Anemia iron deficiency - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Hematopathy

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

Anemia vary for reasons that flow, symptoms and prognosis.Among the first place is iron deficiency anemia, which is up to 80% of cases.According to the World Health Organization, iron deficiency anemia affects one in three women and one in six men in the world, as well as up to 50% of young children, and it is about 2 billion people.

Iron deficiency anemia - a hypochromic (decreased hemoglobin content in an erythrocyte) microcytic (reducing the size of red blood cells) anemia, which develops as a result of an absolute deficiency of iron in the body.

first iron stores human body gets from the mother through the system mother-placenta-fetus, after the birth of the iron is filled with eating or iron-containing preparations.

iron excretion from the b

ody through the urinary and digestive system, sweat glands and during menstruation in women.The daily output of about 2 grams of iron, so to avoid depletion, it is necessary to fill in any way.

Causes of iron deficiency anemia:

1) Lack of iron intake from food

- starvation,
- vegetarian or depleted in iron and protein diet, observe for a long time,
- children breastfed reason may be iron mother anemia,
-early transfer to artificial feeding,
- late introduction of complementary foods.

2) Increasing demand for iron

- period of growth and puberty in adolescents,
- emergence of menstrual function in girls,
- frequent SARS (iron intake infectious agents),
- tumor growth of any localization,
- sports,
- pregnancy,
- breastfeeding.

Despite the fact that the iron during pregnancy is saved due to absence of menses iron requirement increases so that its replenishment need, often with drugs. Almost every pregnancy is accompanied by iron deficiency, expressed in varying degrees.Need proportionally increases with multiple pregnancies.

3) Congenital lack of iron in the body

- prematurity,
- born of multiple pregnancies,
- severe iron deficiency anemia in the mother,
- abnormal bleeding during pregnancy and childbirth,
- fetoplacental insufficiency.

4) Violation of iron absorption.

In this case, the value is not so much the percentage of iron in food products or preparations, as it enters the efficiency of blood.iron Malabsorption due to various diseases of the gastrointestinal tract, absorption occurs predominantly in the duodenum jejunum and depends on the mucosa condition of intestine:

- enteritis (inflammation of the small intestine caused by infection or helminthic invasion),
- gastritis (atrophic, autoimmune) and peptic ulcer and duodenal ulcer (often caused by the bacterium Helicobacter Pylori),
- hereditary diseases: here are paramount cystic fibrosis and celiac disease.In addition to malabsorption of minerals (including iron) they manifest severe symptom, and such children need special food.Therefore, the analysis of these diseases is carried out for 3-4 days in the hospital;
- Crohn's disease (an autoimmune intestinal mucosal damage and possibly stomach),
- condition after the removal of gastric and / or duodenal ulcer,
- cancer of the stomach and intestines (where there is a complex mechanism of anemia, impaired absorption of the mucous glands, a high risk of bleeding, and increasedconsumption as a result of a chronic illness).

5) Increased loss of iron:

- chronic blood loss.This is the most ambitious reason in this group, the anemia is the result of the regular loss of small amounts of blood, here are losses due to:

~ gastric ulcer and duodenal ulcer, ulcerative colitis, Crohn's disease, hemorrhoids and anal fissures, polyposis bowel bleedingfrom decaying tumors of any localization and varicose veins of the esophagus;

~ hemorrhagic vasculitis;

~ pulmonary hemorrhage (bronchiectasis, lung cancer, tuberculosis), pulmonary hemosiderosis (chronic lung disease, manifested by repeated bleeding into the lung bubbles - the alveoli);

~ micro- and gross hematuria (chronic pyelonephritis and glomerulonephritis, polycystic kidney and cancer, polyposis or bladder cancer), the loss in hemodialysis;

~ women frequent causes of chronic iron-deficiency anemia are uterine fibroids, endometriosis, giperpolimenoreya, cervical cancer and other sites;

~ in children and adolescents are a frequent cause of epistaxis (Rendu-Osler disease, and other causes);

- allergic diseases (loss of trace elements in the composition of exfoliated epithelium).

6) Violation transferrin fusion.Transferrin - is iron transport protein that is synthesized in the liver.

- a congenital defect in the synthesis of transferrin (often traceable heredity)
- the presence of antibodies (protective proteins that block its action) to the transferrin
- chronic hepatitis of various nature and cirrhosis

7) Alcoholism.Alcohol damages the mucous membrane of the stomach and intestines, thereby making it more difficult absorption of iron, as well as inhibits the hematopoietic function of bone marrow.

8) The use of drugs.

- nonsteroidal anti-inflammatory drugs (diclofenac, ibuprofen, aspirin) reduce blood viscosity and may contribute to bleeding, in addition, these drugs can provoke the occurrence of gastric and duodenal ulcers.

