Federal guidelines for the treatment of pneumonia. community-acquired pneumonia. Clinical guidelines for antibiotic therapy. Recommendations for the treatment of pneumonia in children from pulmonologists at the Yusupov hospital

The most common type of anemia. Manifestations of iron deficiency are present in 60% of the adult population after 50 years. Symptoms of iron deficiency anemia in the latent period are often overlooked or mistaken for other diseases.

The main causes of the disease: chronic bleeding, diseases of the stomach and intestines, lack of iron in food, pregnancy. Treatment requires a long period and medical supervision.

Varieties of symptoms of the disease

With iron deficiency anemia, it is customary to conditionally divide clinical manifestations into 2 classes, depending on the mechanism of pathology:

• signs of tissue oxygen deficiency associated with a drop in hemoglobin levels;
• symptoms of sideropenia (low iron levels in the blood).

Both types of signs of iron deficiency anemia are directly dependent on the degree of iron deficiency.

In the initial stage of the disease, malaise manifests itself only with increased physical activity or hard work, the general working capacity is preserved. Patients describe in more detail the manifestations of the underlying disease, which subsequently causes anemia.

Signs of hypoxia

Tissue hypoxia in anemia can be identified by characteristic features:

• general unmotivated weakness;
• drowsiness;
• dizziness with noise in the head;
• tachycardia and heart rhythm disturbances (in half of the patients);
• dyspnea;
• constant feeling of cold;
• weakness in the muscles of the arms and legs;
• tendency to faint;
• change in character towards irritability and tearfulness.

On examination, the doctor pays attention to the following signs:

• pale skin and mucous membranes (89% of cases);
• swelling of the face and fingers.

Revealed low blood pressure (90/60 and below), frequent pulse (more than 90 per minute), especially with little physical exertion. Auscultation of the heart allows you to hear a typical murmur in the apex (60% of cases).

Signs of sideropenia

The cause of sideropenia is a lack of iron accumulation in tissues and a sharp decrease in the activity of the cytochrome oxidase enzyme, which provides the biochemical process of energy production in cells. The patient is concerned about:

• poor appetite;
• perverted taste and smell (there is a constant desire to eat something inedible, sniff gasoline, acetone) in 19% of patients;
• sore throat when swallowing liquid and solid food (1.3%).

On examination, they reveal:

• dryness and peeling of the skin;
• early wrinkles and aging;
• striated nails with transverse stripes (90% of cases);
• fragility of nails and hair (in 32% of patients);
• increased hair loss on the head;
• weeping painful cracks (jamming) in the corners of the mouth;
• ulcers (aphthae) on the tongue.

The most common manifestation of iron deficiency

Variants of the clinical course of the disease

The clinical course of iron deficiency anemia in adults and children occurs in three ways: in the form of early chlorosis, chronic anemia and anemia during pregnancy.

For early chlorosis is typical:

• initial manifestations are more common in girls in adolescence, since iron deficiency is caused by an increased expenditure on muscle tissue growth and blood loss that has begun during menstruation;
• complaints of young people about frequent constipation and loss of appetite;
• detection in a teenager of pallor, swelling of the skin on the face, arms and legs.

The causes of chronic anemia in men are prolonged hemorrhoidal bleeding of 100 ml or more per day, in women - heavy and prolonged menstruation. Hidden sources of bleeding in the stomach and intestines are possible.

Nosebleeds in vascular diseases, deviated septum, hypertensive crises cannot be excluded from the complex of causes contributing to anemia.

Iron deficiency anemia in pregnant women is formed as a result of uncompensated nutrition: the woman's body gives iron to the fetus, so it must receive more from food. The consumption is especially increased for infectious diseases in pregnant women. Complaints of a hypoxic series of manifestations are typical.

Iron deficiency in children

In the intrauterine period, the fetus takes iron from the mother's body and accumulates it for its development. At birth, the baby has 0.4 g of the mineral (in premature babies, less than 0.1 g). Pediatricians have proven that a newborn up to four months has enough iron that comes with mother's milk. When breastfeeding is interrupted, iron stores are lost. Then it should come with milk mixtures.

Complementary foods must contain all the nutrients

You can suspect the development of iron deficiency anemia in a child by the following symptom complexes:

• irritability,
• tearfulness,
• lag in the development of intelligence,
• tendency to hypotension
• nocturnal enuresis,
• dry skin,
• frequent respiratory diseases,
• unstable chair,
• listening to unclear heart murmurs.

