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The human body needs iron. The need for iron is about 6 mg until the period of 6 months, from 6 months to 10 years - 10 mg, if a child is older than 10 years, then he needs 12-15 mg. The need for iron in pregnant women and lactating women is high - from 16 mg to 19 mg. In some cases, with iron deficiency, the need for iron increases to 50 mg.

Iron in the body is found in hemoglobin. From chemistry, one molecule of hemoglobin contains 4 iron atoms.

The main indication for iron supplementation is iron deficiency, confirmed by laboratory tests.

Iron can also be prescribed as a prophylaxis.

What foods contain iron?

Iron is found in:

• Meat;
• Fish;
• legumes;
• Cereals (especially in);
• vegetables;
• fruits;
• Berries.

The form of iron in foods is heme iron (that is, it is part of hemoglobin), and the second iron content in foods is inorganic salts.

Heme iron, part of the hemoglobin molecule, is found in meat and fish. In the form of inorganic salts, iron can be found in vegetables and fruits. If you eat iron in the form of meat and fish, then it will be absorbed much faster than if you constantly eat vegetables and fruits.

It is impossible to make up for iron deficiency with plant foods if you have given up meat and fish (for example, adheres to the principles of vegetarian nutrition).

Replenishing iron deficiency in the body with food is very difficult, almost impossible.

Classification of drugs

At the pharmacy, you can find iron preparations that fall into two categories:

• Medicines containing ferrous iron - Lactate, Aktiferrin, Gluconate chloride, Iron Sulfate, Succinate, Fumarate.
• Medicines containing ferric iron - Maltofer, Iron hydroxide as part of the sucrose complex.

How are iron supplements used? They are used orally in the form of solutions, drops, chewable tablets. But, depending on the doctor's testimony, you can administer iron intramuscularly or intravenously.

It is worth noting that intramuscular / intravenous administration of iron leads to the occurrence of adverse reactions in the form of allergies and even.

When is iron administered intravenously or intramuscularly? Only in the case when ingestion was ineffective; The patient recently underwent surgery to remove part of the intestine.

How to take an iron supplement?

You need to start taking it with ferrous iron, and the transition to ferric iron takes place only if anemia does not go away after the course with ferrous iron.

List of ferrous iron preparations

Preparations containing ferrous iron include:

• Iron sulfate or Aktiferrin in the form of capsules, syrup or drops for oral administration;
• Apo-Ferrogluconate (iron gluconate) in the form of tablets;
• Iron chloride - Hemofer in the form of a solution and drops for oral administration;
• Ferrous Gluconate;
• Ferrous fumarate in a dosage of 200 in the form of tablets;
• Iron carbonate or Collet iron in the form of tablets;
• Iron Gluconate or Megaferin in the form of effervescent tablets;
• Iron sulfate / Orferon;
• PMS iron sulfate;
• Tardiferon;
• Theospan;
• Ferronal (tablets, syrup, capsules, oral drops);
• Ferrogradum - Iron Sulphate;
• Heferol in the form of tablets;
• Ektofer solution

Trivalent iron preparations

Unlike preparations of 2-valent iron, preparations containing 3-valent iron can be taken with food, since their absorption by the gastrointestinal tract is in no way dependent on food intake.

The list of preparations of 3-valent iron:

• Iron hydroxide in the form of a sucrose complex/Argeferr;
• Venofer;
• Iron Dextran/Dextrafer;
• Iron Sugar;
• Iron Hydroxide Dextran;
• Maltofer;
• Likferr;
• Cosmofer/iron hydroxide dextran;
• Profer;
• Monofer;
• Fenyuls for children;
• Ferbitol;
• Ferrlecite;
• Ferrum lek;
• Ferumbo.

If a child or an adult is diagnosed with iron deficiency anemia, then the treatment of this condition must be approached comprehensively. In the treatment of anemia, it is necessary to resort to drugs that affect blood circulation in general and metabolism. In addition to iron preparations, it is recommended to use Cyanocobalamin, vitamin complexes and minerals.

