Iron deficiency anemia (IDA). Symptoms, treatment, prevention

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What is anemia?

Anemia- this is a pathological condition of the body, which is characterized by a decrease in the number of red blood cells and hemoglobin in a unit of blood.

Erythrocytes are formed in the red bone marrow from protein fractions and non-protein components under the influence of erythropoietin (synthesized by the kidneys). For three days, erythrocytes provide transport mainly of oxygen and carbon dioxide, as well as nutrients and metabolic products from cells and tissues. The life span of an erythrocyte is one hundred and twenty days, after which it is destroyed. Old erythrocytes accumulate in the spleen, where non-protein fractions are utilized, and protein enters the red bone marrow, participating in the synthesis of new erythrocytes.

The entire cavity of the erythrocyte is filled with protein, hemoglobin, which includes iron. Hemoglobin gives red blood cells their red color and also helps them carry oxygen and carbon dioxide. Its work begins in the lungs, where red blood cells enter with the bloodstream. Hemoglobin molecules capture oxygen, after which oxygen-enriched erythrocytes are sent first through large vessels, and then through small capillaries to each organ, giving cells and tissues the oxygen necessary for life and normal activity.

Anemia weakens the body's ability to exchange gases; by reducing the number of red blood cells, the transport of oxygen and carbon dioxide is disrupted. As a result, a person may experience such signs of anemia as a feeling of constant fatigue, loss of strength, drowsiness, as well as increased irritability.

Anemia is a manifestation of the underlying disease and is not an independent diagnosis. Many diseases, including infectious diseases, benign or malignant tumors can be associated with anemia. That is why anemia is an important symptom that requires the necessary research to identify the underlying cause that led to its development.

Severe forms of anemia due to tissue hypoxia can lead to serious complications such as shock conditions (for example, hemorrhagic shock), hypotension, coronary or pulmonary insufficiency.

Anemia classification

Anemias are classified:

• according to the mechanism of development;
• by severity;
• by color indicator;
• on a morphological basis;
• on the ability of the bone marrow to regenerate.

Classification	Description	Kinds
According to the mechanism of development	According to the pathogenesis, anemia can develop due to blood loss, impaired formation of red blood cells, or due to their pronounced destruction.	According to the mechanism of development, there are: anemia due to acute or chronic blood loss; anemia due to impaired blood formation ( for example, iron deficiency, aplastic, renal anemia, as well as B12 and folate deficiency anemia); anemia due to increased destruction of red blood cells ( for example, hereditary or autoimmune anemia).
By severity	Depending on the level of decrease in hemoglobin, there are three degrees of severity of anemia. Normally, the hemoglobin level in men is 130 - 160 g / l, and in women 120 - 140 g / l.	There are following degrees of severity of anemia: mild degree, at which there is a decrease in the level of hemoglobin relative to the norm up to 90 g / l; average degree, at which the hemoglobin level is 90 - 70 g / l; severe degree, at which the hemoglobin level is below 70 g / l.
By color index	The color indicator is the degree of saturation of red blood cells with hemoglobin. It is calculated based on the results of a blood test as follows. The number three must be multiplied by the hemoglobin index and divided by the red blood cell index ( the comma is removed).	Classification of anemia by color index: hypochromic anemia (weakened color of red blood cells) color index less than 0.8; normochromic anemia the color index is 0.80 - 1.05; hyperchromic anemia (erythrocytes are overly stained) color index greater than 1.05.
According to morphological features	With anemia, red blood cells of various sizes can be observed during a blood test. Normally, the diameter of erythrocytes should be from 7.2 to 8.0 microns ( micrometer). Smaller RBCs ( microcytosis) can be observed in iron deficiency anemia. Normal size may be present in posthemorrhagic anemia. Larger size ( macrocytosis), in turn, may indicate anemia associated with a deficiency of vitamin B12 or folic acid.	Classification of anemia by morphological features: microcytic anemia, at which the diameter of erythrocytes is less than 7.0 microns; normocytic anemia, at which the diameter of erythrocytes varies from 7.2 to 8.0 microns; macrocytic anemia, at which the diameter of erythrocytes is more than 8.0 microns; megalocytic anemia, at which the size of erythrocytes is more than 11 microns.
According to the ability of the bone marrow to regenerate	Since the formation of red blood cells occurs in the red bone marrow, the main sign of bone marrow regeneration is an increase in the level of reticulocytes ( erythrocyte precursors) in blood. Also, their level indicates how actively the formation of red blood cells proceeds ( erythropoiesis). Normally, in human blood, the number of reticulocytes should not exceed 1.2% of all red blood cells.	According to the ability of the bone marrow to regenerate, the following forms are distinguished: regenerative form characterized by normal bone marrow regeneration ( the number of reticulocytes is 0.5 - 2%); hyporegenerative form characterized by a reduced ability of the bone marrow to regenerate ( the reticulocyte count is below 0.5%); hyperregenerative form characterized by a pronounced ability to regenerate ( the number of reticulocytes is more than two percent); aplastic form characterized by a sharp suppression of regeneration processes ( the number of reticulocytes is less than 0.2%, or their absence is observed).

Causes of anemia

There are three main causes leading to the development of anemia:

• blood loss (acute or chronic bleeding);
• increased destruction of red blood cells (hemolysis);
• reduced production of red blood cells.

It should also be noted that depending on the type of anemia, the causes of its occurrence may differ.

Factors affecting the development of anemia	Causes
genetic factor	hemoglobinopathies ( a change in the structure of hemoglobin is observed with thalassemia, sickle cell anemia); Fanconi's anemia develops due to an existing defect in the cluster of proteins that are responsible for DNA repair); enzymatic defects in erythrocytes; cytoskeletal defects ( cell scaffold located in the cytoplasm of a cell) erythrocyte; congenital dyserythropoietic anemia ( characterized by impaired formation of red blood cells); abetalipoproteinemia or Bassen-Kornzweig syndrome ( characterized by a lack of beta-lipoprotein in intestinal cells, which leads to impaired absorption of nutrients); hereditary spherocytosis or Minkowski-Choffard disease ( due to a violation of the cell membrane, erythrocytes take on a spherical shape).
Nutritional factor	iron deficiency; vitamin B12 deficiency; folic acid deficiency; deficiency of ascorbic acid ( vitamin C); starvation and malnutrition.
physical factor
Chronic diseases and neoplasms	kidney disease ( e.g. liver tuberculosis, glomerulonephritis); liver disease ( e.g. hepatitis, cirrhosis); diseases of the gastrointestinal tract ( e.g. gastric and duodenal ulcer, atrophic gastritis, ulcerative colitis, Crohn's disease); collagen vascular diseases ( e.g. systemic lupus erythematosus, rheumatoid arthritis); benign and malignant tumors for example, uterine fibroids, polyps in the intestines, cancer of the kidneys, lungs, intestines).
infectious factor	viral diseases ( hepatitis, infectious mononucleosis, cytomegalovirus); bacterial diseases ( tuberculosis of the lungs or kidneys, leptospirosis, obstructive bronchitis); protozoal diseases ( malaria, leishmaniasis, toxoplasmosis).
Pesticides and medicines	inorganic arsenic, benzene; radiation; cytostatics ( chemotherapy drugs used to treat cancer); antithyroid drugs ( reduce the synthesis of thyroid hormones); antiepileptic drugs.

Iron-deficiency anemia

Iron deficiency anemia is hypochromic anemia, which is characterized by a decrease in the level of iron in the body.

Iron deficiency anemia is characterized by a decrease in red blood cells, hemoglobin and a color index.

Iron is a vital element involved in many metabolic processes in the body. In a person weighing seventy kilograms, the iron reserve in the body is approximately four grams. This amount is maintained by maintaining a balance between the regular loss of iron from the body and its intake. To maintain balance, the daily need for iron is 20-25 mg. Most of the incoming iron in the body is spent on its needs, the rest is deposited in the form of ferritin or hemosiderin and, if necessary, is consumed.

Causes of iron deficiency anemia

Causes	Description
Violation of the intake of iron in the body	vegetarianism due to the lack of animal proteins ( meat, fish, eggs, dairy products); socio-economic component ( for example, there is not enough money for good nutrition).
Impaired absorption of iron	Iron absorption occurs at the level of the gastric mucosa, therefore, stomach diseases such as gastritis, peptic ulcer or gastric resection lead to impaired iron absorption.
Increased body's need for iron	pregnancy, including multiple pregnancy; lactation period; adolescence ( due to rapid growth); chronic diseases accompanied by hypoxia ( e.g. chronic bronchitis, heart defects); chronic suppurative diseases ( e.g. chronic abscesses, bronchiectasis, sepsis).
Loss of iron from the body	pulmonary bleeding ( e.g. lung cancer, tuberculosis); gastrointestinal bleeding ( for example, gastric and duodenal ulcers, gastric cancer, intestinal cancer, varicose veins of the esophagus and rectum, ulcerative colitis, helminthic invasions); uterine bleeding ( e.g. placental abruption, uterine rupture, uterine or cervical cancer, aborted ectopic pregnancy, uterine fibroids); kidney bleeding ( e.g. kidney cancer, kidney tuberculosis).

Symptoms of iron deficiency anemia

The clinical picture of iron deficiency anemia is based on the development of two syndromes in a patient:

• anemic syndrome;
• sideropenic syndrome.

Anemia syndrome is characterized by the following symptoms:

• severe general weakness;
• increased fatigue;
• attention deficit;
• malaise;
• drowsiness;
• black stool (with gastrointestinal bleeding);
• heartbeat;

Sideropenic syndrome is characterized by the following symptoms:

• taste perversion (for example, patients eat chalk, raw meat);
• perversion of smell (for example, patients sniff acetone, gasoline, paints);
• brittle, dull, split ends;
• white spots appear on the nails;
• the skin is pale, the skin is flaky;
• cheilitis (bites) may appear in the corners of the mouth.

Also, the patient may complain of the development of leg cramps, for example, when climbing stairs.

Diagnosis of iron deficiency anemia

On physical examination, the patient has:

• cracks in the corners of the mouth;
• "glossy" language;
• in severe cases, an increase in the size of the spleen.

• microcytosis (small erythrocytes);
• hypochromia of erythrocytes (weak color of erythrocytes);
• poikilocytosis (erythrocytes of various forms).

In the biochemical analysis of blood, the following changes are observed:

• decrease in the level of ferritin;
• serum iron is reduced;
• serum iron-binding capacity is increased.

Instrumental research methods
To identify the cause that led to the development of anemia, the following instrumental studies can be prescribed to the patient:

• fibrogastroduodenoscopy (for examination of the esophagus, stomach and duodenum);
• Ultrasound (for examining the kidneys, liver, female genital organs);
• colonoscopy (to examine the large intestine);
• computed tomography (for example, to examine the lungs, kidneys);
• X-rays of light.

Treatment of iron deficiency anemia

Nutrition for anemia
In nutrition, iron is divided into:

• heme, which enters the body with products of animal origin;
• non-heme, which enters the body with plant products.

It should be noted that heme iron is absorbed in the body much better than non-heme iron.

Food	Product Names
Food animal origin	liver; beef tongue; rabbit meat; turkey; goose meat; beef; fish.	9 mg; 5 mg; 4.4 mg; 4 mg; 3 mg; 2.8 mg; 2.3 mg.
	dried mushrooms; fresh peas; buckwheat; Hercules; fresh mushrooms; apricots; pear; apples; plums; cherries; beet.	35 mg; 11.5 mg; 7.8 mg; 7.8 mg; 5.2 mg; 4.1 mg; 2.3 mg; 2.2 mg; 2.1 mg; 1.8 mg; 1.4 mg.

