Iron deficiency anemia
Iron deficiency anemia - This is common clinical and hematological syndrome, caused by insufficient percentage of iron in the body and manifesting declining as red blood cells and hemoglobin in the peripheral blood.In the overall structure of anemia, iron has the highest frequency of occurrence in adults and children, and the population is at least 80%.
Under normal circumstances, the body of an average healthy adult contains about 5000 mg of iron which is part of hemoglobin (2/3 of the total), cytochrome oxidase (300 mg), ferritin and hemosiderin, which are deposited in the tissues of the bone marrow, liver and spleen(1000 mg) and the so-called serum or transport of iron (up to 30.4 mmol / l).
first necessary supply of iron man accumulates even during the prenatal period, receiving it from the mother through the placental vasculature.In postnatal iron enters the body only with food.
basic ways of removing iron from the body is to sweat glands, urinary system and o
order not to provoke iron deficiency anemia need only provide the intake of iron from food in the amount of 2 g per day, as the daily output from the body is that amount of iron.
Iron deficiency anemia causes
Among the factors that can trigger the occurrence of iron-deficiency anemia forms, occupies a leading position chronic blood loss.The sources of such chronic blood loss, which initially causes a latency period, and then the clear signs of iron deficiency anemia are:
- organs of the gastrointestinal tract defects mucosa (ulcerative form of gastritis, colitis, hemorrhoids and anal fissures, divertikullez, oncopathology);
- diseases of the genitourinary system in women (uterine fibroids, endometriosis, cervical cancer, ovarian dysfunction);
- pulmonary hemorrhage (bronchiectasis, lung cancer, various forms of tuberculosis, hemosiderosis)
- hematuria (polycystic kidney disease, gipernefroidny cancer, polyps, tumors of the urinary bladder);
- epistaxis (illness Rendu - Osler).
Another cause of anemia is iron absorption disturbance of the gastrointestinal tract.Iron is absorbed mucous membrane of the duodenum, but in this department iron absorbed only in the soluble reduced form.In order to make a soluble form of iron necessary effect of perchloric acid, which is in the stomach.The initial small intestine iron undergoes additional changes, and then binds to transferrin and deposited in various tissues.Thus, any pathology of upper gastrointestinal tract causing malabsorption of iron (total and subtotal resection of the stomach and small intestine, chronic enteritis).
addition violations in the supply of iron in the body, iron deficiency anemia often causes increased consumption of iron, which often occurs during pregnancy and lactation, and therefore, there is even a separate nosological form of "iron deficiency anemia in pregnant women."
Increased consumption of iron also occurs during puberty, when there is rapid growth of muscle mass, accompanied by a decrease in the iron content in the structure of the bone marrow.There is a clear relationship - if the mother during pregnancy anemia was observed, then the birth of a girl during the onset of menstruation in 100% of cases triggered by anemia, which is called "early chlorosis."
not common cause is iron deficiency anemia is a form of chronic infectious diseases for which there is a redistribution of iron and its binding macrophages involved in the immune response (brucellosis, tuberculosis, bacterial sepsis).
Despite the fact that the iron enters the body only with food, nutritional type of iron-deficiency anemia is a rare case and more observed in children and vegetarians.
Iron deficiency anemia symptoms
Iron deficiency in adults is a wide range of clinical symptoms, and the degree of symptoms depends on the severity of iron deficiency.
If the patient is a moderate decrease in the amount of iron, it retains the ability to work for a long time, and these or other symptoms appear only in excessive physical activity.
clinical manifestations of iron deficiency anemia is quite varied, but all of them can be attributed to one of the two major syndromes - Anemic syndrome sideropenia.Symptoms included in the anemic syndrome caused resulting from iron deficiency anemia hypoxia.Manifestations of the syndrome sideropenia result from a lack of tissue iron and decrease the activity of cytochrome oxidase.In addition to these symptoms, the patient usually complains, the main characteristic of the disease, against which there was an iron deficiency anemia.