In severe conditions of anemia, it is recommended to take 3-valent iron preparations with the addition of folic acid - Biofer, Maltofer Fol, Orofer, Ferri-Fol (before using them, you should consult your doctor). Among the effective preparations of 2-valent iron with the addition of folic acid are Gino-Tardiferon, Fefol, Ferretab Comp; drugs with 2-valent iron, folic acid, cyanocobalamin - Hemoferon, Irovit, Ferro-foilgamma, Folirubra.

List of medicines containing vitamins and microelements

Among medicines containing iron, vitamins, minerals, there are:

• Capsules Globigen;
• Globiron;
• Glorem;
• Ranferon;
• totem;
• Fenotek;
• Feron;
• Hemsey.

By the way, oh, which parents are actively buying for their children with the idea that a sweet tile, similar to Toffee, will increase the level of iron in the baby's blood. If we are talking about natural hematogen, which is made from the blood of cattle, then indeed, the effect of an increase in iron in the blood is observed.

Hematogen is not a remedy, but a food supplement!

Summary

Iron deficiency anemia can be cured by:

• Power correction;
• Preparations of ferrous and trivalent iron;
• Intramuscular or intravenous administration of the drug if hemoglobin does not rise to the required level;
• After normalization of the hemoglobin level, it is taken over the next 3 months as a prophylaxis.

• Why do we need iron preparations;

• Why does a person need iron in the body, and how is its deficiency formed;

• How iron tabletsdifferent from injections;

• What kind iron supplements for anemiabetter: with ferrous or ferric iron;

• What features doesmedical treatment for anemia.

Iron deficiency anemia (IDA) is the most common form of anemia (90% of all recorded cases). It is diagnosed in every third child and in almost all pregnant and lactating women. Patients with IDA are always prescribed replacement therapy - this ispreparations containing iron,for oral and parenteral administration. The success of treatment largely depends on themedicine for anemiathe patient will receivedrugs for anemiashould be selected individually, taking into account age, the presence of concomitant diseases, the rate of decrease in hemoglobin levels and the tolerability of different types of therapy.

Drugs for iron deficiency anemiafill the daily need of the body and lead to the accumulation of deposited reserves of the microelement in the liver and muscle tissue. The dose of the active substance in them is much higher than a person can get from food. This allows you to quickly restore the level of hemoglobin to normal.

The role of iron in the human body

The normal content of iron in the body of a healthy adult is about 4 grams. Most of it (2.5 g) is part of hemoglobin, the rest is in the liver, muscles and bone marrow. The trace element is constantly consumed, so 10-20 mg of iron should be supplied daily with food.

The need for women is about twice as high as for men, this is due to the fact that the female body loses more iron (due to menstruation, pregnancy, breastfeeding). Therefore, women are often prescribed preparations for raising the content iron in the blood for preventive purposes.

Iron functions:

Transporting oxygen to cells- an iron molecule in the composition of hemoglobin is able to attach oxygen molecules and give them away;

Hormone production- iron is involved in the work of the thyroid gland;

Metabolism - iron is necessary for the work of many enzymes responsible for cholesterol metabolism, immune responses, hematopoiesis;

Physical activity and muscle growth- iron is part of myoglobin (the main protein of muscle fibers).

The lack of iron obtained from food may not manifest itself at first, since at this time the body will use up the deposited reserves - this stage is called latent iron deficiency, it is difficult to detect without special tests. If you start takingiron supplementsat this stage, the treatment will be quick and effective, and the consequences of the deficiency will not affect health in any way. When the lack of a microelement becomes apparent, the concentration of hemoglobin will decrease, and the erythrocytes will acquire a hypochromic color. If no action is taken, the disease will progress, an anemic syndrome will appear. It presents with a number of symptoms:

pale skin;

dizziness, headaches;

Fatigue, apathy, sleep disturbance;

Dyspnea;

Fragility of hair and nail plates, dry skin.

These symptoms are characteristic of all types of anemia. IDA can be identified by specific signs: spoon-shaped nails, perverted perception of tastes and smells, painful “jams” in the corners of the mouth.