While dieting, you should also increase your intake of foods containing vitamin C, as well as meat protein (they increase the absorption of iron in the body) and reduce the intake of eggs, salt, caffeine and calcium (they reduce the absorption of iron).

Medical treatment
In the treatment of iron deficiency anemia, the patient is prescribed iron supplements in parallel with the diet. These drugs are designed to compensate for iron deficiency in the body. They are available in the form of capsules, dragees, injections, syrups and tablets.

The dose and duration of treatment is selected individually depending on the following indicators:

• patient's age;
• the severity of the disease;
• causes of iron deficiency anemia;
• based on the results of the analyses.

Iron supplements are taken one hour before a meal or two hours after a meal. These drugs should not be taken with tea or coffee, as iron absorption is reduced, so it is recommended to drink them with water or juice.

Iron preparations in the form of injections (intramuscular or intravenous) are used in the following cases:

• with severe anemia;
• if anemia progresses despite taking doses of iron in the form of tablets, capsules or syrup;
• if the patient has diseases of the gastrointestinal tract (for example, gastric and duodenal ulcers, ulcerative colitis, Crohn's disease), since the iron supplement taken may aggravate the existing disease;
• before surgical interventions in order to accelerate the saturation of the body with iron;
• if the patient has intolerance to iron preparations when they are taken orally.

Surgery
Surgery is performed if the patient has acute or chronic bleeding. So, for example, with gastrointestinal bleeding, fibrogastroduodenoscopy or colonoscopy can be used to identify the area of ​​bleeding and then stop it (for example, a bleeding polyp is removed, a gastric and duodenal ulcer is coagulated). With uterine bleeding, as well as with bleeding in organs located in the abdominal cavity, laparoscopy can be used.

If necessary, the patient may be assigned a transfusion of red blood cells to replenish the volume of circulating blood.

B12 - deficiency anemia

This anemia is due to a lack of vitamin B12 (and possibly folic acid). It is characterized by a megaloblastic type (increased number of megaloblasts, erythrocyte progenitor cells) of hematopoiesis and represents hyperchromic anemia.

Normally, vitamin B12 enters the body with food. At the level of the stomach, B12 binds to a protein produced in it, gastromucoprotein (Castle's intrinsic factor). This protein protects the vitamin that has entered the body from the negative effects of the intestinal microflora, and also promotes its absorption.

The complex of gastromucoprotein and vitamin B12 reaches the distal (lower) small intestine, where this complex breaks down, absorption of vitamin B12 into the intestinal mucosa and its further entry into the blood.

From the bloodstream, this vitamin comes:

• in the red bone marrow to participate in the synthesis of red blood cells;
• in the liver, where it is deposited;
• to the central nervous system for the synthesis of the myelin sheath (covers the axons of neurons).

Causes of B12 deficiency anemia

There are the following reasons for the development of B12-deficiency anemia:

• insufficient intake of vitamin B12 with food;
• violation of the synthesis of internal factor Castle due to, for example, atrophic gastritis, gastric resection, gastric cancer;
• intestinal damage, for example, dysbiosis, helminthiasis, intestinal infections;
• increased body needs for vitamin B12 (rapid growth, active sports, multiple pregnancy);
• violation of vitamin deposition due to cirrhosis of the liver.

Symptoms of B12 deficiency anemia

The clinical picture of B12 and folate deficiency anemia is based on the development of the following syndromes in the patient:

• anemic syndrome;
• gastrointestinal syndrome;
• neuralgic syndrome.

Name of the syndrome	Symptoms
Anemia syndrome	weakness; increased fatigue; headache and dizziness; skin integuments are pale with an icteric shade ( due to liver damage); flashing flies before the eyes; dyspnea; heartbeat; with this anemia, there is an increase in blood pressure;
Gastrointestinal syndrome	the tongue is shiny, bright red, the patient feels a burning sensation of the tongue; the presence of ulcers in the oral cavity ( aphthous stomatitis); loss of appetite or its decrease; feeling of heaviness in the stomach after eating; weight loss; there may be pain in the rectum; stool disorder constipation); enlargement of the liver ( hepatomegaly). These symptoms develop due to atrophic changes in the mucous layer of the oral cavity, stomach and intestines.
Neuralgic syndrome	feeling of weakness in the legs when walking for a long time or when climbing up); feeling of numbness and tingling in the limbs; violation of peripheral sensitivity; atrophic changes in the muscles of the lower extremities; convulsions.

Diagnosis of B12 deficiency anemia

In the general blood test, the following changes are observed:

• decrease in the level of red blood cells and hemoglobin;
• hyperchromia (pronounced color of erythrocytes);
• macrocytosis (increased size of red blood cells);
• poikilocytosis (a different form of red blood cells);
• microscopy of erythrocytes reveals Kebot rings and Jolly bodies;
• reticulocytes are reduced or normal;
• a decrease in the level of white blood cells (leukopenia);
• increased levels of lymphocytes (lymphocytosis);
• decreased platelet count (thrombocytopenia).

In the biochemical blood test, hyperbilirubinemia is observed, as well as a decrease in the level of vitamin B12.

A puncture of the red bone marrow revealed an increase in megaloblasts.

The patient may be assigned the following instrumental studies:

• study of the stomach (fibrogastroduodenoscopy, biopsy);
• examination of the intestine (colonoscopy, irrigoscopy);
• ultrasound examination of the liver.

These studies help to identify atrophic changes in the mucous membrane of the stomach and intestines, as well as to detect diseases that led to the development of B12-deficiency anemia (for example, malignant tumors, cirrhosis of the liver).

Treatment of B12 deficiency anemia

All patients are hospitalized in the hematology department, where they undergo appropriate treatment.

Nutrition for B12 deficiency anemia
Diet therapy is prescribed, in which the consumption of foods rich in vitamin B12 is increased.

The daily requirement for vitamin B12 is three micrograms.

Medical treatment
Drug treatment is prescribed to the patient according to the following scheme:

• For two weeks, the patient receives 1000 mcg of Cyanocobalamin intramuscularly daily. Within two weeks, the patient's neurological symptoms disappear.
• Over the next four to eight weeks, the patient receives 500 mcg daily intramuscularly to saturate the depot of vitamin B12 in the body.
• Subsequently, the patient for life receives intramuscular injections once a week, 500 mcg.

During treatment, simultaneously with Cyanocobalamin, the patient may be prescribed folic acid.

A patient with B12-deficiency anemia should be observed for life by a hematologist, gastrologist and family doctor.

folate deficiency anemia

Folate deficiency anemia is a hyperchromic anemia characterized by a lack of folic acid in the body.

Folic acid (vitamin B9) is a water-soluble vitamin, which is partly produced by intestinal cells, but mainly must come from outside to replenish the body's needs. The daily intake of folic acid is 200-400 micrograms.

In foods, as well as in the cells of the body, folic acid is in the form of folates (polyglutamates).

Folic acid plays an important role in the human body:

• participates in the development of the organism in the prenatal period (contributes to the formation of nerve conduction of tissues, the circulatory system of the fetus, prevents the development of some malformations);
• participates in the growth of the child (for example, in the first year of life, during puberty);
• affects the processes of hematopoiesis;
• together with vitamin B12 is involved in DNA synthesis;
• prevents the formation of blood clots in the body;
• improves the processes of regeneration of organs and tissues;
• participates in the renewal of tissues (for example, skin).

Absorption (absorption) of folate in the body is carried out in the duodenum and in the upper part of the small intestine.

Causes of folate deficiency anemia

There are the following reasons for the development of folate deficiency anemia:

• insufficient intake of folic acid from food;
• increased loss of folic acid from the body (for example, with cirrhosis of the liver);
• impaired absorption of folic acid in the small intestine (for example, with celiac disease, when taking certain medications, with chronic alcohol intoxication);
• increased body needs for folic acid (for example, during pregnancy, malignant tumors).

Symptoms of folate deficiency anemia

With folate deficiency anemia, the patient has an anemic syndrome (symptoms such as increased fatigue, palpitations, pallor of the skin, decreased performance). Neurological syndrome, as well as atrophic changes in the mucous membrane of the oral cavity, stomach and intestines, are absent in this type of anemia.

Also, the patient may experience an increase in the size of the spleen.

Diagnosis of folate deficiency anemia

In a general blood test, the following changes are observed:

• hyperchromia;
• decrease in the level of red blood cells and hemoglobin;
• macrocytosis;
• leukopenia;
• thrombocytopenia.

In the results of a biochemical blood test, there is a decrease in the level of folic acid (less than 3 mg / ml), as well as an increase in indirect bilirubin.

When conducting a myelogram, an increased content of megaloblasts and hypersegmented neutrophils is detected.

Treatment of folate deficiency anemia

Nutrition in folate deficiency anemia plays a big role, the patient needs to consume foods rich in folic acid daily.

It should be noted that with any culinary processing of products, folates are destroyed by approximately fifty percent or more. Therefore, to provide the body with the necessary daily norm, it is recommended to consume fresh products (vegetables and fruits).

Food	Name of products	The amount of iron per hundred milligrams
Food of animal origin	beef and chicken liver; pork liver; heart and kidneys; fatty cottage cheese and cheese; cod; butter; sour cream; beef meat; rabbit meat; chicken eggs; chicken; mutton.	240 mg; 225 mg; 56 mg; 35 mg; 11 mg; 10 mg; 8.5 mg; 7.7 mg; 7 mg; 4.3 mg; 4.1 mg;
Foods of plant origin	asparagus; peanut; lentils; beans; parsley; spinach; walnuts; Wheat groats; white fresh mushrooms; buckwheat and barley groats; wheat, grain bread; eggplant; green onions; red pepper ( sweet); peas; tomatoes; White cabbage; carrot; oranges.	262 mg; 240 mg; 180 mg; 160 mg; 117 mg; 80 mg; 77 mg; 40 mg; 40 mg; 32 mg; 30 mg; 18.5 mg; 18 mg; 17 mg; 16 mg; 11 mg; 10 mg; 9 mg; 5 mg.

Drug treatment of folic acid deficiency anemia involves taking folic acid in an amount of five to fifteen milligrams per day. The required dosage is set by the attending physician, depending on the age of the patient, the severity of the course of anemia and the results of the studies.

The prophylactic dose includes taking one to five milligrams of the vitamin per day.

aplastic anemia

Aplastic anemia is characterized by bone marrow hypoplasia and pancytopenia (decrease in the number of red blood cells, white blood cells, lymphocytes, and platelets). The development of aplastic anemia occurs under the influence of external and internal factors, as well as due to qualitative and quantitative changes in stem cells and their micro-environment.

Aplastic anemia can be congenital or acquired.

Causes of aplastic anemia

Aplastic anemia can develop due to:

• stem cell defect
• suppression of hematopoiesis (blood formation);
• immune reactions;
• lack of factors stimulating hematopoiesis;
• not using the hematopoietic tissue of elements important for the body, such as iron and vitamin B12.

There are the following reasons for the development of aplastic anemia:

• hereditary factor (for example, Fanconi anemia, Diamond-Blackfan anemia);
• drugs (eg, non-steroidal anti-inflammatory drugs, antibiotics, cytostatics);
• chemicals (eg inorganic arsenic, benzene);
• viral infections (eg, parvovirus infection, human immunodeficiency virus (HIV));
• autoimmune diseases (eg, systemic lupus erythematosus);
• severe nutritional deficiencies (eg, vitamin B12, folic acid).