- antacids (Almagel, Gustav, Rennie) reduce the production of hydrochloric acid, which is necessary for the efficient absorption of iron

- iron-drug (Desferal), these drugs bind and remove free iron and iron in the composition of ferritin and transferrin, and an overdose canlead to iron deficiency.

9) donation.300 ml of blood contains about 150 mg of iron, with the donation often 4 times a year develop iron deficiency.

Symptoms of iron deficiency anemia

1) Anemic syndrome
2) sideropenic syndrome
3) hematological manifestations of anemia

Anemic syndrome is generated due to the reduction of red blood cells and hemoglobin, which causes a decrease in cell saturation andof oxygen to tissues.Signs of anemia are nonspecific but help to suspect the presence of anemia and in combination with data from other surveys diagnosis.

Subjective symptoms first appear at a load of more than usual, and further (disease progression), and alone: ​​

- general weakness
- increased fatigue and reduced
performance - dizziness
- ringing in the ears and flashing "flies" before the eyes
- episodes of palpitations
- increased dyspnea on exertion
- fainting

An objective examination revealed:

- pale skin and visible mucous membranes (eg, the inner surface of the lower eyelid)
- pastoznost (small swelling) legs, feet,face (mainly the area around the eyes)
- tachycardia, various options for arrhythmia
- mild heart murmur, muffled heart sounds

sideropenic syndrome is caused by deficiency of iron in the tissues, which causes a decrease in the activity of many enzymes (protein substances that regulate many vital functions).

sideropenic syndrome is manifested by numerous symptoms:

- changes in taste (irresistible desire to eat unusual foods: sand, chalk, clay, tooth powder, ice and raw beef, soggy batter, dry cereals), more pronounced in women andteens

- a tendency to eat spicy, salty, spicy food

- a perversion of smell (attracting odors are perceived by the majority as unpleasant: gasoline, acetone smell of varnishes, paints, lime)

- decrease in muscle strength and muscle atrophy due todeficit myoglobin (kislorodosvyazyvayuschy protein in skeletal muscle) and enzymes of tissue respiration

- degenerative changes in the skin (dryness up to the formation of cracks, peeling), hair (fragility, loss, tarnish, early graying), nails (dullness, transverse striations, koilonychia -spoon-shaped concavity of the nail).Reduced recovery function of the skin (long time to heal minor injuries, abrasions).

- angular stomatitis (dryness and cracks in the corners of the mouth) in 10-15% of patients

- glossitis (tongue inflammation), is characterized by a feeling of pain and fullness in the field of language, redness and atrophy of the papilla (the so-called "lacquered language" surfacelanguage in this case is not velvety, both in normal and smooth and even brilliant), frequent periodontal disease and caries

- atrophic changes in the mucosa of the gastrointestinal tract (dryness of the lining of the esophagus, causing pain when swallowing, and difficulty in swallowing solid food -sideropenic dysphagia), the development of atrophic gastritis and enteritis

- degenerative changes in the muscles of the sphincter of the bladder (the urgent need to urinate, inability to hold urine when coughing, laughing, sneezing, episodes of bedwetting)

- symptom of "blue sclera" is characterized by bluishcoloration of the sclera (due to iron deficiency and lack of function of certain enzymes breaks down collagen synthesis tunica eye shell, it becomes thinner and shine through her small vessels)

- «sideropenic subfebrilitet" - prolonged fever to subfebrile (37.0-37.9 ° C) for no apparent reason

- susceptibility to infectious and inflammatory diseases (frequent SARS and other infections), susceptibility to chronic

infections - reduced resistance in cases of poisoning by heavy metals

hematological effects of anemia:

- fetal growth retardation in pregnantanemia,
- menstrual disorders,
- impotence,
- behavioral change, decrease motivation, intellectual abilities, these symptoms are more pronounced in children and adolescents disappear and the reduction of iron stores.

diagnosis of iron deficiency anemia

I. General inspection (skin and mucous membranes, body type), patient survey (chronic diseases, habits, family history, women have a menstrual period and the date of last menstrual period), palpation (tenderness of the abdomen andwaist, abdomen and the formation volume of breast, lymph node size and mobility), percussion (percussion to determine the boundaries of the heart and liver, and pain flat tubular bones) auscultation (auscultation possible wheezing, noise and heart rhythm).

II. KLA (complete blood count) or CRAC (Clinical full blood count) - this is a major study in the primary diagnosis of anemia.

Here we present the most important indicators so that you can navigate the result of the analysis:

Hb (hemoglobin) - the rate for women is 120-150 g / l in men 130-170 g / l.