Signs of varying degrees of iron deficiency

There are three stages according to the degree of deficiency. They have characteristic features.

1. The first stage - the deficiency can be judged by the definition of hemosiderin in the bone marrow. It has no clinical manifestations.
2. The second stage (latent) - symptoms are detected only after exercise. In the general blood test, there is already a decrease in the color index, the average volume of erythrocytes. Serum ferritin level is slightly reduced.
3. The third stage (clinical) - all the described symptoms of tissue hypoxia and sideropenia, signs of heart and cerebral insufficiency, urinary incontinence, muscle weakness appear.

Diagnostics

Diagnosis of iron deficiency anemia is based mainly on laboratory tests.

In the general blood test, in addition to hemoglobin and erythrocytes, more subtle indicators are determined, indicating a low saturation of erythrocytes with oxygen, impaired synthesis:

According to biochemical analysis, the ability to accumulate and transfer iron is judged:

• a decrease in serum iron levels is determined;
• decrease in ferritin;
• level of saturation of transferrin with iron;
• latent ability of blood serum to bind iron.

The level of erythropoietin (a hormone that stimulates the production of erythrocyte cells) indicates the processes of compensation for the synthesis of red blood cells.

Conducting a test with Desferal or Defericolixam: normally, with intravenous administration of the drug at a dose of 0.5 g, from 0.8 to 1.2 mg of iron is found in the urine. With iron deficiency anemia, excretion is reduced to 0.2 mg.

To identify hidden sources of chronic blood loss, mandatory esophagogastroscopy and colonoscopy are performed to exclude peptic ulcer disease and tumors.

If any unmotivated weakness, fatigue, dizziness occurs, it is necessary to check the blood test for anemia.

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 the hemoglobin level decreases.

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, when 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. Various factors may be involved 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 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, a sufficient level of iron absorption from food entering the body is still maintained (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 indicators.

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;
• violations of the hematopoietic system, the 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, 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, increase the intake 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 taking 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 medicines 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.
In 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-related 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.

Iron is one of the most common chemical elements on Earth. It takes part in various biological processes and plays an important role in any living organism, including the human one. Therefore, iron deficiency negatively affects a person’s well-being and can lead to such a life-threatening syndrome as iron deficiency anemia (IDA).

Iron deficiency anemia: mechanism of development

The main function of iron (Fe) in the human body is to provide it with oxygen. The excellent oxidizing power of iron is well known. This ability is used by the body to capture and retain oxygen. The mechanism of oxygen transfer to tissues is very complex. The most important role in it is played by the iron-containing protein hemoglobin, which is part of the red blood cells - erythrocytes.

Erythrocytes are the main component of blood. Red blood cells circulate throughout the body and, entering the lungs through the pulmonary circulation, are enriched with oxygen in the alveoli. The bloodstream then delivers red blood cells, and with it oxygen, to the tissues.

There is very little iron in the body - about 4-5 g. And most of it is used in hemoglobin, to carry oxygen. Thus, iron deficiency can lead to the fact that hemoglobin is unable to perform its functions. And this, in turn, leads to a lack of oxygen, which negatively affects the work of all organs and tissues.

This syndrome is called iron deficiency anemia. The term "anemia" in translation means "anemia". However, with iron deficiency anemia, the volume of blood in the body may be within the normal range. Another thing is that the main function of blood - supplying tissues with oxygen, cannot be fully performed.

The metabolism of iron in the body is also very complex. The element enters the body with food, but only a very small part of it is absorbed. In total, the body should receive 2-2.5 mg of Fe per day. The largest part is immediately sent to the bone marrow, where new red blood cells are formed. Partially, the element is also consumed by other tissues.

The remaining share is set aside in reserve. The main stores of iron are found in the liver. The accumulation of the element in the body begins even in the prenatal period. However, the liver contains only a small part of iron, most of it circulates in the blood. However, if there is a lack of iron, then the body replenishes the element at the expense of the liver depot. A special protein, ferritin, is used to store the element in the depot, and transferrin protein is used to transport it from the intestines. Ferritin is also responsible for the conversion of ferrous iron to insoluble ferric iron. In addition, Fe is stored in another compound, hemosiderin.