Causes of iron deficiency

Deficiency is formed under the influence of physiological (natural) and pathological processes.

Why is there a deficit?

iron enters the body in insufficient quantities with dietary restrictions (vegetarianism, raw food diet, diet, malnutrition);

the need for a microelement has increased (the period of active growth of muscle mass, pregnancy, lactation);

the body loses iron mechanically (acute and chronic bleeding, heavy menstruation, surgery, donation, bloodletting for therapeutic purposes);

the function of the gastrointestinal tract is impaired, due to which iron is not able to be absorbed (various diseases of the stomach and intestines: gastritis, ulcer, Crohn's disease, etc.);

congenital iron deficiency due to anemia in the mother during pregnancy.

A long-term iron deficiency negatively affects human health: immunity decreases, the brain and heart suffer from hypoxia, which leads to a deterioration in their performance, physical weakness is observed due to muscle atrophy, metabolic processes are disturbed, chronic diseases are exacerbated. Anemia in pregnant women leads to complications in childbirth and the postpartum period, in children to a delay in psychomotor development.

According to recent studies by American scientists, anemia suffered during life increases the risk of developing mental disorders in old age.

To avoid consequences, it is necessary to urgently begin treatment.Modern iron preparationsallow in a short time to compensate for the lack of trace elements and bring blood counts back to normal. Treatment should be as effective as possible, so it is important to choose the right one.preparations containing iron.

Remedies for the treatment of anemia: which is better pills or injections

Medications for iron deficiency anemiaavailable in three main forms:

Tablets for oral administration (the most preferred option);

Drops or syrup for oral use (recommended for young children);

Injections for parenteral administration (if it is impossible to take the tablet form of the drug).

The most comfortable and safe formiron booster drugs- tablets. They can be used at home. Unlike drops, a tablet, if not chewed, will not stain the enamel of the teeth.

Children under a certain age are not able to swallow a whole tablet, so it is advisable to use syrup or drops for treatment.Liquid iron preparationsit is better to take it through a tube so that the active substance does not get on the teeth.

Intravenous and intramuscular injections are used to increase iron in patients with gastrointestinal pathologies and malabsorption. The method of treatment is faster than taking pills, butparenteral iron preparations can causepronounced side effects.

Before starting treatment for IDA, it is necessary to find outwhat are the best drugs for anemiaexactly in your case. Since there is no universal prescription for this disease.

Iron tablets: name, price, effectiveness of drugs

Anemia pillsmost often contain ferrous sulfate, there are preparations based on ferrous gluconate, ferrous fumarate, ferrous chloride - these are inorganic and organic metal compounds.Modern iron preparations for anemiacan be produced exclusively from natural raw materials - animal hemoglobin ( hemobin).

Tablets containing ironshown to patients with mild to moderate anemia. They are taken at home, under the supervision of a specialist and with a regular blood test for the level of hemoglobin, serum iron, red blood cells.

Let's compare pills of well-known brands and determinewhat is the best iron supplement.

Table 1. Tabletediron preparations. Scroll, price, efficiency and other indicators.

* Iron from the preparation is absorbed several times better, therefore the content of the microelement in it is lower than in analogues, respectively, the daily dose is lower.

Which iron preparations are better absorbed by the human body? Those that contain vitamin C in their composition, which promotes absorption, and do not react with food and other medicines. This is a very important point, as it directly affects the effectiveness of treatment.

Anemia pillsit is recommended to take half an hour before or after a meal, but at the same time, the gastrointestinal mucosa is intensely irritated. If the patient is difficult to tolerate therapy, he is allowed to drink drugs during meals. But in such cases it is necessary to chooseiron preparations of the latest generation, which do not form insoluble compounds with substances from food.

Inexpensive pills for anemiaare produced on the basis of an inorganic iron compound - ferrous sulfate. This substance is foreign to the human body, so the digestive tract will reject the drug - hence the side effects. From this, the percentage of assimilation of the active substance decreases. In addition, this compound is toxic, an overdose is extremely dangerous.

Important! When choosing a tool, it is important to pay attention towhich drug has more ironand how well it is absorbed.