RBC (red blood cells) - the rate of 3,9-6,0 1012 men, 1012 3,7-5,0 / L in women, the number of red blood cells in newborns is a maximum of 6.0-9.0* 1012 / l, the elderly erythrocyte concentration may also be increased to 6.0 * 1012 / l.In both cases, these figures are the norm.

RET (reticulocytes) - the rate of 0.8 - 1.3 to 0.2 - 2%.

Hct (hematocrit, ie the ratio of blood cells and the liquid portion thereof) - in men it reaches 40-48%, slightly lower in women - 36-42%.

MCV (mean corpuscular volume) - the norm 75-95mkm3.

MCH (average content of hemoglobin in red blood cells) - the rate of 24-33 m.

MCHC (mean concentration of hemoglobin in red blood cells) - the rate of 30-38%.

WBC (white blood cells) - 3.6-10.2 x 10 9 / L.

PLT (platelets) - 152-343 x 10 9 / L.

III. OAM (urinalysis) , paramount protein loss in the urine and the presence of blood in urine

IV. General biochemical studies (total protein, glucose, total bilirubin and direct, ALT, AST, alkaline phosphatase, creatinine, urea, LDH, CRP)

V. specific biochemical studies

1. determination of serum iron

Norm: children up to 1 year - 7,16-17,90 mmol / l;
children from 1 year to 14 years - 8,95-21,48 mmol / l;
women - 8,95-30,43 mmol / l;
men - 11,64-30,43 mol / L.

2. the total iron binding capacity of serum (normal women: 38,0-64,0 m / l in men 45.0 - 75.0 m / l)

3. iron saturation of transferrin (normally about 30%)

4. transferrin content (rate of 2.0-4.0 g / l)

5. ferritin content in serum (mg / l = ng / mL)

newborns 25 - 200
1 month 200 - 600
6 months- 15 30 - 140

men 20 - 350
women 10 - 150


1st trimester 56 - 90
2nd trimester 25 - 74
3rd trimester 10 - 15

6. desferalovy test (after intravenous administration of 500 mg of desferal in a healthy person in the urine is released from 0.8 to 1.2 mg iron in patients with iron deficiency anemia, the figure below).

VI.Further, in terms of further examination you can assign:

- a blood test for HIV and hepatitis B and C
- chest X-ray, if necessary, bronchoscopy with biopsy (removal of tissue slices for analysis), computed tomography pulmonary
- fecal parasites and fecal occult blood
- EGD and research of acidity of gastric juice
- ultrasound of the internal organs and
kidneys - intestines study (barium enema, sigmoidoscopy, colonoscopy)
- consulting urologist, gynecologist, proctologist, a gastroenterologist
- sternal puncture (taking a sample of bone marrow from the sternum to the study)
- ultrasound of the uterus and appendages
- sputum alveolar macrophages containing hemosiderin
- advice endocrinologist, rheumatologist
- analysis for tumor markers

treatment of iron deficiency anemia

1. Diet
2. oral iron preparations
3. injectable iron preparations
4. transfusion

diet in the treatment of iron deficiency anemia

diet in treatment of iron-deficiency anemia can be effective in the normal absorption of iron from the diet, the absence of diseases of the gastrointestinal tract.

Diet for iron deficiency anemia should include foods rich in iron (beef tongue, chicken, turkey, liver, saltwater fish, heart, buckwheat and millet, eggs, greens, peas, nuts, cocoa, apricots, apples, peaches, persimmons, quinces, blueberries, pumpkin seeds), ascorbic acid, which improves the absorption of iron (sweet peppers, cabbage, rose hips, currants, citrus fruits, sorrel).

should limit foods that hinder the absorption of iron: black tea, all dairy products.

Medicines for iron deficiency anemia

oral iron supplements (tablets, drops, syrups, solutions) are starting treatment for anemia mild to moderate severity, the presence of pregnancy intake consistent with the obstetrician-gynecologist.

- Sorbifer durules / fenyuls 100 1-2 tablets 1-2 times a day to restore the level of hemoglobin (in pregnant women for prevention 1 tablet 1 time per day, for the treatment of 1 tablet 2 times a day).

- Ferretab 1 capsule per day, to a maximum of 2-3 capsules per day in 2 divided doses, the minimum deadline of 4 weeks, followed by indications.

- Maltofer happens in three dosage forms (drops, syrup, tablets), the reception of iron deficiency anemia in drops at 40-120 / ml syrup 10-30 / 1-3 tablets per day in 1-2 reception.Children under 1 year of 10-20 drops of 2.5-5 ml of syrup 1-2 reception, for children from 1 year to 12 years 20-40 drops, 5-10 ml of syrup 1-2 reception;reception for 3-5 months under the control of hemoglobin levels.

- tardiferron / ferrogradumet 1-2 tablets per day to restore hemoglobin level, pregnant women: 1 tablet a day II-III trimester.