The development of IDA occurs in several stages. At the first stage, when reserves are mobilized from the depot, pathology can be detected only by ferritin deficiency. At the second stage, when iron for transport and functional purposes is mobilized, the level of the element in the blood serum decreases. At this stage, signs such as dry skin, weakness, dizziness may appear. And only when all the reserves of the body are exhausted, the actual signs of iron deficiency anemia appear - a decrease in hemoglobin, a decrease in the number of red blood cells.

The development of anemia can eventually lead to coma and death.

Distribution of iron in the body

The body of a man is more saturated with iron, and the reserves of the element in men are about 2 times higher than in women.

Spreading

Iron deficiency anemia is an extremely common condition. Of all cases of various anemias, it is 90%. And in total in the world there are 2 billion suffering from this syndrome. It is estimated that latent iron deficiency (sideropenia) is present in every second person on Earth.

Women are more susceptible to iron deficiency anemia syndrome. In them, the condition is observed about 3 times more often than in men. Adolescents (12-17 years old) are also at risk, as they must consume more iron due to the needs of a growing body.

Reasons for the development of the disease

Any anemia, including iron deficiency, is not a disease in the strict sense of the word. This is a symptom that indicates some other disease or an external factor that causes a decrease in the concentration of Fe in the blood. Therefore, without treating the underlying disease or eliminating the causes of the condition, unpleasant manifestations will persist.

The reasons for this condition may be:

• chronic blood loss due to disease, menstruation, injury, etc.;
• lack of iron intake with food;
• insufficient absorption of iron in the intestine;
• increased consumption of iron;
• violation of the process of iron intake from the depot or transportation to the bone marrow.

In newborns, anemia can be inherited from the mother. If the mother's body experienced a lack of iron, then the state of deficiency of the element passes to the newborn, and in an even more pronounced form.

What diseases and conditions can lead to chronic blood loss:

• prolonged menstruation;
• tumors of the uterus,;
• urolithiasis disease;
• frequent nosebleeds with hypertension;
• stomach ulcer, duodenal ulcer and gastritis;
• tumors of the gastrointestinal tract;
• diseases of the oral cavity;
• worm infestations.

Even small but chronic bleeding can eventually lead to iron deficiency anemia. If a person loses only 4 ml of blood per day, then this means that 3 mg of iron is lost, which exceeds the average daily intake of an element with food.

A decrease in the intake of iron from food occurs with prolonged fasting, an unbalanced diet. The largest amount of the element is found in meat products, fish and eggs. In addition, an element from such products is best absorbed.

Stocks of Fe contained in plant foods can also be absorbed. However, an important condition is necessary here - a sufficient content of vitamin C in the diet. Thus, the development of iron deficiency anemia is not uncommon with a lack of meat and vitamins in the diet. A similar situation is typical for people sitting on various trendy diets, especially if they are based exclusively on plant products and are completely unbalanced in their composition. A similar cause of iron deficiency anemia - nutritional imbalance, is most common in children.

Violations of iron absorption in the intestine can occur with various diseases of the stomach and intestines, with alcoholism, removal of part of the stomach or duodenum, pancreatitis. All these reasons lead to a lack of iron due to the fact that the mechanism of its binding to the transferrin protein is disrupted.

Causes of increased excretion of iron from the body, not associated with bleeding, may be pregnancy and lactation, increased physical activity, prolonged fever and increased sweating.

Violation of the process of iron intake from the depot occurs in liver diseases (hepatitis, cirrhosis). Since the elimination of iron deficiency at the expense of the body's reserves is a process that occurs infrequently, anemia occurs in patients with liver failure in only 20% of cases.

Prolonged infectious diseases (tuberculosis, brucellosis) lead to the fact that iron molecules are captured by immune cells. As a result, red blood cells also suffer from a deficiency of an important element for them.

Can pregnancy lead to IDA?

Iron deficiency anemia is a common condition in women during pregnancy. This is due to the fact that the female body is forced to share iron with the body of the baby. If the child does not receive a sufficient amount of a chemical element, then this will lead to improper development of his organs and to anemia in the first months of life.

Symptoms and signs of iron deficiency anemia in women

The fair sex most often suffers from iron deficiency anemia. This is due to the fact that, firstly, women have slightly less iron in their bodies than men. In addition, ladies are subject to significant monthly blood loss. It's about menstruation. In some cases, during the week of menstruation, the female body loses up to 700 ml of blood. For comparison, more than 250 ml is rarely lost during childbirth.