Modern iron preparations - no side effects. They are more expensive, but are made from natural hemoglobin. The bioavailability of the active substance is very high, for example in Hemobin it reaches 90%.

What pills to take for anemiayou choose, but do not self-medicate, be sure to consult your doctor, as not all drugs are safe.

Iron preparations in drops and in the form of syrup

Liquid forms of iron preparations, such as drops, suspensions and syrups are intended for children from birth.Iron preparations in syrup, drops are produced on the basis of ferric and ferrous iron in the form of iron hydroxide. The principle of action is the same as that of other forms of pererol preparations.

anemia cure for childrenRecommended to be taken with meals. Trivalent iron is less likely to react with substances from food.

liquid iron medicines:

Maltofer (this one is producediron (III) preparation in vials, each drop contains 2.5 mg of iron);

Ferrum Lek (this medicine represents liquid iron (III) in syrup);

Fenyuls (iron (III) drops);

Hemopher ( preparation containing iron (II), for children in the form of drops).

Anemia drugs for childrenmay also be available in tablet form. But in this case, the tablet will need to be crushed and mixed with food or liquid beforehand. For example, Hemobin allowed for babies up to 1 year. This is one of the mosteffective iron preparations for children.The tests were carried out on the basis of numerous medical and scientific centers in Russia. During which the therapeutic effect and the absence of adverse reactions were proven. In addition, the remedy is natural and safe. The iron in it is not toxic, since it is present in the body in exactly the same form, which means it is a familiar compound that is easily absorbed.

Important! At anemia in children, drugsshould be selected only by a specialist!

Iron-containing drugs for anemia in the form of injections

Iron injections for iron deficiency anemiaare indicated only in cases where the body does not absorb oral forms of drugs or with a pathological decrease in hemoglobin. Injectable forms always contain ferric iron. The drugs are administered intravenously and intramuscularly. The maximum concentration of iron in the blood is reached in 30-40 minutes.

Iron preparations intravenously, list:

CosmoFer;

Ektofer;

Ferlatum;

Ferinject;

Venofer.

Iron preparations for intramuscular administration for anemia:

Ferbitol;

Ferrum Lek;

Maltofer.

injection formsiron preparations available in ampoules . Using them on your own is strictly prohibited. itmost effective iron supplements for anemia, but at the same time, the most dangerous - they can cause anaphylactic shock.

Before starting treatment,medicine for anemia in ampoulesadministered in a test dose. Therapy is possible only in the absence of side effects. Preparations in this form have many contraindications. Treatment is carried out only under the supervision of doctors.

Generations of iron preparations. Ferric and trivalent iron

Which iron preparation is betterchoose depends not only on its form of release, but also on the composition. Iron-containingdrugs for anemiain Russia are divided into generations.

Generations of iron preparations:

First generation preparations based on inorganic salts and iron oxides (Soviet drugs for anemia). Their negative impact on the intestinal mucosa and toxicity has been proven. They are prescribed less and less, however, they are still used, as thischeap anemia pills.

Second generation iron preparationsproduced on the basis of organic iron compounds (ferrous gluconate, fumarate). Safer drugs, but ineffective.

Third generation iron preparations (complex preparations of iron), based on organic compounds, with additives that improve the beneficial effect.

Fourth generation drugsiron preparations that do not irritate the digestive tract), produced on the basis of liposomal iron. Safe and non-toxic.

Today it is recommended to use for anemianew generation iron preparations(2-4). They are less likely to cause side effects, interact less with food components and are better absorbed.

To modern effective iron preparations includes hemobin . But its composition is unique - purified hemoglobin from the blood of agricultural animals (containing heme ferrous iron) and ascorbic acid. Due to the natural composition, this remedy is safe even in the treatment of babies under 1 year old and pregnant women. itgentle iron supplementyet highly efficient.

Another criterion to help determinewhat is the best iron to take for anemia- valency of the metal in the composition of the drug.The drugs used in the treatment of anemia can be produced on the basis of ferric and ferrous iron.

Ferric iron preparations, names:

Ferrum Lek;

Iron preparation F erlatum;

Maltofer;

Fefol.