It should be noted that in half of the cases the cause of the disease cannot be identified.

Symptoms of aplastic anemia

The clinical manifestations of aplastic anemia depend on the severity of pancytopenia.

With aplastic anemia, the patient has the following symptoms:

• pallor of the skin and mucous membranes;
• headache;
• dyspnea;
• increased fatigue;
• gingival bleeding (due to a decrease in the level of platelets in the blood);
• petechial rash (red spots on the skin of small sizes), bruises on the skin;
• acute or chronic infections (due to a decrease in the level of leukocytes in the blood);
• ulceration of the oropharyngeal zone (the oral mucosa, tongue, cheeks, gums and pharynx are affected);
• yellowness of the skin (a symptom of liver damage).

Diagnosis of aplastic anemia

In the general blood test, the following changes are observed:

• decrease in the number of red blood cells;
• decrease in hemoglobin level;
• decrease in the number of leukocytes and platelets;
• decrease in reticulocytes.

The color index, as well as the concentration of hemoglobin in the erythrocyte, remain normal.

In a biochemical blood test, the following is observed:

• increase in serum iron;
• saturation of transferrin (iron-carrying protein) with iron by 100%;
• increased bilirubin;
• increased lactate dehydrogenase.

Puncture of the red brain and subsequent histological examination revealed:

• underdevelopment of all germs (erythrocyte, granulocytic, lymphocytic, monocytic and macrophage);
• replacement of bone marrow with fat (yellow marrow).

Among the instrumental methods of research, the patient can be assigned:

• ultrasound examination of parenchymal organs;
• electrocardiography (ECG) and echocardiography;
• fibrogastroduodenoscopy;
• colonoscopy;
• CT scan.

Treatment of aplastic anemia

With the right supportive treatment, the condition of patients with aplastic anemia improves significantly.

In the treatment of aplastic anemia, the patient is prescribed:

• immunosuppressive drugs (for example, cyclosporine, methotrexate);
• glucocorticosteroids (for example, methylprednisolone);
• antilymphocyte and antiplatelet immunoglobulins;
• antimetabolites (eg, fludarabine);
• erythropoietin (stimulates the formation of red blood cells and stem cells).

Non-drug treatment includes:

• bone marrow transplantation (from a compatible donor);
• transfusion of blood components (erythrocytes, platelets);
• plasmapheresis (mechanical blood purification);
• compliance with the rules of asepsis and antisepsis in order to prevent the development of infection.

Also, in severe cases of aplastic anemia, the patient may need surgical treatment, in which the spleen is removed (splenectomy).

Depending on the effectiveness of the treatment, a patient with aplastic anemia may experience:

• complete remission (attenuation or complete disappearance of symptoms);
• partial remission;
• clinical improvement;
• no effect of treatment.

Treatment effectiveness	Indicators
Complete remission	hemoglobin index more than one hundred grams per liter; the granulocyte index is more than 1.5 x 10 to the ninth power per liter; platelet count more than 100 x 10 to the ninth power per liter; no need for blood transfusion.
Partial remission	hemoglobin index more than eighty grams per liter; granulocyte index more than 0.5 x 10 to the ninth power per liter; platelet count more than 20 x 10 to the ninth power per liter; no need for blood transfusion.
Clinical Improvement	improvement in blood counts; reducing the need for blood transfusion for replacement purposes for two months or more.
No therapeutic effect	no improvement in blood counts; there is a need for a blood transfusion.

Hemolytic anemia

Hemolysis is the premature destruction of red blood cells. Hemolytic anemia develops when the activity of the bone marrow is not able to compensate for the loss of red blood cells. The severity of anemia depends on whether hemolysis of red blood cells began gradually or abruptly. Gradual hemolysis may be asymptomatic, while anemia in severe hemolysis may be life-threatening for the patient and cause angina pectoris, as well as cardiopulmonary decompensation.

Hemolytic anemia can develop due to hereditary or acquired diseases.

By localization, hemolysis can be:

• intracellular (for example, autoimmune hemolytic anemia);
• intravascular (eg, transfusion of incompatible blood, disseminated intravascular coagulation).

In patients with mild hemolysis, the hemoglobin level may be normal if the production of red blood cells matches the rate of their destruction.

Causes of hemolytic anemia

Premature destruction of red blood cells may be due to the following reasons:

• internal membrane defects of erythrocytes;
• defects in the structure and synthesis of hemoglobin protein;
• enzymatic defects in the erythrocyte;
• hypersplenomegaly (enlargement of the liver and spleen).

Hereditary diseases can cause hemolysis as a result of red blood cell membrane abnormalities, enzymatic defects, and hemoglobin abnormalities.

There are the following hereditary hemolytic anemias:

• enzymopathies (anemia, in which there is a lack of enzyme, deficiency of glucose-6-phosphate dehydrogenase);
• hereditary spherocytosis or Minkowski-Choffard disease (erythrocytes of an irregular spherical shape);
• thalassemia (violation of the synthesis of polypeptide chains that are part of the structure of normal hemoglobin);
• sickle cell anemia (a change in the structure of hemoglobin leads to the fact that red blood cells take on a sickle shape).

Acquired causes of hemolytic anemia include immune and non-immune disorders.

Immune disorders are characterized by autoimmune hemolytic anemia.

Non-immune disorders can be caused by:

• pesticides (for example, pesticides, benzene);
• medicines (for example, antivirals, antibiotics);
• physical damage;
• infections (eg malaria).

Hemolytic microangiopathic anemia results in the production of fragmented red blood cells and can be caused by:

• defective artificial heart valve;
• disseminated intravascular coagulation;
• hemolytic uremic syndrome;

Symptoms of hemolytic anemia

Symptoms and manifestations of hemolytic anemia are diverse and depend on the type of anemia, the degree of compensation, and also on what treatment the patient received.

It should be noted that hemolytic anemia may be asymptomatic, and hemolysis may be detected incidentally during routine laboratory testing.

Symptoms of hemolytic anemia include:

• pallor of the skin and mucous membranes;
• fragility of nails;
• tachycardia;
• increased respiratory movements;
• lowering blood pressure;
• yellowness of the skin (due to an increase in the level of bilirubin);
• ulcers may appear on the legs;
• skin hyperpigmentation;
• gastrointestinal manifestations (eg, abdominal pain, stool disturbance, nausea).

It should be noted that with intravascular hemolysis, the patient has an iron deficiency due to chronic hemoglobinuria (the presence of hemoglobin in the urine). Due to oxygen starvation, cardiac function is impaired, which leads to the development of patient symptoms such as weakness, tachycardia, shortness of breath and angina pectoris (with severe anemia). Due to hemoglobinuria, the patient also has dark urine.

Prolonged hemolysis can lead to the development of gallstones due to impaired bilirubin metabolism. At the same time, patients may complain of abdominal pain and bronze skin color.

Diagnosis of hemolytic anemia

In the general analysis of blood is observed:

• decrease in hemoglobin level;
• decrease in the level of red blood cells;
• an increase in reticulocytes.

Microscopy of erythrocytes reveals their crescent shape, as well as Cabot rings and Jolly bodies.

In a biochemical blood test, there is an increase in the level of bilirubin, as well as hemoglobinemia (an increase in free hemoglobin in the blood plasma).

In children whose mothers suffered from anemia during pregnancy, iron deficiency is also often found by the first year of life.

Symptoms of anemia often include:

• feeling tired;
• sleep disorder;
• dizziness;
• nausea;
• dyspnea;
• weakness;
• fragility of nails and hair, as well as hair loss;
• pallor and dryness of the skin;
• perversion of taste (for example, the desire to eat chalk, raw meat) and smell (the desire to sniff liquids with pungent odors).

In rare cases, a pregnant woman may experience fainting.

It should be noted that a mild form of anemia may not manifest itself in any way, so it is very important to regularly take blood tests to determine the level of red blood cells, hemoglobin and ferritin in the blood.

During pregnancy, the norm of hemoglobin is considered to be 110 g / l and above. A drop below normal is considered a sign of anemia.

Diet plays an important role in the treatment of anemia. From vegetables and fruits, iron is absorbed much worse than from meat products. Therefore, the diet of a pregnant woman should be rich in meat (for example, beef, liver, rabbit meat) and fish.

The daily iron requirement is:

• in the first trimester of pregnancy - 15 - 18 mg;
• in the second trimester of pregnancy - 20 - 30 mg;
• in the third trimester of pregnancy - 33 - 35 mg.

However, it is impossible to eliminate anemia only with the help of a diet, so a woman will additionally need to take iron-containing preparations prescribed by a doctor.

Name of the drug	Active substance	Mode of application
Sorbifer	Ferrous sulfate and ascorbic acid.	As a preventive measure for the development of anemia, it is necessary to take one tablet per day. For therapeutic purposes, two tablets should be taken daily in the morning and evening.
Maltofer	iron hydroxide.	In the treatment of iron deficiency anemia, two to three tablets should be taken ( 200 - 300 mg) per day. For prophylactic purposes, the drug is taken one tablet at a time ( 100 mg) in a day.
Ferretab	Ferrous fumarate and folic acid.	It is necessary to take one tablet per day, if indicated, the dose can be increased to two to three tablets per day.
Tardyferon	Iron sulfate.	For prophylactic purposes, take the drug, starting from the fourth month of pregnancy, one tablet daily or every other day. For therapeutic purposes, it is necessary to take two tablets a day in the morning and evening.

In addition to iron, these preparations may additionally contain ascorbic or folic acid, as well as cysteine, as they contribute to better absorption of iron in the body. There are contraindications. Before use, you should consult with a specialist.

Iron deficiency anemia is a clinical and hematological syndrome caused by a lack of iron in the human body, which leads to a violation of the normal synthesis of hemoglobin and tissue hypoxia.

The pathology is widespread. According to statistics, 8-10% of women of childbearing age are diagnosed with iron deficiency anemia, and 30% of women have latent iron deficiency. In early childhood, signs of iron deficiency anemia are detected in every second child. In the structure of all anemia, iron deficiency accounts for 90%.

Causes and risk factors

The development of iron deficiency anemia is based on a negative balance of iron metabolism. Various factors can lead to this, but the most common cause of iron deficiency is chronic blood loss:

• bleeding from hemorrhoids or anal fissures;
• dysfunctional uterine bleeding;
• heavy menstruation;
• gastrointestinal bleeding (from erosions and ulcers of the mucous membrane of the stomach or intestines).

Other causes of blood loss:

• helminthiases;
• hemosiderosis of the lungs;
• hemorrhagic diathesis (von Willebrand's disease, hemophilia);
• hemoglobinuria;
• extensive injuries and operations;
• frequent blood donation (donation).

Often, iron deficiency anemia develops in patients with chronic renal failure who are on program hemodialysis.

In iron deficiency states, there is a decrease in IgA activity; as a result, patients often develop intestinal and respiratory infections.

Iron deficiency in the body can also be formed as a result of its insufficient intake from food for the following reasons:

• low standard of living;
• vegetarianism;
• adherence to a diet that limits the consumption of meat products;
• anorexia;
• artificial feeding of infants, especially with the late introduction of complementary foods.

A number of diseases and pathological conditions of the digestive system can lead to impaired iron absorption and the development of iron deficiency anemia:

• gasterectomy;
• condition after resection of the small intestine;
• malabsorption syndrome;
• chronic enteritis;
• hypoacid gastritis;
• intestinal infections.

Iron deficiency anemia also develops in patients suffering from chronic hepatitis or cirrhosis of the liver. In this case, the transport of iron from the depot is disrupted.