In addition, ladies watch their figure more, more often sit on various diets, consume less meat than men. Although the symptoms of iron deficiency anemia in women are not fundamentally different from the symptoms of this condition in men.

Complaints

If the development of IDA has reached a certain stage, then the patient may feel signs of malaise. First of all, it is:

• weakness,
• fatigue,
• drowsiness,
• low BP,
• tachycardia,
• headache,
• dizziness,
• fainting
• noise in ears.

In the initial stage, all these phenomena can be noticeable only during physical exertion. Then the symptoms of anemia appear at rest. It is also worth bearing in mind that these phenomena can be observed in various diseases, so additional studies are needed to make a diagnosis.

Changes in taste and smell are characteristic phenomena for iron deficiency anemia. A patient with iron deficiency anemia often wants to taste chalk, lime, paint, etc. The odors that previously seemed unpleasant become pleasant. Patients complain of deterioration of memory, attention.

Clinical manifestations in women

The set of clinical signs in IDA is extensive. People suffering from anemia often experience pallor, poor hair condition, and dry skin. Nails easily break, split, or change shape.

Blood tests show a low level of hemoglobin, erythrocytopenia (a small number of red blood cells). The color index of the blood becomes below normal. This means that the red blood cells are deficient in iron and are paler than usual. Reduced erythrocytes are observed. The level of serum iron (contained in transferrin) decreases. But the iron-binding function of the blood (the ability of transferrin to bind Fe) increases with IDA.

The level of ferritin in the blood is also important. This protein is extremely sensitive to any fluctuations in the level of Fe in the body. Even with a mild degree of anemia, ferritin levels are markedly reduced.

Norms of iron-containing proteins in the blood

Also, if iron deficiency anemia is suspected, the average content of hemoglobin in erythrocytes is examined. With anemia, the value of this parameter is usually reduced.

Degrees of anemia

It is customary to distinguish the degree of anemia depending on the concentration of hemoglobin in the blood.

Another classification is also used, in which the degree of IDA depends on the clinical manifestations.

Mild iron deficiency anemia

The first stage of IDA may not be accompanied by any signs of malaise. As soon as a state of iron deficiency occurs in the body, the reserves from the liver begin to be used. And only after they are completely exhausted, there is actually IDA. In this case, only a state of a slight lack of an element in the body is observed, however, anemia itself is still far away. This condition is called sideropenia.

Diagnostics

IDA is a symptom showing that something is wrong in the body. This may be an internal cause (occult bleeding, helminthic disease) or external (eg, dietary disturbances). And the doctor is obliged to find out the root cause of the lack of hemoglobin in order to prescribe the correct treatment. To this end, he collects all the information about the patient - his complaints, lifestyle, diseases he has suffered. To identify possible sources of bleeding, additional studies may be prescribed - FGDS, colonoscopy, x-rays of the lungs and stomach, stool tests for occult blood and helminth eggs.

Treatment in adults

The main component of treatment is taking iron-containing preparations in tablets and capsules. Treatment only with the help of a diet with a pronounced deficiency of a chemical element in the body is ineffective, even in the early stages. Although the right diet is also necessary to observe. Only in severe cases, with a severe lack of hemoglobin that threatens the patient's life, is a transfusion of donor blood performed.

Diet treatment

Although the main focus of IDA is on taking iron supplements, however, without proper diet and iron-rich foods, the treatment process can be very long.

Most easily digestible iron is found in meat and fish products. This is especially true for the meat of mammals (beef, veal, lamb). The champion in terms of element content is beef liver. Animal fats interfere with the absorption of Fe, so lean meats should be preferred. A lot of the element is also found in egg yolks.

Among fruits, pomegranates, plums, apples, blueberries, strawberries are the most rich in iron. These fruits and berries have a lot of vitamin C, so the Fe from them will also be easily absorbed. And among the cereals, the championship belongs to the Greek. There are almost no vitamins in buckwheat, so it is best to drink buckwheat porridge with juices. A lot of iron is also found in nuts (walnuts and hazelnuts), mushrooms, beans, cocoa.

Absorption of iron from various foods:

• meat - 25%;
• fish, eggs - 10-15%;
• vegetable products - 1-5%.