What are the drugs for anemia contain ferrous iron:

Sorbifer Durules;

Tardiferon;

Hemopher;

totem;

Fenyuls;

Ferroplex.

In the human body, iron is present in the divalent form. It is this form of drugs that gives a more pronounced therapeutic effect. But in most drugs indicated with iron deficiency in the bodycontains non-heme ferrous iron. It is absorbed only partially, because of this, the patient has to take large doses of tablets and endanger the mucous membranes of the stomach and intestines. Heme Iron (Animal Origin) Found in Dietary Supplement Hemobin , while the iron molecules in it are already associated with the protein, due to this, the developers managed to achieve 90% of the bioavailability of the active substance. Doses when taking Hemobin are several times lower than when taking other drugs. The product is free of allergens. Before getting into the drug, natural hemoglobin undergoes a multi-stage filtration from impurities.

To datedrugs in tablets more often contain ferric iron. It is considered to be safer. But it absorbs worse. For assimilationferric iron preparations for anemiaascorbic acid is needed, which converts iron into a divalent form. Can be taken separately or purchasediron supplements with vitamin C in composition.

What is the best iron supplement to take?: more effective or safer - the doctor should determine based on the patient's condition, the rate of hemoglobin decline, the presence of diseases of the stomach and intestines, and other factors that may affect the outcome of treatment and tolerability of therapy.

There is also an alternative -Russian iron preparation Hemobin . At the moment, it is registered as a dietary supplement, but the effectiveness and safety have already been confirmed by many studies in scientific and medical centers in Russia. Registration as a medicinal product is a matter of time. But many patients need help today. Therefore, while the drug is sold only directly from the manufacturer.

Drugs for the treatment of anemia in women

Women are in a particular risk group for developing anemia. Therefore, abouttreatment of anemia in women and iron supplementsfor them it is worth talking separately. According to statistics, they are the most likely to suffer from anemia.

Predisposing factors for a decrease in hemoglobin in females:

Increased need for trace elements and vitamins during pregnancy and lactation;

Abundant and unstable menstruation;

Diseases of the internal genital organs, accompanied by bleeding;

Multiple and repeated pregnancies;

Food restrictions, diets;

Stress.

Iron preparations for women, if they are not pregnant can be any. But during the period of gestation, it is necessary to select specialanemia pills for pregnant women. They must be safe not only for the mother, but also for the unborn child.

Important! Hemobin passed a series of tests, during which it was found that there was no negative impact on the development of the fetus and the body of a pregnant woman.

Iron supplements for anemia in pregnancy:

totem;

Sorbifer Durules;

Fenyuls;

Hemobin;

Ferlatum;

Maltofer.

Some anemia medicines for womenshould not be taken in certain trimesters of pregnancy, as a rule, restrictions apply to the first trimester. Assignpills for anemia during pregnancya specialist should, since it is necessary to take into account a lot of factors and features of the course of pregnancy, so as not to harm the baby and mother.

Due to the high risk of anemia due to iron deficiency, women are advised to take regularvitamins with iron in tablets (listpopular means, given in the next chapter) as a preventive measure.

The effectiveness of iron-containing vitamins in anemia

Often, patients with anemia try to be cured with vitamins, which contain iron. Butvitamins with iron tablets- is not iron supplements for anemiabut a means to prevent disease. The iron content in them does not exceed 15 mg, while the therapeutic dose is 100-200 mg. They are not suitable for treatment.

Important! It is forbidden to take vitamins with iron in high doses, as they contain a complex of other substances, the excess of which can harm health.

Medications for anemia in adultsand children are monocomponent, and contain, in addition to iron, only excipients. Vitamin complexes withiron tablets intended for preventionlack of vitamins and minerals. They are prescribed for children during the period of active growth, puberty, women during pregnancy and lactation. With already identified anemia or latent iron deficiency, takeiron supplements for adults and children.

Vitamins with iron in tablets drug names:

Alphabet;

Complete iron;

Multitabs classic;

Centrum from A to Zinc;

Supradin.