Iron deficiency anemia can also appear against the background of an increased need for iron (during puberty, pregnancy or lactation) or with significant losses of this element (with cancer, infectious diseases).

Forms of the disease

Depending on the cause, iron deficiency anemia is divided as follows:

• alimentary;
• posthemorrhagic;
• associated with impaired transport of iron, insufficiency of its resorption or increased consumption;
• due to congenital (initial) iron deficiency.

According to the severity of laboratory and clinical signs, iron deficiency anemias are:

• lungs (hemoglobin above 90 g/l);
• moderate (hemoglobin from 70 to 90 g/l);
• heavy (hemoglobin less than 70 g/l).

Mild iron deficiency anemia in most cases proceeds without any clinical manifestations or with minimal severity. The severe form is accompanied by the development of hematological, sideropenic and circulatory-hypoxic syndromes.

Stages of the disease

During iron deficiency anemia, several stages are distinguished:

1. Prelatent iron deficiency - the deposited iron is depleted, hemoglobin and transport reserves are preserved.
2. Latent iron deficiency - there is a decrease in the reserves of transport iron contained in the blood plasma.
3. Actually iron deficiency anemia is the depletion of all metabolic reserves of iron (erythrocyte, transport and deposited).

Symptoms

In the clinical picture of iron deficiency anemia, syndromes are distinguished:

• circulatory-hypoxic;
• sideropenic;
• asthenovegetative.

Circulatory-hypoxic disorders arising against the background of iron deficiency anemia worsen the course of concomitant diseases of the cardiovascular and respiratory systems.

The development of the circulatory-hypoxic syndrome is due to a violation of hemoglobin synthesis, as a result of which oxygen transport suffers and tissue hypoxia develops. Clinically, this manifests itself:

• general weakness;
• drowsiness;
• dizziness;
• tinnitus;
• transient fainting;
• rapid heartbeat;
• hypersensitivity to low temperature;
• shortness of breath that occurs during physical exertion, and in severe anemia - even at rest.

The mechanism of development of sideropenic syndrome is associated with a deficiency of iron-containing tissue enzymes (cytochromes, peroxidase, catalase). The lack of these enzymes becomes the cause of trophic disorders observed against the background of iron deficiency anemia from the mucous membranes and skin. Signs of sideropenic syndrome:

• dry skin;
• deformation, increased fragility and transverse striation of nails;
• hair loss;
• atrophic gastritis;
• dysphagia;
• angular stomatitis;
• glossitis;
• taste distortions (the desire to eat inedible objects, such as clay or tooth powder);
• dysuric disorders;
• dyspepsia;
• muscle weakness.

Asthenovegetative syndrome is characterized by emotional lability, increased irritability, memory impairment, and decreased performance.

Features of the course of the disease in children

The clinical picture of iron deficiency anemia in children is nonspecific, one of the following syndromes predominates:

1. Asthenovegetative. Associated with oxygen starvation of the tissues of the nervous system. It is manifested by a decrease in muscle tone and a delay in the psychomotor development of the child. With a severe degree of iron deficiency anemia and the absence of necessary therapy, intellectual deficiency is possible. Other manifestations of asthenovegetative syndrome include enuresis, fainting, dizziness, irritability and tearfulness.
2. Epithelial. It is characterized by changes in the skin and its appendages. The skin becomes dry, hyperkeratosis develops in the area of ​​the knees and elbows, the hair loses its luster and actively falls out. Often develop cheilitis, glossitis, angular stomatitis.
3. Dyspeptic. Appetite decreases up to complete refusal of food, stool instability (diarrhea alternating with constipation), bloating, dysphagia are observed.
4. Cardiovascular. It develops against the background of severe iron deficiency anemia and is manifested by shortness of breath, low blood pressure, tachycardia, heart murmurs and degenerative changes in the myocardium.
5. immunodeficiency syndrome. It is characterized by an unmotivated rise in temperature to subfebrile values. Children are susceptible to respiratory intestinal infections with severe and (or) prolonged course.
6. Hepatolienal. It is observed against the background of severe iron deficiency anemia, especially combined with other types of anemia or rickets. It is manifested by an increase in the size of the liver and spleen.

In early childhood, signs of iron deficiency anemia are detected in every second child.

Diagnostics

Diagnosis of the condition, as well as determining the degree of its severity, are carried out according to the results of laboratory tests. Iron deficiency anemia is characterized by the following changes:

• a decrease in the content of hemoglobin in the blood (the norm for women is 120-140 g / l, for men - 130-150 g / l);
• poikilocytosis (change in the shape of red blood cells);
• microcytosis (the presence in the blood of abnormally small red blood cells);
• hypochromia (color index - less than 0.8);
• a decrease in the concentration of serum iron (the norm for women is 8.95–30.43 µmol / l, for men - 11.64–30.43 µmol / l);
• a decrease in the concentration of ferritin (the norm for women is 22-180 mcg / l, for men - 30-310 mcg / l);
• decrease in saturation of transferrin with iron (norm - 30%).

For effective treatment of iron deficiency anemia, it is important to establish the cause that caused it. In order to detect the source of chronic blood loss, the following is indicated:

• FEGDS;
• radiography of the stomach with contrast;
• colonoscopy;
• irrigoscopy;
• ultrasound examination of the pelvic organs;
• stool examination for occult blood.

According to statistics, 8-10% of women of childbearing age are diagnosed with iron deficiency anemia, and 30% of women have latent iron deficiency.

In difficult diagnostic cases, a puncture of the red bone marrow is performed, followed by a histological and cytological examination of the resulting punctate. A significant decrease in sideroblasts in it indicates the presence of iron deficiency anemia.

Differential diagnosis is carried out with other types of hypochromic anemia (thalassemia, sideroblastic anemia).

Treatment

Principles of treatment of iron deficiency anemia:

• elimination of the source of chronic blood loss;
• diet correction;
• replenishment of iron deficiency.

Diet plays an important role. The diet includes tongue, liver, rabbit meat, lamb, beef, veal - foods rich in heme iron. To improve the absorption of iron from the gastrointestinal tract, ascorbic, succinic and citric acids are needed, which are found in large quantities in fresh fruits and berries. Exclude chocolate, milk, soy protein, tea, coffee, as they inhibit the absorption of iron.

But it is impossible to compensate for the already formed iron deficiency with diet alone. Patients with iron deficiency anemia undergo replacement therapy with ferropreparations for a long course (at least 2-2.5 months).

In severe iron deficiency anemia and severe circulatory-hypoxic syndrome, there are indications for blood transfusion.

Possible complications and consequences

Circulatory-hypoxic disorders arising against the background of iron deficiency anemia worsen the course of concomitant diseases of the cardiovascular and respiratory systems.

In iron deficiency states, there is a decrease in IgA activity; as a result, patients often develop intestinal and respiratory infections.

Against the background of a long course of a severe form of iron deficiency anemia, patients may develop myocardial dystrophy.

Forecast

The prognosis is favorable, provided that iron deficiency is corrected in a timely manner and the cause of anemia is eliminated.

Prevention

Prevention of iron deficiency anemia includes:

• complete rational nutrition;
• annual monitoring of hemoglobin content in the blood;
• timely elimination of sources of chronic blood loss;
• preventive intake of iron preparations by persons at risk.

Video from YouTube on the topic of the article:

Abundant menstruation - all this can cause iron deficiency in the body. According to some reports, iron deficiency is found in a quarter of the world's population. Why iron deficiency anemia occurs, how it manifests itself and how it is treated, we will tell in this article.

What role does iron play in the human body?

Iron is an integral part of hemoproteins, the main task of which is the transport of gases.
Hemoglobin in erythrocytes brings oxygen to the tissues and takes out carbon dioxide.
myoglobin in skeletal muscle and myocardial cells, it transports oxygen into the cell and participates in cellular respiration.
cytochrome oxidase in the mitochondria of the cell is involved in the utilization of oxygen.
catalase regulates the content of hydrogen peroxide in erythrocytes, preventing cell breakdown in its excess.
The same function in the mucosa of the small intestine and leukocytes is performed by peroxidase.

How does iron get into the body?

Iron enters the human body mainly with food. Especially a lot of it is contained in meat, and from it this microelement is most well absorbed.

With food, mainly of animal origin, iron enters the intestines.
The mucous membrane of the duodenum and jejunum captures iron and transfers it to the blood vessels.
Iron enters into an unstable combination with the blood transport protein - transferrin and is evacuated to tissues - mainly the spleen, liver, muscles and bone marrow.
In tissues, iron binds to proteins, turning into hemoglobin (70% iron), myoglobin, cytochromes, etc. (0.6% iron), and in excess - into ferritin or hemosiderin (reserve iron - 30%).

What causes iron deficiency?

1) Blood loss:

• abundant prolonged menstruation, childbirth, abortion;
• chronic bleeding in the gastrointestinal tract;
• nosebleeds;
• donation;
• hematuria.

2) Reduced intake of iron in the body:

• starvation;
• strict posts;
• vegetarianism.

3) Malabsorption

• enteritis;
• resection of the stomach and intestines.

4) Violation of transport:

• loss of transferrin in massive proteinuria (eg, glomerulonephritis with nephrotic syndrome);
• congenital transferrin deficiency.

5) Increased need for iron:

• pregnancy;
• lactation;
• period of growth and puberty.

How does iron deficiency manifest itself?

1) Anemia.

The synthesis of hemoglobin is disrupted and its amount in the blood decreases.

• With a mild degree - up to 90-110g / l;
• with moderate severity - up to 70-90g / l;
• with a severe degree - less than 70 g / l.

There may be complaints of shortness of breath, palpitations, dizziness and headache, drowsiness and general weakness.

2) Sideropenia

• The skin is dry, pale and sallow, dull hair, early gray hair, flat nails, cracks in the corners of the mouth and on the tongue.
• Atrophic gastritis, choking on swallowing.
• Muscle weakness, weakness of the sphincters (urinary incontinence).
• Perversion of taste and smell (for example, begins to like the taste of chalk and the smell of gasoline).
• Violation of immunity, especially antiviral, frequent colds.
• Swelling of the legs.
• Decreased memory and attention.
• Slight rise in temperature.

How does anemia develop?

Stage 1: the body mobilizes the iron reserve. There is no anemia, no complaints, a ferritin deficiency can be detected during the study.
Stage 2: tissue and transport iron is mobilized, hemoglobin synthesis is preserved. There is no anemia, dry skin, muscle weakness, dizziness, signs of gastritis appear. The examination reveals a deficiency of serum iron and a decrease in transferrin saturation.
Stage 3. All funds suffer. Anemia appears, the amount of hemoglobin decreases, and then erythrocytes.

How is iron deficiency anemia treated?

Iron preparations are an integral part of the complex treatment of iron deficiency anemia.