There are also products - Fe antagonists. These include those that contain tannin (tea) or calcium (dairy products). Therefore, during the period of treatment, they should be consumed as little as possible or even excluded from the diet.

Treatment with iron supplements

Iron supplements are usually taken by mouth. Fe from them is absorbed several times better than from food. Therefore, iron-containing preparations fight the deficiency much more effectively than iron-rich meals. Many iron-containing preparations are available in the form of capsules, which can reduce their negative impact on the gastric mucosa. IDA is treated with preparations based on ferrous and ferric iron. The course of treatment depends on the severity of the condition. The duration of the course can be several months.

Available in pharmacies, divalent drugs are presented in the form of organic and inorganic salts. The first group includes gluconates and fumarates. To the second - chlorides and sulfates. Trivalent preparations are represented by succinylates and hydroxides in combination with polymaltose. The bioavailability of bivalent drugs can reach 40%, while for trivalent drugs it is only 10%. Which drug is most suitable in a particular situation, the doctor decides. In order to get rid of the deficiency of a chemical element, iron supplements often need to be taken for months.

There are also forms of iron-containing preparations for parenteral administration:

• Venofer,
• Ferrum Lek,
• Ferrinject,
• Ferrovir,
• Cosmopher.

The process of treatment with iron-containing drugs must be carried out under the supervision of a physician, since an overdose of these drugs can adversely affect health.

Stages of treatment for IDA

Treatment of iron deficiency anemia consists of three main stages. The first stage of treatment is to eliminate the hemoglobin deficiency and restore its normal values. During the second stage, the body's iron stores are restored. And, finally, the third stage is maintenance therapy, aimed at maintaining the level of the element in the body at the required level and preventing the development of relapses.

IDA in infants

If IDA is diagnosed in an infant, the underlying cause is likely to be maternal iron deficiency. In this case, the mother needs to take iron-containing preparations to treat the condition. Breast milk contains iron compounds, from which this element passes into the baby's body without loss. Therefore, for the prevention of IDA in infants, their mothers should adhere to as long as possible.

Iron deficiency anemia is a hematological syndrome manifested by impaired hemoglobin synthesis resulting from iron deficiency.

The main causes are lack of iron-rich food and blood loss. It is observed in approximately 20% of the world's population and is most often detected in women.

Description of the syndrome

The human body should contain 4-5 g of iron. More than half of it is part of the blood. The chemical element may accumulate. It is deposited in the spleen, bone marrow, or liver. Iron is excreted in urine, feces, during menstruation and while breastfeeding.

Normally, the amount of iron in the blood should be:

• In children under 2 years old - 7-18 µmol / l.
• From 2 to 14 years - 9-22 µmol / l.
• Men - 11-31 µmol / l.
• Women - 9-30 µmol / l.

The amount of iron depends not only on sex and age, but also on weight, height and general health. In some cases, there is a situation in which a reduced level of metal is detected with normal hemoglobin. In order to get an accurate idea of ​​the amount of iron, two values ​​are compared - the concentration of hemoglobin and the amount of iron in the blood serum.

The amount of serum iron is the main indicator in detecting anemia.

With a normal amount of iron, the body can function and develop normally, and with a lack of this element, the circulatory system malfunctions, which affects all organs.

Iron deficiency is most commonly seen in:

• Children and teenagers.
• Pregnant.
• During lactation.
• Old people.

iron deficiency can be observed in people involved in heavy sports who do not monitor the quality of their diet. Women suffering from heavy bleeding during menstruation are also at risk. It is important for these people to regularly monitor their iron levels and fill their diet with iron-containing foods.

Classification

Classification according to the severity and level of hemoglobin is divided into 3 types.

These include:

1. Light. Hemoglobin is about 90 g/l.
2. Average. Hemoglobin 70-90 g/l.
3. Heavy. Hemoglobin<70 г/л.

There is another classification option, according to clinical manifestations:

• 1st degree. No symptoms.
• 2nd degree. Weakness and dizziness.
• 3rd degree. Disability, all symptoms are present.
• 4th degree. Precoma state.
• 5th degree. Anemic coma, can be fatal.

Only the attending physician can determine the severity, depending on the results of the tests and examination.

The reasons

Most people are deficient in iron due to a lack or small amount of foods rich in this metal in their diet. This can occur with vegetarianism or, conversely, taking a large amount of fatty foods. An excess of dairy products can also negatively affect the absorption of this element and cause its deficiency.