The daily dose of iron in these vitamin complexes is from 5 to 15 mg (depending on age and gender) - this amount is sufficient for malnutrition, diet, with an increased need for a trace element. If taken regularlyinexpensive vitamins with iron, you can protect the body from the development of anemia. Iron deficiency can often be predicted. This condition is especially common when:

pregnancy;

profuse menstruation;

Active sports and muscle growth;

donation;

Vegetarianism;

In children born prematurely;

surgical interventions;

Blood loss (external and internal).

Before taking vitamins with iron in tablets from the list of drugsabove, you should consult a specialist.

Some iron supplements for anemia(in lists above) are already outdated, however, they are sometimes prescribed by doctors for treatment, since they are inexpensive, but at the same time they are quite effective. But stillbest cure for anemiashould combine high efficiency and safety. Therefore, it is worth paying attention to modern iron preparations, and getting advice from several specialists.

Note! Biological food supplement Hemobin suitable not only for treatment, but also as a prophylaxis of IDA in people at risk. The dosage is calculated according to the age of the patient.

Iron deficiency anemia is the most common form of anemia (up to 95% of all cases). Statistics on its prevalence say that almost 30% of the adult population has an iron deficiency, and after the age of 50 - 60%. Women get sick more often. Iron preparations for anemia are the main drug.

The value of iron for the body

The human body really needs this mineral. It has been established that there are 2.5-3.5 g of iron in the body. At the same time, 2.1 g (70%) is included in hemoglobin. Iron is not synthesized by internal organs. It comes entirely from food. As you know, the protein hemoglobin is necessary for the binding of oxygen molecules in red blood cells.

Without a sufficient amount of iron, the required amount of hemoglobin is not formed, which disrupts the process of oxygen transfer by red blood cells from the lungs to tissues, and contributes to oxygen starvation.

Iron molecules are bound in the upper intestines by a special carrier protein transferrin and delivered to bone marrow cells for the synthesis of red blood cells. The mineral is incorporated into hemoglobin.

Iron stores are created in the liver in the form of hemosiderin, always ready to add to normal or replace the loss.

Why is there a deficiency?

Iron deficiency can occur for four reasons:

• low intake of iron-containing products;
• poor absorption in the intestines;
• increased consumption;
• uncompensated increase in demand.

The maximum content of iron is found in vegetables, fruits, cereals, meat products, eggs

The lack of these products in the diet quickly leads to a deficient state, causing anemia.

Anemia occurs in athletes against the background of high physical exertion, in vegetarians, and in lovers of fashionable diets for weight loss.

It has been established that the substance obtained with dietary protein is absorbed only by 25-40%, and from vegetables and fruits - by 80%. It turns out that this is facilitated by vitamins, which are available in large quantities in vegetables and fruits. Lack of sufficient vitamin C in the diet leads to a decrease in hemoglobin.

In diseases of the intestine (chronic gastritis, duodenitis, peptic ulcer, pancreatitis), the process of iron absorption is sharply disrupted. It does not linger, but is excreted from the body.

The necessary chemical element is lost with blood loss. In men, bleeding from the stomach or intestines associated with damage to these organs, nosebleeds are more common. In the female body, menstruation requires replenishment. During pregnancy, the fetus takes everything necessary from the mother's body, without iron-containing agents, the laying of the internal organs of the fetus is disturbed, and the health of the expectant mother suffers.

Iron deficiency anemia is caused by an increased need for iron in children in the growth stage, in nursing mothers. The lack of a sufficient set of minerals and vitamins in the diet is compensated by iron-containing preparations.

How to determine the iron deficiency state

To establish the cause of iron deficiency anemia, a comparison of symptoms and blood test data is necessary. The main manifestations are general weakness, fatigue, dizziness, taste disturbances (disgust for ordinary food, the appearance of a desire to eat something inedible), sometimes fainting, a tendency to low blood pressure, pallor and dry skin.