1. First of all, the cause must be eliminated. Continued bleeding will negate the effect of taking iron supplements. Therefore, with uterine bleeding, women, first of all, need to be examined and treated by a gynecologist, with nosebleeds - an ENT consultation, recurrent hemorrhoids - an occasion to meet with a surgeon, and if the reason is unclear, it is necessary to carefully examine the gastrointestinal tract (ultrasound, FGDS, radiography stomach and intestines, sigmoidoscopy).
2. Diet. Contrary to popular belief, iron is best absorbed not from apples, buckwheat and walnuts, but from meat, especially veal. There is also a lot of iron in by-products (liver, kidneys), but there it is contained in the form of ferritin and hemosiderin, which are also not absorbed very well.
3. Iron preparations. If there is no exacerbation of peptic ulcer, indomitable vomiting, a significant part of the small intestine is not removed, it is better to drink medicines containing iron, and not to receive them in the form of injections. There are saline (sorbifer, ferrogradum, totem, and so on) and non-ionic (maltofer, ferlatum or ferrum-lek) preparations. The effectiveness of both groups is approximately the same, but non-ionic ones have fewer side effects (and these are nausea, vomiting, stool disturbance and black staining of teeth) and a lower risk of poisoning in case of accidental overdose.
4. Phytotherapy. It is quite acceptable as an adjunct to treatment, but will not replace iron supplements. Nettle is most often used in the collections - it increases blood clotting and reduces bleeding; strawberries - the microelements included in its composition stimulate hematopoiesis; rose hips - contain a large amount of vitamin C, which improves the absorption of iron. For the same purpose, beet juice, pomegranate, black currant juice is used.

How long do I need to take iron supplements?

If the treatment is effective, then on the 10-12th day the number of young erythrocytes - reticulocytes - sharply increases in the blood.
After 3-4 weeks, hemoglobin rises.
Complaints disappear after 1.5-2 months.
Iron deficiency in tissues can be eliminated only after 3 months of continuous intake of iron preparations - this is how long the course of treatment should continue.

Thus, iron deficiency anemia is a common and well-studied, but not harmless disease. A low hemoglobin level is just the tip of the iceberg, under which serious tissue changes associated with iron deficiency are hidden. Fortunately, modern drugs can eliminate these problems - provided that the treatment is carried out to the end, and the causes, if possible, are eliminated.

Which doctor to contact

If you suspect anemia, you need to contact a therapist and take a blood test. In severe anemia, the patient will be referred for a consultation with a hematologist. In order to eliminate the cause of anemia, an examination by a gastroenterologist, gynecologist, ENT doctor, proctologist is prescribed. In the examination of patients with iron deficiency anemia, an endoscopist plays an important role, because it is endoscopy that helps to identify the source of blood loss.

Weakness, dizziness and fatigue are constant companions for many. And no wonder: according to statistics, almost a quarter of the world's population is prone to iron deficiency anemia (IDA). What are the causes of the disease, how to identify it in yourself and is it treatable?

Definition of IDA

Anemia or anemia is a condition of the body in which the level of erythrocytes in the blood and / or hemoglobin in erythrocytes is below normal. Violations of this kind interfere with the vital process of gas exchange in tissues, since red blood cells transport oxygen or carbon dioxide combined with hemoglobin. Erythrocytes, or red blood cells, can take oxygen at lightning speed thanks to the iron in hemoglobin. They create an unstable bond, which allows it to be delivered to the organs, changing to carbon dioxide. If there is not enough iron, gas exchange is disturbed. This is called iron deficiency anemia or anemia.

This pathological condition is not an independent disease. Therefore, in order to return the levels of iron in the blood to normal, it is necessary to determine the cause of its deficiency.

Causes of iron deficiency anemia

First of all, you need to figure out why iron deficiency anemia has appeared or may occur. This will determine the path of treatment and prevention. Apart from rare genetic disorders, there are four main causes of iron deficiency:

• lack of iron in the diet;
• absorption problems;
• increased consumption of iron by the body;
• blood loss.

The first reason most often occurs in those whose lifestyle implies a meager or vegetarian diet. It is meat products that contain iron, which is better and faster absorbed in the body. Therefore, completely eliminating meat from the diet, you will have to look for an additional source of essential trace elements. In addition, some foods, such as milk, can interfere with iron absorption.

The second reason arises as a consequence of problems with the gastrointestinal tract. Iron, which enters the body through food, will only be beneficial if it reaches the small intestine unhindered - there it will combine with protein and, thanks to this, can be absorbed. Inflammation, ulcers, scars, bariatric surgery - all this prevents the absorption of essential trace elements.

There are a number of diseases and procedures that can lead to poor absorption of iron. These include:

Some medicines and products can disrupt the absorption of iron during its normal intake. These include calcium supplements, proton pump blockers, drugs that reduce the acidity of gastric juice. Of the products, strong tea and coffee can damage, since they contain substances that create strong compounds with iron and prevent it from being absorbed. In addition, those who do not want to interfere with the absorption of iron should limit their milk intake.

At certain periods of life, the need for iron increases. These stages include pregnancy and childhood, when the body grows especially rapidly. As for the first, almost half of women have an iron deficiency even before pregnancy - this is due to the physiology of the body, in particular, blood loss during menstruation. Moreover, women tend to limit their diet due to the desire to lose weight, thinking about kilograms, not about iron.

During pregnancy, the volume of blood in the body increases by 30-40%. This is because the uterus is enlarged and requires more blood supply. In order for the body to provide such production and supply all organs and tissues with oxygen in a timely manner, 30 mg of iron is needed instead of the usual 15-20. Read more about iron deficiency anemia during pregnancy -.

Similar needs in children during the period of active growth. If the mother of the baby took enough iron when she was pregnant and breastfeeding, then in the period from 3-6 months of life, he will need iron. If the mother suffered from anemia, even in a mild stage, even earlier.

If the results of the tests showed a level below the norm, you should not immediately give the child iron supplements. If, with its indicators, the baby does not have other symptoms of IDA, but remains ruddy and mobile, it is better to simply adjust the diet. Otherwise, you can overdo it and create an excess of iron.

Another cause of iron deficiency is blood loss. This is not only about the large losses that are likely with serious injuries and large burns. For iron deficiency anemia, a little bleeding for some time is enough. In total, 15 ml of blood contains the amount of iron that is absorbed by the body per day. Therefore, if you lose this or even less volume of blood every day, this will lead to depletion of iron stores and anemia.

Such losses include bleeding from ulcers, erosion and varicose veins of the stomach or duodenum. They are usually small but long lasting. This includes nosebleeds, hemorrhoids, heavy menstruation and uterine bleeding.

In order to timely identify iron deficiency anemia in yourself, you need to know the symptoms of this pathology.

Symptoms, signs at various stages of development

Like all other types of anemia, iron deficiency has 3 degrees of severity in terms of grams of hemoglobin per liter. Mild anemia is considered to be at least 90 g / l, medium - at least 70 g / l, and severe - below 70. However, the picture of manifestations looks different, and often the state of health does not correspond to the severity. According to the symptoms, anemia can be divided into five stages.

First stage

Has no noticeable symptoms. This usually corresponds to 110 g/l.

Second stage

Accompanied by a growing feeling of fatigue, which does not leave for a long time. Along with this, the pallor of the visible mucous membranes and skin becomes apparent. No wonder in the Middle Ages this disease was called "pale sickness" or "chlorosis", which means "pale green". Both of these names clearly describe the appearance of the patient.

Third stage

It is already considered severe and requires treatment from specialists. To the above symptoms, dizziness and tinnitus are added. A person gets tired even with small loads, while appetite disappears. Despite fatigue and drowsiness, sleep problems begin: it is difficult to fall asleep or causeless awakenings at night. The patient constantly feels cold and often takes colds, his nails become thin and brittle.

There are oddities in addictions: favorite dishes do not cause appetite, but chalk, lime, ice make you want to gnaw. There is a craving for strong odors, such as kerosene or exhaust gases. Although such addictions can often be heard, all this cannot be called the norm.

Fourth stage

At this stage of iron deficiency anemia, shortness of breath begins even at rest - the body acutely feels a lack of oxygen. Fatigue and drowsiness increase, there are signs of depression and even hallucinations. The skin acquires a bluish tint, which is especially noticeable on the lips and mucous membranes. This condition is considered precoma and requires immediate hospitalization.

Fifth stage

Loss of consciousness, low blood pressure, involuntary urination. There is no reaction to stimuli, that is, reflexes on the limbs. This .

Diagnosis of iron deficiency anemia

Usually, a conversation with a patient is enough for a doctor to suspect anemia. In the conversation, it turns out what symptoms the patient noticed, how long ago they appeared. The doctor may ask about eating habits and chronic diseases. To confirm the doctor's assumption, the patient will need to donate blood for analysis.

First you need a complete blood count. It should not be expected that it will show a decrease in the concentration of red blood cells. With its help, iron deficiency in red blood cells will be detected. This can be determined by their size. Iron deficiency anemia is characterized by microcytosis- a decrease in red blood cells, while in the same person they can be of different sizes - anisocytosis.

Another characteristic of IDA is the color of erythrocyte cells. If this indicator is lower than 0.85, then there is not enough hemoglobin in the blood cells. This condition is called hypochromia, the color of the blood in the smear becomes pale.

After a deficiency of hemoglobin in blood cells is detected, it is necessary to check the process of iron metabolism. Exists iron redistributive anemia: in this case, iron coming from outside accumulates in isolation in reservoir organs. The process of penetration of iron into the blood plasma is disrupted, therefore, erythrocytes cannot "take" it. So there is a lack of iron in the blood with its normal intake and absorption. This type of anemia is the second most common after iron deficiency. It can develop with tuberculosis, inflammation of the liver, rheumatoid arthritis and other diseases.

To distinguish iron deficiency from its redistribution, you need to do a biochemical blood test. If it is indeed IDA, then serum ferritin, serum iron and iron transferrin concentrations will be below normal, and the level of TIBC (the ability of transferrin to bind iron) will be increased. With the accumulation of iron in the depot, the level of ferritin will be increased, the serum iron will remain normal or slightly lower, and the FBC will be normal or slightly lower.

Once the diagnosis has been determined and verified, treatment begins. First of all, you need to get rid of the cause: bleeding, injury or disease.

Medical treatment

The next step is taking iron supplements. The body does not produce it, it must come from outside, while it is necessary to make up for the already existing shortage. First, ferrous salts are taken: sulfates, fumarates and gluconates. You should not start immediately with trivalent salts - they may be ineffective.

The drugs are taken in the form of tablets, and usually the patient's condition improves quickly, in contrast to the results of his tests. The increase in hemoglobin will have to wait up to six weeks. The course of treatment is usually designed for six months, if the cause has been eliminated. If this is not possible, the tablets must be taken throughout life.

If the daily dose causes side effects, you can reduce it until it stops causing a violent reaction in the body. At the same time, it is worth proportionally increasing the duration of the intake: for example, if instead of a whole capsule you drink half, then the course will not be three months, but six.

Read more about drugs for iron deficiency anemia -.

Diet for iron deficiency anemia

Contrary to popular belief, IDA is not treated alone. Even with the most optimal nutrition, it is possible to absorb only 10 mg of iron per day, and the therapeutic dose for anemia exceeds this amount by 10 times.

The correct "iron" menu will be an additional help for the body. Iron is well absorbed on an empty stomach in an acidic environment, poorly - with milk, fats and tea. So, you should not combine foods rich in iron with them.

It is necessary to include meat, fish, eggs in your diet. Iron from such products is called heme, and is absorbed 2-4 times better than from plant sources. Although pork and beef liver are considered leaders among meat products in this area, they should not be consumed with IDA, as they contain iron in a form that is poorly absorbed. It is better to give preference to rabbit meat, veal, boiled beef tongue and turkey.

It will be right to add vegetables and greens to them, for example, spinach, cabbage and legumes. In addition to the necessary element, they contain acids that promote its absorption, and green vegetables contain chlorophyll - this element is chemically very similar to hemoglobin.

As a snack, nuts, raisins, peaches and apples are ideal, and for drinks - freshly squeezed fruit juices.

You need to pay attention to the cooking process - the longer it is thermally processed, the less likely it is to find something useful in it.