characteristic feature of the onset of anemia is the emergence of general weakness, decreased performance, drowsiness, dizziness, tinnitus, feeling heart palpitations and shortness of breath, and various degrees of impaired consciousness, fever and irritability.A common complaint of patients with iron deficiency anemia is severe muscle weakness, the occurrence of which is not associated with physical activity.
objective signs of iron deficiency anemia, which are noticeable even at the initial examination of the patient are: the emergence of severe pallor and / or mucous membranes, puffy face expressed pastoznost distal parts of the lower limbs, rapid heart rate during exercise, lowering blood pressure and appearanceauscultatory systolic murmur at apex of the heart auscultation.
Typical complaints of iron deficiency anemia, which refer to the syndrome sideropenia are: lack of appetite, a perversion of taste preferences (the desire to eat chalk, sand, clay) and smell (the desire to inhale the vapors of gasoline, acetone and exhaust), pain on swallowing bothsolid and liquid food (Plummer-Vinson symptom).An objective examination of the patient with the syndrome identified sideropenic trophic disorders of the skin and mucous membranes - dryness, peeling skin, striated nail plates, hair loss, Zayed corners of the mouth, aphthous cracks and changes in the surface of the tongue.
The main variants of iron deficiency anemia include: early chlorosis, chronic iron deficiency anemia and iron deficiency anemia during pregnancy.
early chlorosis peculiarity is that the symptoms of iron deficiency anemia occur during puberty and more common for girls.Iron deficiency occurs for two reasons - as a result of increased flow rate on the growth of muscle tissue and the resulting bleeding during menstruation.Already at the initial examination of a teenager, you can suspect the presence of early symptoms of chlorosis: skin pale, pasty, marked swelling of the face and lower extremities.A common complaint of patients is a loss of appetite and frequent constipation.
Chronic iron deficiency anemia is more common for women and due to regular menstrual bleeding.Men cause chronic anemia can be gastrointestinal bleeding in a volume of 100 ml / day.Note that hidden stomach bleeding can cause anemia, so all patients with iron deficiency anemia shows instrumental examination of the gastrointestinal tract (esophagogastroscopy, colonoscopy, sigmoidoscopy, and barium enema X-ray of the stomach).Often, symptoms suggestive of hypoxia and sideropenia, go by the wayside, and the patient's primary complaints are symptoms of the underlying disease, which was the original cause of anemia.
Iron deficiency anemia among pregnant women is a common disease and it is caused by an unbalanced diet expectant mother in a high consumption of iron.It is also a common cause of reduction of iron in the blood of pregnant women are infectious diseases, and therefore, it is recommended to sanitize all chronic foci of infection during pregnancy planning.For pregnant women, characterized by complaints, indicating the occurrence 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 consider not only the clinical but also laboratory data available to the patient.Evaluation of gravity and severity of iron deficiency anemia include a mandatory algorithm for the study of the patient before prescribing treatment.
If we evaluate the severity of the patient according to the available clinical symptoms, it stands 5 degrees of severity: Latent iron deficiency anemia (there are no clinical symptoms), moderate-severe iron deficiency anemia (symptoms of anemia and sideropenic symptom) expressed a degree of iron deficiency anemia (accession clinicalmanifestations of hypoxia and disorders of the central hemodynamics), precoma and coma.
Considering laboratory changes typical of iron deficiency, one manifestation of which is the anemia, it should be noted that none of the biochemical parameters of blood can not be regarded as an absolute criterion demonstrative and only if the aggregate performance can be judged on the severity of anemia.
Thus, for the first degree of iron deficiency characterized by reduction of hemosiderin in bone marrow macrophages and reduced iron absorption in the intestine.
When the second degree of iron deficiency anemia in the erythrocyte protoporphyrin concentration increases, there is a decrease the level of sideroblasts, morphological changes of erythrocytes in the form microcytosis and hypochromia, decreased hemoglobin concentration, decreased ferritin levels.
third degree of iron-deficiency anemia is accompanied not only by laboratory, and clinical signs of anemia.