Other reasons include:

• The presence of diseases of the gastrointestinal tract. Gastritis, enteritis, malignant neoplasms and other pathologies of the digestive system negatively affect the process of iron absorption and can cause iron deficiency anemia.
• Hemosiderosis. An excess of hemosiderin in the tissues of the internal organs causes a low level of iron in the plasma.
• Renal failure and nephrotic syndrome. The kidneys cannot produce the proper amount of erythropoietin, which is important for the proper absorption of iron. In nephrotic syndrome, excess metal is excreted in the urine.
• Bleeding. They can occur not only during menstruation, but also as a result of injuries, diseases of the nose and gums, as well as hemorrhoids.
• Cirrhosis or cancer of the liver. The absorption of iron is directly affected by the presence of malignant and benign tumors that adversely affect the human body.
• cholestasis. Stagnation of bile in the biliary tract and jaundice can cause a lack of iron in the blood.
• Lack of vitamin C. Necessary for the full absorption of iron from food.
• Inflammatory, infectious diseases. The absorption of iron by the body increases, and with a poor diet leads to a deficiency of this element.

Children under 2 years of age, adolescents during puberty, as well as pregnant and lactating women are most in need of iron. The high needs of the body lead not only to iron deficiency, but also to other important trace elements.

In women, the body requires a higher consumption of iron, so about 18 mg of iron should be supplied daily with food.

During pregnancy, a woman's body should receive up to 30 mg of iron with a diet. In children during the period of intensive growth, a similar situation is observed. That is why it is so important to monitor the quality of the diet and saturate it with foods that are rich in iron, and, if necessary, take medication.

Latent deficiency in children can affect both physical and mental development.

What to do with low hemoglobin?

Symptoms

You can recognize the disease by unpleasant symptoms that occur regardless of age and gender.

These include:

• Breathlessness.
• Muscular hypotension.
• Tachycardia.
• Lack of appetite.
• Digestive problems.

The manifestation of clinical symptoms depends on the level of iron reduction. With a mild degree of IDA, a person suffers from a constant feeling of fatigue, dizziness, lack of oxygen and ringing in the ears. The lower the level of iron in the blood, the more pronounced the clinical manifestations.

A decrease in the norms of iron in the blood in childhood threatens to retard mental development and growth.

Iron deficiency anemia affects the appearance of women and men.

So, the external manifestations of the disease are:

• Hair loss and dryness.
• Paleness of the skin.
• early wrinkles.
• Destruction of nails and teeth.
• Seizures in the corners of the lips.

As the disease develops, a number of unpleasant symptoms appear, which are simply impossible not to pay attention to:

• There is no appetite at all. A person eats out of habit.
• There is a desire to eat not normal food, but objects not intended for this, for example, clay or chalk.
• During the swallowing of food, unpleasant sensations appear.
• Sometimes there is a significant increase in body temperature.

In most cases, a person does not pay attention to these symptoms, and treatment becomes more difficult as sideropenic syndrome develops.

This condition is characterized by damage to all organs and systems as a result of iron deficiency.
The disease gradually becomes chronic, and it will be too difficult to cure it.

First of all, the skin is damaged, which becomes dry, after which, as a result of a lack of oxygen, the internal organs suffer.

In people suffering from anemia, salivation is observed at night, the tongue hurts and microcracks appear on it. The slightest scratch heals very slowly, and the body hardly resists infections and viruses. There is constant weakness in the muscles.

In severe cases, the following symptoms may appear:

• Urinary incontinence.
• Nested atrophy of the esophagus.
• Sudden urge to urinate.
• Swelling of the face.
• Constant drowsiness and weakness.

It is important to know that such an unpleasant condition with deficiency anemia can be observed up to 10 years. People suffering from this ailment can use iron preparations, which relieve unpleasant symptoms only for a while. If the root cause of the disease is not eliminated, no medicine can give a positive result.

Diagnostics

Iron deficiency conditions lend themselves well to diagnosis.

The very appearance of a person indicates the presence of a disease:

• Paleness of the skin.
• Pastosity of the face.
• "Bags" under the eyes.

Auscultation of the heart often reveals tachycardia or arrhythmia. In order to confirm the diagnosis, a general and biochemical blood test is prescribed. If necessary, the doctor prescribes a number of additional studies in order to make not only an accurate diagnosis, but also to identify the cause of the disease.