Traditional medicine pays attention to herbs. Ginseng, cinnamon, anise and mint improve iron absorption. And thanks to onions and garlic, iron from cereal products is absorbed 70% better.

Prevention of iron deficiency anemia

To prevent a large loss of iron, you need to follow a few simple principles:

• First, the greater the load on the body and the possible loss of blood (for example, during menstruation), the more iron-rich the food should be.
• Secondly, regular check-ups. This will help prevent the development of diseases that can lead to various consequences, among them IDA.
• Thirdly, if a course of the drug is prescribed, it must be drunk completely and to the end. Relief comes quickly, and the temptation to quit, forget or save on treatment will be great, but this should not be allowed. Otherwise, the pathology will return to the asymptomatic stage and the condition will slowly worsen.

Video about iron deficiency anemia

The doctor tells more about the disease, its causes, symptoms, diagnosis and treatment in this video:

ZHDA is quite possible to win and keep under control. You just need to monitor your condition, undergo simple examinations and a relatively inexpensive course of treatment. This will not only restore order in the body, but also get rid of chronic fatigue, problems with sleep and appetite, in order to enjoy life to the fullest again.

Anemia is considered one of the most common pathological conditions among the world's population. Among the varieties of anemia, there are several main conditions, classifying them according to the causes of anemia:

• Iron-deficiency anemia;
• hemolytic anemia;
• aplastic anemia;
• sideroblastic type of anemia;
• B12-deficient, resulting from vitamin B12 deficiency;
• posthemorrhagic anemia;
• sickle cell anemia and other forms.

Approximately every fourth person on the planet, in accordance with the research of specialists, suffers from an iron deficiency form of anemia due to a decrease in the concentration of iron. The danger of this condition is in the erased clinical picture of iron deficiency anemia. Symptoms become pronounced when the level of iron and, accordingly, hemoglobin drops to a critical level.

The risk groups for developing anemia in adults include the following categories of the population:

• followers of vegetarian principles of nutrition;
• people suffering from blood loss due to physiological causes (heavy menstruation in women), diseases (internal bleeding, severe stages of hemorrhoids, etc.), as well as donors who donate blood and plasma on a regular basis;
• pregnant and lactating women;
• professional athletes;
• patients with chronic or acute forms of certain diseases;
• categories of the population experiencing malnutrition or a limited diet.

The most common form of iron deficiency anemia is due to a lack of iron, which in turn can be triggered by one of the following factors:

• insufficiency of iron intake with food;
• increased need for iron due to situational or individual characteristics (developmental pathologies, dysfunctions, diseases, physiological conditions of pregnancy, lactation, professional activity, etc.);
• increased loss of iron.

Mild forms of anemia, as a rule, can be cured by correcting the diet, prescribing vitamin-mineral complexes, and iron-containing preparations. The moderate and severe form of anemia requires the intervention of a specialist and a course of appropriate therapy.

Causes of anemia in men

Anemia in women

Anemia in women is diagnosed when hemoglobin levels are below 120 g / l (or 110 g / l during childbearing). Physiologically, women are more prone to anemia.
With monthly menstrual bleeding, the female body loses red blood cells. The average volume of monthly blood loss is 40-50 ml of blood, however, with heavy menstruation, the amount of discharge can reach up to 100 ml or more over a period of 5-7 days. Several months of such regular blood loss can lead to the development of anemia.
Another form of occult anemia, common among the female population with a high frequency (20% of women), is provoked by a decrease in the concentration of ferritin, a protein that stores iron in the blood and releases it when hemoglobin levels decrease.

Anemia in pregnancy

Anemia in pregnant women occurs under the influence of various factors. The growing fetus removes from the maternal bloodstream substances necessary for development, including iron, vitamin B12, folic acid, necessary for the synthesis of hemoglobin. With insufficient intake of vitamins and minerals with food, violations of its processing, chronic diseases (hepatitis, pyelonephritis), severe toxicosis of the first trimester, as well as with multiple pregnancy, anemia develops in the expectant mother.
Physiological anemia of pregnant women includes hydremia, “thinning” of the blood: in the second half of the gestational period, the volume of the liquid part of the blood increases, which leads to a natural decrease in the concentration of red blood cells and the iron transported by them. This condition is normal and is not a sign of pathological anemia if the hemoglobin level does not fall below 110 g / l or recovers on its own in a short time, and there are no signs of vitamin and microelement deficiency.
Severe anemia in pregnant women threatens with miscarriage, premature birth, toxicosis of the third trimester (preeclampsia, preeclampsia), complications of the delivery process, as well as anemia in the newborn.
The symptoms of anemia in pregnant women include the general clinical picture of anemia (fatigue, drowsiness, irritability, nausea, dizziness, dry skin, brittle hair), as well as perversions of smell and taste (the desire to eat chalk, plaster, clay, raw meat, sniff substances with a sharp smell among household chemicals, building materials, etc.).
Slight anemia of pregnant and lactating women recovers after childbirth and the end of the lactation period. However, with a short interval between repeated births, the process of restoring the body does not have time to complete, which leads to increased signs of anemia, especially pronounced when the interval between births is less than 2 years. The optimal recovery period for the female body is 3-4 years.

Anemia during lactation

According to the research of specialists, lactation anemia is most often diagnosed at a fairly pronounced stage of the disease. The development of anemia is associated with blood loss during delivery and lactation against the background of a hypoallergenic diet of nursing. By itself, the production of breast milk does not contribute to the development of anemia, however, if some important food groups are excluded from the diet, for example, legumes (due to the risk of increased gas formation in the child), dairy and meat products (due to allergic reactions in the infant) the likelihood of developing anemia increases significantly.
The reason for the late diagnosis of postpartum anemia is considered to be a shift in the focus of attention from the state of the mother to the child, especially in the youngest mother. The health features of the baby excite her more than her well-being, and the symptom complex of anemia - dizziness, fatigue, drowsiness, decreased concentration, pallor of the skin - are most often perceived as a result of overwork associated with caring for a newborn.
Another reason for the prevalence of iron deficiency anemia in nursing is associated with the wrong opinion about the effect of iron preparations that penetrate into breast milk on the functioning of the infant's gastrointestinal tract. This opinion is not confirmed by specialists, and, when diagnosing iron deficiency anemia, medicines and vitamin-mineral complexes prescribed by a specialist are mandatory.

Anemia of the menopause

Anemia during the female menopause is quite common. Hormonal restructuring, the consequences of the period of menstruation, gestation, childbirth, various dysfunctional conditions and surgical interventions cause chronic anemia, which is aggravated against the background of menopausal changes in the body.
A provocative role is also played by dietary restrictions, unbalanced diets, which are resorted to by women seeking to reduce the rate of weight gain due to fluctuations in hormonal balance in the premenopausal period and directly during menopause.
By the age of menopause, there is also a decrease in ferritin reserves in the body, which is an additional factor in the development of anemia.
Fluctuations in well-being, fatigue, irritability, dizziness are often perceived as symptoms of menopause, which leads to late diagnosis of anemia.

Anemia of childhood

According to research by the World Health Organization (WHO), 82% of children suffer from anemia of varying severity. Low hemoglobin levels and iron deficiency states of various etiologies lead to impaired mental and physical development of the child. The main causes of anemia in childhood include:

The need for iron differs in children depending on age, and after reaching puberty, it correlates with gender. Therapy of deficient anemia in children with a balanced diet is not always effective, so experts prefer regulation with medications that guarantee the intake of the required dose of trace elements in the child's body.

Anemia in infancy

A newborn baby is born with a certain supply of iron obtained from the mother's body during fetal development. The combination of imperfection of one's own hematopoiesis and rapid physical growth lead to a physiological decrease in the level of hemoglobin in the blood in healthy children born on time by 4-5 months of life, in premature babies - by the age of 3 months.
Artificial and mixed feeding are considered risk factors that increase the likelihood of developing anemia. Hemoglobin deficiency develops especially rapidly when replacing breast milk and / or artificial mixtures with cow's, goat's milk, cereals and other products in the period up to 9-12 months.
Symptoms of anemia in children under one year old include:

• pallor of the skin, since the skin is still very thin, there is an increased "transparency", "cyanosis" of the skin;
• anxiety, causeless crying;
• sleep disorders;
• loss of appetite;
• hair loss outside the physiological framework of the change of hairline;
• frequent regurgitation;
• low weight gain;
• lagging behind first in physical, then in psycho-emotional development, a decrease in interest, the lack of expression of the revitalization complex, etc.

A feature of children of this age is the ability for high (up to 70%) absorption of iron from food, therefore, not in all cases of anemia, pediatricians see the need for prescribing drugs, limiting themselves to correcting the child’s diet, transferring to full breastfeeding, and selecting a substitute mixture that meets the needs. With a pronounced degree of anemia, iron preparations are prescribed in an age dosage, for example, Ferrum Lek or Maltofer in the form of syrup drops.
When diagnosing a pronounced degree of anemia, the causes may not be in the diet, but in diseases, pathologies and dysfunctions of the child's body. Anemia can also be caused by hereditary diseases, some hereditary developmental disorders and diseases are characterized by a decrease in iron concentration, erythrocytopenia, insufficiency of the hematopoietic system, etc. With persistently low hemoglobin levels, a mandatory examination of children and correction of the primary disease are necessary.

Anemia in preschool children

A large-scale study conducted in 2010 revealed a high incidence of iron deficiency anemia in preschool children: every second child suffers from a lack of hemoglobin due to low iron levels. There may be various factors in the etiology of this phenomenon, but the most common is the consequences of uncorrected anemia in the first year of life.
The second factor that provokes anemia in preschoolers is often combined with the first. An insufficiently balanced diet, a lack of protein (meat products) and vitamins (vegetables) is often explained by the child's reluctance to eat meat and vegetables, preferring semi-finished products and sweets. It is purely a matter of educating and focusing parents on a healthy diet without providing alternative foods from an early age, which also requires the transfer of family members to a rationally formulated diet.
In the case when the nutrition corresponds to age norms, and the child shows signs of anemia (pallor, dry skin, fatigue, decreased appetite, increased fragility of the nail plates, etc.), an examination by a specialist is necessary. Despite the fact that in 9 out of 10 preschool children diagnosed with anemia it is due to iron deficiency, in 10% of anemia the cause is in diseases and pathologies (celiac disease, leukemia, etc.).

Anemia in children of primary school age

The norms of hemoglobin content in the blood in children 7-11 years old are 130 g / l. Manifestations of anemia in this age period increase gradually. The signs of developing anemia include, in addition to the symptoms of anemia in preschoolers, decreased concentration, frequent acute respiratory viral and bacterial diseases, increased fatigue, which can affect the results of educational activities.
An important factor in the development of anemia in children attending educational institutions is the lack of control over the diet. In this age period, there is still a sufficient level of iron absorption from the food entering the body (up to 10%, decreasing by the age of an adult to 3%), therefore, the prevention and correction of the iron deficiency type of anemia is a properly organized meal with dishes rich in vitamins and microelements based on it. .
Hypodynamia, limited stay in the fresh air, preference for games in the house, especially with tablets, smartphones, etc., dictating a long stay in a static position, also provoke anemia.