Iron deficiency anemia in children
basic structure of iron in the blood of a child is formed during the period of the mother's pregnancy, but the most intense intake of iron through the placental blood vessels occurs in the third trimester.The norm contained in the body iron term infants considered to 400 mg, and in children born prematurely, this figure does not exceed 100 mg.
While in the body of a newborn baby is not disturbed positive balance between consumption and iron intake, there is no change.Neonatologists and pediatricians say that the stock of iron contained in human breast milk is sufficient to prevent iron deficiency in a child under the age of 4 months.In this regard, the early abandonment of breastfeeding can provoke iron deficiency, having serious consequences for the health and early childhood development.
in the development of iron deficiency in a child distinguish 3 pathogenetic steps prelatent (reduction of iron by reducing its accumulation in tissues in intact performance formula of red blood cells), latent (reduced performance, not only the content of iron in the tissues, but the level of iron containedserum) and anemia (low levels of red blood count parameters).
Based on these figures all the causes that trigger the appearance of iron deficiency in the body of the child can be divided into several groups:
♦ utero: pathological conditions involving placental insufficiency (early and late toxicosis syndrome, hypoxia, infections pregnancy), uterine-platsentranoebleeding, multiple pregnancy with fetal transfusion syndrome, chronic iron deficiency anemia is severe during pregnancy.
♦ intrapartum period: premature tying the umbilical cord, massive bleeding during delivery.
♦ Postpartum: nutritional reasons (early termination of breast-type feeding, early solid foods whole cow's milk, vegetarian type diets), causes, based on the accelerated growth of the child (prematurity, birth of a child with a lot of weight during thepubertal development), diseases accompanied by violation of intestinal absorption (malabsorption syndrome, developmental abnormalities, hereditary diseases of the gastrointestinal tract).
In children, the diagnosis of iron deficiency anemia on clinical grounds is difficult, because the symptoms of anemia are nonspecific and may be represented by one of the following symptom:
- asthenovegetative manifestations (their appearance is due to an impaired functioning of the basic structures of the brain and manifest as the backlogpsychomotor development, irritability, decreased intellectual capacity, tendency to hypotension and enuresis);
- trophic changes of the skin, mucous membranes caused by the so-called epithelial syndrome;
- immunodeficiency syndrome (susceptibility to infectious disease that infects the upper respiratory tract and intestines);
- syndrome hemodynamic disorders (hypotension, tachyarrhythmia, rough auscultation noise).
Recent centralized randomized studies have shown that children with symptoms of iron deficiency anemia, living in large cities are more likely to suffer from lead poisoning, which can have severe complications in the form of mental and neurological disorders, renal and hepatic failure and absolute refractory to the use of iron-containing preparations.
Among the clinical forms of iron deficiency anemia occurring in childhood, distinguish:
- anemia in premature baby, the first signs of which are already evident in the first month of life, and is accompanied by a pronounced decline in hemoglobin in the blood up to 80 g / l.As the drug of choice in this situation is erythropoietin, which is administered subcutaneously 3 times a week at a dose of 200 IU per kg body weight rate of not less than 10 injection;
- infectious and nutritional anemia, which manifests itself in the second half of life and due to insufficient intake of iron useful with breast milk during breastfeeding disorders and infectious diseases;
- chlorosis caused by endocrine dysfunction in puberty and has all the signs of a lack of iron in the blood, but does not need specialized medical correction and passes independently after the establishment of a regular menstrual cycle.
In order to prevent the development of a child of iron deficiency states in a given period, it is necessary to apply preventive measures: balanced diet of pregnant women and the use of prolonged forms of iron-containing drugs in existing symptoms of anemia, prolonged and regular breastfeeding with a rational approach to the introduction of complementary foods, periodicLaboratory analysis of peripheral blood.
Iron deficiency anemia treatment
When selecting therapies iron deficiency anemia should take into account many factors, since treatment must be individualized, continuity and pathogenetically substantiated.per day.per day.