If a decrease in hemoglobin and ferritin concentration (less than 30) with an increase in the iron-binding capacity of serum (more than 60) is detected, one can speak of iron deficiency.

Further research should be aimed at identifying the causes of this condition. First of all, the doctor is engaged in collecting an anamnesis. Some people stick to strict diets for a long time without thinking about the harm they cause to the body.

In this case, it is enough to change the diet - and after a while the human condition returns to normal.

After that, the doctor must find out if the process associated with bleeding is taking place in the human body.

For this pass:

• FGDS.
• Sigmoidoscopy.
• Bronchoscopy.

If these procedures did not reveal any pathologies, the doctor suggests a number of other studies to determine what caused the iron deficiency. A complete physical examination may be required to identify the underlying disease.

Women with anemia are required to be examined by a gynecologist on a chair and a pelvic ultrasound is performed. What is the danger of stagnation of blood in the pelvis you will learn from.

It is often difficult to determine what caused anemia, but without finding out the cause, treatment will be unsuccessful. Compensating for the lack of drugs, you can feel only temporary relief. After a short period of time, the disease will begin to progress again and manifest itself with unpleasant symptoms.

How to treat anemia in adults

For treatment, it is important to establish and eliminate the cause that caused iron deficiency. In addition, drugs are used to compensate for the lack of metal.

The following treatment regimen must be observed:

• Elimination of the cause of the disease.
• Medical nutrition.
• Ferrotherapy.
• Prevention.

Therapy includes glandular preparations in the form of tablets or injections. Their selection should be handled exclusively by a doctor. Self-medication and uncontrolled intake of such serious medications can only harm the body and aggravate the underlying disease that caused anemia.

Preparations with iron can be divided into two groups - ionic (bivalent) and non-ionic (trivalent). The mechanism of their absorption is different. Divalent iron penetrates into the intestinal mucosa, and through them into the bloodstream. For anemia, they must be taken 2 hours before meals.

Drugs irritate the walls of the stomach and can cause:

• Heartburn.
• Bloating.
• Nausea and vomiting.
• Constipation.

Non-ionic preparations transfer iron using a transport protein, which reduces the risk of side effects and negative effects on the gastrointestinal tract.

However, these drugs are rarely used, and doctors prefer ionic drugs.

In the treatment of moderate anemia, medications containing ferrous iron with a daily dosage of 2 mg / kg are more often used. The duration of treatment is from 3 months.

Parenteral administration is indicated for intolerance to oral drugs, which is often observed in diseases of the gastrointestinal tract.

This method is indicated for severe forms of anemia that threaten life.

The effectiveness of treatment can be judged by the results of laboratory tests. After about 10 days, an increase in hemoglobin is observed.

The list of drugs for iron deficiency anemia is shown in the table:

The dosage is selected strictly individually, depending on the severity of the disease and age. Most often, it is 200 mg per day, with a pronounced deficiency - 300 mg. After normalization of iron indicators, medication should be continued (about 2 months) to replenish metal reserves and exclude recurrences of iron deficiency anemia. The dosage of the drug is reduced by half.

Treatment of anemia has a duration of six months or more. At the same time, every month it is necessary to take control tests and not stop drinking medicines.

Diet

These include:

• The basis of the diet should be meat and products from it.
• At least 135 grams of protein should be ingested per day.
• Give preference to steaming, boiling, baking and stewing.
• Limiting the amount of fat.

Iron foods include:

• Pomegranate juice.
• Buckwheat.
• Yolks.
• Red meat.
• Legumes.

It is impossible to cure iron deficiency anemia only by changing the diet and filling it with healthy foods. A maximum of 5 mg of iron can be absorbed per day through food.

Useful for anemia are decoctions of wild rose and black currant. It is advisable to refuse dairy products, since calcium interferes with the absorption of iron. During treatment, it is necessary to give up alcohol, since it is completely incompatible with medications that supply iron to our body.

Iron deficiency anemia is a disease that responds well to treatment when the cause is identified.

Treatment of the underlying disease and taking iron-containing medications gives an excellent result and avoids relapses in the future. If the cause of anemia is not established, a general examination of the body is required.

Video: Iron deficiency anemia. Causes and methods of treatment.