Anemia of puberty

Adolescence is dangerous for the development of anemia, especially in girls with the onset of menstruation, characterized by a periodic decrease in hemoglobin with blood loss. The second factor that provokes the onset of anemia in adolescent girls is associated with a concentration on one's own appearance, the desire to follow various diets and reduce the daily diet, and the exclusion of products necessary for health.
Rapid growth rates, intensive sports, malnutrition and anemia of the previous period also affect adolescents of both sexes. Symptoms of anemia of adolescence include a blue tint of the sclera of the eyes, a change in the shape of the nails (cup-shaped form of the nail plate), dysfunction of the digestive system, disturbances in taste, smell.
Severe forms of the disease in adolescence require drug therapy. A change in the blood formula is noted, as a rule, not earlier than 10-12 days after the start of the course of treatment, signs of clinical recovery, subject to the specialist's prescriptions, are observed after 6-8 weeks.

Causes of anemia

Anemia is characterized by a decrease in the concentration of hemoglobin and red blood cells in a unit of blood. The main purpose of erythrocytes is participation in gas exchange, transport of oxygen and carbon dioxide, as well as nutrients and metabolic products to cells and tissues for further processing.
The red blood cell is filled with hemoglobin, a protein that gives red blood cells and blood their red color. The composition of hemoglobin includes iron, and therefore its lack in the body causes a high incidence of iron deficiency anemia among all varieties of this condition.
There are three main factors in the development of anemia:

• acute or chronic blood loss;
• hemolysis, destruction of red blood cells;
• decreased production of red blood cells by the bone marrow.

According to the variety of factors and causes, the following types of anemia are distinguished:

The classification of an anemic state is based on various signs describing the etiology, mechanisms of the development of the disease, the stage of anemia, and diagnostic parameters.

Classification according to the severity of the condition

The severity of anemia is based on blood tests and depends on age, gender and physiological period.
Normally, in a healthy adult male, hemoglobin levels are 130-160 g / l of blood, in a woman - from 120 to 140 g / l, during the gestation period from 110 to 130 g / l.
A mild degree is diagnosed when the level of hemoglobin concentration drops to 90 g / l in both sexes, with an average indicator corresponding to the range from 70 to 90 g / l, a severe degree of anemia is characterized by a decrease in hemoglobin levels below the limit of 70 g / l.

Classification of varieties according to the mechanism of state development

In the pathogenesis of anemia, three factors are observed that can act individually or together:

• blood loss of an acute or chronic nature;
• disorders of the hematopoietic system, production of red blood cells by the bone marrow (iron deficiency, renal, aplastic anemia, deficiency anemia with a lack of vitamin B12 and / or folic acid);
• increased destruction of erythrocytes before the end of the functioning period (120 days) due to genetic factors, autoimmune diseases.

Classification by color index

The color indicator serves as an indicator of the saturation of red blood cells with hemoglobin and is calculated using a special formula in the blood test process.
A hypochromic form with a weakened color of erythrocytes is diagnosed with a color index below 0.80.
The normochromic form, with a color index within the normal range, is determined by the range of 0.80-1.05.
The hyperchromic form, with excessive hemoglobin saturation, corresponds to a color index above 1.05.

Classification by morphological feature

The size of red blood cells is an important indicator in diagnosing the cause of anemia. Different sizes of red blood cells may indicate the etiology and pathogenesis of the condition. Normally, red blood cells are produced with a diameter of 7 to 8.2 micrometers. The following varieties are distinguished on the basis of determining the size of the prevailing number of red blood cells in the blood:

• microcytic, erythrocyte diameter less than 7 microns, indicates a high probability of iron deficiency;
• normocytic variety, the size of red blood cells is from 7 to 8.2 microns. Normocytosis is a sign of the posthemarogic form;
• macrocytic, with a red blood cell size of more than 8.2 and less than 11 microns, as a rule, indicates a deficiency of vitamin B12 (pernicious form) or folic acid;
• megalocytosis, megalocytic (megaloblastic) form, in which the diameter of red blood cells is more than 11 microns, corresponds to the severe stages of some forms, disorders in the formation of red blood cells, etc.

Classification based on the assessment of the ability of the bone marrow to regenerate

The degree of erythropoiesis, the ability of the red bone marrow to form erythrocytes, is assessed by the quantitative index of reticulocytes, progenitor cells or "immature" erythrocytes, which is considered the main criterion in assessing the ability of bone marrow tissues to regenerate and is an important factor for predicting the patient's condition and choosing methods of therapy . The normal concentration of reticulocytes is an indicator of 0.5-1.2% of the total number of red blood cells per unit of blood.
Depending on the level of reticulocytes, the following forms are distinguished:

• regenerative, indicating the normal ability of the bone marrow to recover. The level of reticulocytes is 0.5-1.2%;
• hyporegenerative, with a concentration of immature erythrocytes below 0.5%, which indicates a reduced ability of the bone marrow to self-repair;
• hyperregenerative, reticulocyte count more than 2%;
• aplastic anemia is diagnosed when the concentration of immature erythrocytes is less than 0.2% among the mass of all red blood cells and is a sign of a sharp suppression of the ability to regenerate.

Iron deficiency anemia (IDA)

The iron deficiency form accounts for up to 90% of all types of anemic conditions. According to research by the World Health Organization, this form affects one in 6 men and every third woman in the world.
Hemoglobin is a complex protein compound containing iron, capable of reversible bonding with oxygen molecules, which is the basis for the process of transporting oxygen from the lungs to body tissues.
The iron deficiency form is hypochromic anemia, with signs of microcytosis, the presence of erythrocytes with a diameter less than normal in the blood formula, which is associated with iron deficiency, the basic element for the formation of hemoglobin, which fills the erythrocyte cavity and gives it a red color.
Iron is a vital trace element involved in many metabolic processes, nutrient metabolism, and gas exchange in the body. During the day, an adult consumes 20-25 mg of iron, while the total supply of this element in the body is about 4 g.

Reasons for the development of IDA

The reasons for the development of this form of the condition include factors of various etiologies.
Iron intake disorders:

• unbalanced diet, strict vegetarianism without compensation for iron-containing products, starvation, diets, taking medications, narcotic and other substances that suppress hunger, appetite disorders due to diseases of physical or psycho-emotional etiology;
• socio-economic causes of malnutrition, lack of food.

Violations of the process of absorption, assimilation of iron:

• diseases of the gastrointestinal tract (gastritis, colitis, gastric ulcer, resection of this organ).

Imbalance of consumption and intake of iron due to increased needs of the body:

• pregnancy, lactation;
• age of pubertal jumps in physical growth;
• chronic diseases that provoke hypoxia (bronchitis, obstructive pulmonary disease, heart defects and other diseases of the cardiovascular system and respiratory organs);
• diseases accompanied by purulent-necrotic processes: sepsis, tissue abscesses, bronchiectasis, etc.

Loss of iron by the body, acute or chronic post-hemorrhagic:

• with pulmonary bleeding (tuberculosis, tumor formations in the lungs);
• with gastrointestinal bleeding accompanying gastric ulcer, duodenal ulcer, cancer of the stomach and intestines, severe erosion of the gastrointestinal mucosa, varicose veins of the esophagus, rectum, hemorrhoids, helminthic invasion of the intestine, ulcerative colitis and others;
• with uterine bleeding (heavy menstruation, cancer of the uterus, cervix, fibroids, placental abruption in the gestational period or in childbirth, ectopic pregnancy during exile, birth trauma of the uterus and cervix);
• bleeding with localization in the kidneys (tumor formations in the kidneys, tuberculous changes in the kidneys);
• bleeding, including internal and hidden, due to injuries, blood loss from burns, frostbite, during planned and emergency surgical interventions, etc.

IDA symptoms

The clinical picture of the iron deficiency form is anemic and sideropenic syndrome, caused primarily by insufficient gas exchange in the tissues of the body.
Symptoms of anemic syndrome include:

• general malaise, chronic fatigue;
• weakness, inability to endure prolonged physical and mental stress;
• attention deficit disorder, difficulty concentrating, rigidity;
• irritability;
• headache;
• dizziness, sometimes fainting;
• drowsiness and sleep disturbances;
• shortness of breath, rapid heart rate both during physical and / or psycho-emotional stress, and at rest;
• black color of the stool (with bleeding of the gastrointestinal tract).

Sideropenic syndrome is characterized by the following manifestations:

• perversion of taste preferences, craving for eating chalk, clay, raw meat, etc.;
• distortion of smell, desire to sniff paint, household chemicals, substances with a pungent odor (acetone, gasoline, washing powder, etc.);
• fragility, dry hair, lack of shine;
• white spots on the nail plates of the hands;
• dry skin, peeling;
• pallor of the skin, sometimes blueness of the sclera;
• the presence of cheilitis (cracks, "zayed") in the corners of the lips.

In severe stages of IDA, neurological symptoms are noted: sensations of "goosebumps", numbness of the extremities, difficulty in swallowing, weakening of bladder control, etc.

Diagnosis of IDA

The diagnosis of "iron deficiency anemia" is based on external examination data, evaluation of the results of laboratory blood tests and instrumental examination of the patient.
During an external medical examination and anamnesis, attention is paid to the condition of the skin, mucous surfaces of the mouth, corners of the lips, and the size of the spleen is assessed on palpation.
A general blood test in the classical clinical picture of IDA shows a decrease in the concentration of erythrocytes and hemoglobin relative to age and gender norms, the presence of erythrocytes of different sizes (poikilocytosis), reveals microcytosis, the presence, in severe forms, the predominance of red blood cells with a diameter of less than 7.2 microns, hypochromic , weakly expressed color of erythrocytes, low color index.
The results of a biochemical blood test for IDA have the following indicators:

• the concentration of ferritin, a protein that performs the function of an iron depot in the body, is reduced relative to the limits of the norm;
• low serum iron;
• increased iron-binding capacity of blood serum.

Diagnosis of IDA is not limited to the detection of iron deficiency. For effective correction of the condition after collecting anamnesis, the specialist, if necessary, prescribes instrumental studies in order to clarify the pathogenesis of the disease. Instrumental studies in this case include:

• fibrogastroduodenoscopy, examination of the condition of the mucosa of the esophagus, walls of the stomach, duodenum;
• ultrasound examination of the liver, kidneys, female reproductive organs;
• colonoscopy, examination of the walls of the large intestine;
• methods of computed tomography;
• x-ray examination of the lungs.

Treatment of anemia of iron deficiency etiology

Depending on the stage and pathogenesis of IDA, therapy is chosen with the help of diet correction, a drug course of treatment, surgical intervention to eliminate the causes of blood loss, or a combination of methods.

Therapeutic diet for iron deficiency

Iron that enters the body with food is divided into heme, animal origin, and non-heme iron of plant origin. The heme variety is much better absorbed and its lack in nutrition, for example, in vegetarians, leads to the development of IDA.
Products recommended for correcting iron deficiency include the following:

• heme group in descending order of the amount of iron: beef liver, beef tongue, rabbit meat, turkey meat, goose meat, beef, some varieties of fish;
• non-heme group: dried mushrooms, fresh peas, buckwheat, oats and oats, fresh mushrooms, apricots, pears, apples, plums, cherries, beets, etc.

Despite the seemingly high content of iron in vegetables, fruits, and products of plant origin when studying the composition, the absorption of iron from them is insignificant, 1-3% of the total volume, especially when compared with products of animal origin. So, when eating beef, the body is able to absorb up to 12% of the necessary element contained in the meat.
When correcting IDA with diet, you should increase the content in the diet of foods rich in vitamin C and protein (meat) and reduce the intake of eggs, salt, caffeinated drinks and foods rich in calcium due to the effect on the absorption of dietary iron.

