) courses or the appointment of such iron therapy within 7 to 10 days on a monthly basis (usually during and after menstruation)under the control of the level of hemoglobin and iron metabolism.
In identifying low hemoglobin associated with insufficient intake of vitamin B12 (megaloblastic anemia), appointed by subcutaneous injection vitaminaV12 (cyanocobalamin).Administered at a dose of 200-500 mg once a day for four to six weeks.After normalization of blood formation and the composition of blood, usually occurs in 1.5-2 months, continued administration of vitamin once a week for 2-3 months more.
In the treatment of iron preparations should not expect to increase the amount of hemoglobin earlier than a month of treatment.The effectiveness of the treatment the doctor judges to change the number of reticulocytes (erythrocyte precursors) in total blood analysis.After 8-10 days after the beginning of treatment with vitamin B12, iron preparations and reticulocyte count is increased by several times, there is a so-called "crisis retikulotsitarny".With that said the success of the therapy.B12 deficiency anemia is often accompanied by a deficiency in the body of folic acid and more.In this case, the treatment added to the folic acid in a dose of 5-15 mg per day course 20-30days.
As the degree of reduction of hemoglobin iron-deficiency anemia are divided:
Latent iron deficiency - it is in cases when the hemoglobin in red blood cells rate and reduced serum iron, but low hemoglobin symptoms can already be observed .In these cases, the state of correction is achieved by small doses of iron (30-40 mg per day) during 1-1.5 months on the testimony of 2 to 3 times a year.This state is also characteristic of pregnancy.OTC drugs that case Ferretab composite containing 0,154g ferrous fumarate and folic acid 0,005g.Depending on the serum iron and total serum capacity zhelezosvyazyvyuschey assigned 1-3 capsules per day for at least 4 weeks.
Mild (hemoglobin 110-90 r \ n).
average degree (Hb 90-70 g \ l).
Severe (hemoglobin below 70 g \ l).
OTC drugs most commonly used to correct iron deficiency.
Ferretab composite (0154g ferrous fumarate and folic acid 0.0005g).Additionally desirable intake of ascorbic acid in a daily dose 0,2-0,3g).
Sorbifer durules (0,32 g 0,06g iron sulfate and vitamin C) is produced in a daily dosage of pills depending on the degree of anemia 2-3 times per day.
Totem - is available in bottles of 10 ml, the content of elements rant as in Sorbifer.Administered orally, can be diluted with water, it is possible to assign intolerance tablet forms of iron.The daily dose of 1- 2 admission.
Fenyuls (0,15g, ferrous sulfate, 0.05 g of vitamin C, vitamin B2, calcium pantothenate V6,0,005g.
Vitamin B12 ampoules PA1 ml of 0.02% and 0,05%.
Folic acid tablets of 1mg.
Ampoule iron preparations, for intramuscular and intravenous sold by prescription only and require injections only in stationary conditions of the high frequency of allergic reactions to these drugs.
Given the better absorption of the drug