Medical therapy

In moderate and severe form, a therapeutic diet is combined with the appointment of drugs that supply iron in an easily digestible form. Medicines differ in the type of compound, dosage, form of release: tablets, dragees, syrups, drops, capsules, injection solutions.
Preparations for oral administration are taken one hour before meals or two hours after due to the peculiarities of iron absorption, while it is not recommended to use caffeinated drinks (tea, coffee) as a liquid that facilitates swallowing, as this impairs the absorption of the element. The interval between doses of drugs should be at least 4 hours. Self-administration of medications can cause side effects from an incorrectly selected form or dosage, as well as iron poisoning.
The dosage of drugs and the form of release is determined by the specialist, focusing on the age, stage of the disease, the causes of the condition, the general clinical picture and the individual characteristics of the patient. Doses may be adjusted during the course of treatment based on the results of intermediate or control blood tests and / or the patient's well-being.
Iron preparations in the course of treatment are taken from 3-4 weeks to several months with periodic monitoring of hemoglobin levels.
Among the preparations-suppliers of iron taken orally, there are medicines with two- and three-valent form of iron. For now, according to research, ferrous iron is considered to be the preferred oral form due to its higher absorption capacity and gentler effect on the stomach.
For children, iron-containing products are produced in the form of drops and syrups, which is caused both by age-related characteristics of taking drugs and a shorter course of therapy than in adults, due to the increased absorption of iron from food. If it is possible to take capsules, dragees and tablets, as well as for long courses, preference should be given to solid forms of drugs containing iron, since liquid ones with prolonged use can have a negative effect on tooth enamel and cause it to darken.
The most popular tablet forms include the following medicines: Ferroplex, Sorbifer, Aktiferrin, Totem (ferrous form of iron) and Maltofer, Ferrostat, Ferrum Lek with ferric iron.
Oral forms are combined with vitamin C (ascorbic acid) at the dosage prescribed by the doctor for better absorption.
Intramuscular and intravenous injections of iron preparations are prescribed in limited situations, such as:

• severe stage of anemia;
• ineffectiveness of the course of taking oral forms of drugs;
• the presence of specific diseases of the gastrointestinal tract, in which oral forms may worsen the patient's condition (with acute gastritis, gastric ulcer, duodenal ulcer, ulcerative colitis, Crohn's disease, etc.);
• with individual intolerance to oral forms of iron-containing drugs;
• in situations where there is a need for urgent saturation of the body with iron, for example, with significant blood loss due to trauma or before surgery.

The introduction of iron preparations intravenously and intramuscularly can lead to an intolerance reaction, which is why such a course of therapy is carried out exclusively under the supervision of a specialist in a hospital or clinical setting. Side negative consequences of intramuscular administration of iron-containing fluids include the deposition of hemosiderin subcutaneously at the injection site. Dark spots on the skin at the injection sites can persist from one and a half to 5 years.
Iron deficiency anemia responds well to drug therapy, provided that the prescribed dose and duration of treatment are observed. However, if primary serious diseases and disorders lie in the etiology of the condition, therapy will be symptomatic and have a short-term effect.
To eliminate causes such as internal bleeding, with a hemorrhagic form, iron deficiency anemia is treated with surgical methods. Surgical intervention allows you to eliminate the main factor of acute or chronic bleeding, stop blood loss. With internal bleeding of the gastrointestinal tract, fibrogastroduodenoscopy methods or colonoscopy are used to identify the area of ​​bleeding and measures to stop it, for example, cutting off a polyp, coagulating an ulcer.
With internal bleeding of the peritoneal organs and reproductive organs in women, a laparoscopic method of intervention is used.
The methods of emergency treatment include the transfusion of donor erythrocyte mass to quickly restore the level of concentration of erythrocytes and hemoglobin per unit of blood.
Prevention of the iron deficiency form is considered to be a balanced diet and timely diagnostic and therapeutic measures to maintain health.

Anemia due to deficiency of cobalamin or vitamin B12

Deficiency forms are not limited to iron deficiency anemia. Pernicious anemia is a condition that occurs against the background of malabsorption, its insufficient intake, increased consumption, abnormalities in the synthesis of a protective protein, or liver pathologies that prevent the accumulation and storage of cobalamin. In the ptogenesis of this form, a frequent combination with folic acid deficiency is also noted.
Among the reasons for this deficient form are the following:

The clinical picture of vitamin B12 and folic acid deficiency includes anemic, gastrointestinal and neuralgic syndromes.
The features of the anemic symptom complex in this type of deficiency include such specific symptoms as icterus of the skin and sclera and increased blood pressure. Other manifestations are typical for IDA: weakness, fatigue, dizziness, shortness of breath, rapid heartbeat (situational), tachycardia, etc.
The manifestations associated with the functioning of the gastrointestinal tract include the following symptoms of atrophy of the mucous membranes of the gastrointestinal tract and oral cavity:

• red, "glossy" tongue, often with complaints of a burning sensation on its surface;
• phenomena of aphthous stomatitis, ulceration of the mucous surface of the oral cavity;
• appetite disorders: decrease up to complete absence;
• feeling of heaviness in the stomach after eating;
• weight loss of the patient in the immediate history;
• violations, difficulties in the process of defecation, constipation, pain in the rectum;
• hepatomegaly, enlarged liver.

Neuralgic syndrome with vitamin B12 deficiency consists of the following manifestations:

• feeling of weakness in the lower extremities with severe physical exertion;
• numbness, tingling, "goosebumps" on the surface of the arms and legs;
• decreased peripheral sensitivity;
• atrophy of the muscle tissue of the legs;
• convulsive manifestations, muscle spasms, etc.

Diagnosis of cobalamin deficiency

Diagnostic measures include a general medical examination of the patient, anamnesis, laboratory blood tests and, if necessary, instrumental examination methods.
With a general blood test, the following changes are noted:

• the level of erythrocytes and hemoglobin levels decreased relative to the limits of the age norm;
• hyperchromia, an increase in the color index of the color of erythrocytes;
• macrocytosis of erythrocytes, exceeding their size in diameter of more than 8.0 microns;
• poikilocytosis, the presence of red blood cells of different sizes;
• leukopenia, insufficient concentration of leukocytes;
• lymphocytosis, exceeding the limits of the norms of the level of lymphocytes in the blood;
• thrombocytopenia, insufficient number of platelets per unit of blood.

Biochemical studies of blood samples reveal hyperbilirubinemia and vitamin B12 deficiency.
To diagnose the presence and severity of atrophy of the mucous membranes of the stomach and intestines, as well as to identify possible primary diseases, instrumental methods of examining patients are used:

• fibrogastroduodenoscopy study;
• analysis of biopsy material;
• colonoscopy;
• irrigoscopy;
• Ultrasound of the liver.

Treatment Methods

In most cases, B12-deficiency anemia requires hospitalization or treatment in a hospital setting. For therapy, first of all, a diet with foods saturated with cobalamin and folic acid (liver, beef, mackerel, sardines, cod, cheese, etc.) is prescribed, and secondly, drug support is used.
In the presence of neurological symptoms, injections of Cyancobalamin intramuscularly at an increased dose are prescribed: 1000 mcg daily until the neurological signs of deficiency disappear. In the future, the dosage is reduced, however, with a diagnosis of secondary etiology, the drug is most often prescribed on a lifelong basis.
After discharge from the hospital, the patient is required to undergo regular preventive examinations by a general practitioner, hematologist and gastrologist.

Aplastic anemia: symptoms, causes, diagnosis, treatment

Aplastic anemia can be both congenital and acquired disease, developing under the influence of internal and external factors. The condition itself occurs due to bone marrow hypoplasia, a decrease in the ability to produce blood cells (erythrocytes, leukocytes, platelets, lymphocytes).

Reasons for the development of the aplastic form

In aplastic, hypoplastic forms of anemia, the causes of this condition may be as follows:

• stem cell defect
• suppression of the process of hematopoiesis (hematopoiesis);
• insufficiency of hematopoiesis stimulation factors;
• immune, autoimmune reactions;
• deficiency of iron, vitamin B12 or their exclusion from the process of hematopoiesis due to dysfunctions of hematopoietic tissues and organs.

The development of disorders that provoke an aplastic or hypoplastic form include the following factors:

• hereditary diseases and genetic pathologies;
• taking certain medications from the groups of antibiotics, cytostatics, non-steroidal anti-inflammatory drugs;
• chemical poisoning (benzenes, arsenic, etc.);
• infectious diseases of viral etiology (parvovirus, human immunodeficiency virus);
• autoimmune disorders (systemic lupus erythematosus, rheumatoid arthritis);
• pronounced deficiencies of cobalamin and folic acid in the diet.

Despite the extensive list of causes of the disease, in 50% of cases the pathogenesis of the aplastic form remains unidentified.

Clinical picture

The severity of pancytopenia, a decrease in the number of basic types of blood cells, determines the severity of symptoms. The clinical picture of the aplastic form includes the following signs:

• tachycardia, palpitations;
• pallor of the skin, mucous membranes;
• headache;
• increased fatigue, drowsiness;
• shortness of breath
• swelling of the lower extremities;
• bleeding gums;
• petechial rash in the form of small red spots on the skin, a tendency to easy bruising;
• frequent acute infections, chronic diseases as a result of a decrease in general immunity and leukocyte insufficiency;
• erosion, ulcers on the inner surface of the oral cavity;
• yellowness of the skin, sclera of the eyes as a sign of liver damage that has begun.

Diagnostic procedures

To establish the diagnosis, laboratory methods for studying various biological fluids and tissues and instrumental examination are used.
With a general blood test, a reduced number of erythrocytes, hemoglobin, reticulocytes, leukocytes, and platelets is noted, while the color index and hemoglobin content in erythrocytes correspond to the norm. The results of a biochemical study showed an increase in serum iron, bilirubin, lactate dehydrogenase, saturation of transferrin with iron by 100% of the possible.
To clarify the diagnosis, a histological examination of the material removed from the bone marrow during puncture is carried out. As a rule, according to the results of the study, underdevelopment of all sprouts and replacement of the bone marrow with fat are noted.

Treatment of the aplastic form

This type of anemia cannot be treated with dietary modification. First of all, a patient with aplastic anemia is prescribed a selective or combined intake of drugs from the following groups:

• immunosuppressants;
• glucocorticosteroids;
• immunoglobulins of antilymphocytic and antiplatelet action;
• antimetabolic drugs;
• stimulators of production of erythrocytes by stem cells.

With the ineffectiveness of drug therapy, non-drug methods of treatment are prescribed:

• bone marrow transplant;
• transfusion of erythrocyte, platelet mass;
• plasmapheresis.

Aplastic anemia is accompanied by a decrease in general immunity due to a lack of leukocytes, therefore, in addition to general therapy, an aseptic environment, antiseptic surface treatment, and no contact with carriers of infectious diseases are recommended.
If the above methods of treatment are insufficient, the patient is prescribed a splenectomy operation, removal of the spleen. Since it is in this organ that the breakdown of red blood cells occurs, its removal improves the general condition of the patient and slows down the development of the disease.

Anemia: ways to prevent

The most common form of the disease - iron deficiency anemia - is subject to prevention with a balanced diet with an increase in the amount of iron-containing foods in critical periods. An important factor is also the presence in food of vitamin C, cobalamin (vitamin B12), folic acid.
If you are at risk of developing this form of anemia (vegetarianism, age periods of growth, pregnancy, lactation, prematurity in infants, heavy menstrual bleeding, chronic and acute diseases), regular medical examinations, a blood test for quantitative and qualitative indicators of hemoglobin, erythrocytes and additional taking drugs in accordance with the appointment of specialists.