The laboratory investigates:

• blood test - detect a decrease in red blood cells, a low color index. The diagnostic lower level of hemoglobin is considered to be 130 g/l for men, 120 g/l for women;
• determine the concentration of iron in the serum - the lower limit of 12-32 µmol/l for men, for women 10-15% less;
• iron-binding capacity of serum - increases with a deficiency of more than 45-75 µmol / l.

Only a doctor can choose the right treatment and apply iron preparations for anemia.

Benefits of medicines

Modern drugs used to treat iron deficiency anemia contain the necessary amount of a substance to restore hematopoiesis. It is impossible to achieve a similar composition with food.

The absorption of the daily dose of drugs exceeds dietary iron by 20 times. Therefore, trying to eat a lot of diet foods at home will not lead to the desired results.

Rules for choosing iron preparations

In the treatment of iron deficiency anemia, the doctor takes into account the peculiarities of iron metabolism in the body, the conditions for absorption, effective combinations and the form of administration.

1. It has been proven that with intramuscular administration of drugs, the effectiveness of treatment is lower than when taking tablets. This confirms that the main route of iron absorption is through the intestines. In addition, side effects are more common.
2. Medicines should contain the optimal dose of pure iron 80-160 mg (this corresponds to 320 mg of sulfate salt), such an amount can provide a therapeutic effect. Exceeding this dosage may lead to unwanted effects.
3. Tablets should not be chewed, it is better to swallow whole, drink water. The tablet form has an advantage over liquid medicines.
4. The use of complex vitamin and mineral products in this case does not have the necessary effectiveness, the dosage is too low.
5. When choosing drugs, you should be aware that they may contain iron in the divalent and trivalent form. For the assimilation of ferrous iron, vitamin C is needed, and ferric iron requires special amino acids that can carry ions to the bone marrow.
6. Advantages are given to encapsulated preparations coated with a protective shell. They protect the mucous membrane of the esophagus and stomach from irritating effects.

Treatment of anemia with basic drugs

The course of treatment for anemia lasts six months or more. Blood tests are carried out every month. After normalization of the content of red blood cells, hemoglobin, it is necessary to take drugs for another 1.5-2 months. This allows you to consolidate the achieved effect, saturate the renewed red blood cells with iron.

For pregnant and lactating mothers, the duration of medication is determined by the period of breastfeeding. This provides, in addition to the treatment of iron deficiency anemia in the mother, the prevention of this disease in the child.

What drugs can be bought at the pharmacy?

Patient feedback on the use of drugs for the treatment of anemia allows us to recommend two groups of drugs.

Products containing ferrous iron

Iron is included in the composition of medicines in the form of a sulfate salt, they contain vitamin supplements that improve absorption and assimilation. Most popular:

Sorbifer durules contains ferrous sulfate + ascorbic acid

• In the form of tablets: Sorbifer durules, Tardiferron (sulfate + folic acid). Apply two tablets a day (morning and evening), half an hour before meals, drink a glass of water. Sorbifer durules is not indicated for children under 12 years of age, as there are no data from clinical trials.
• In capsules: Ferrofolgamma (iron sulfate + cyanocobalamin + vitamin C), Ferretab (fumarate + folic acid), Fenyuls (sulfate + folic, pantothenic and ascorbic acids, pyridoxine, riboflavin).
• The drug Aktiferrin is used in capsules, drops, syrup. Indicated for the treatment of children.
• Totem - contains in solution a combination of iron gluconate with copper and manganese.
• In the form of a dragee, Hemofer prolongatum (sulfate) is used.
• The well-known Hematogen - contains food protein and ferrous sulfate.

Ferric iron preparations

Iron is used in the form of polymaltose hydroxide:

• In tablets: Maltofer, Ferrum lek, Biofer (polymaltose hydroxide + folic acid).
• In syrup, drops, solution: Maltofer, Fenyuls, Ferlatum (protein succinate).
• For intramuscular injection: Maltofer, Ferrum Lek, Venofer, Argeferr, Kosmofer.
• Injections are used in patients with diseases of the stomach and intestines, damage to the walls of small vessels, large blood loss. With the intravenous route of administration, thrombophlebitis (inflammation of the vein at the injection site) is possible.

Ferrum Lek for intramuscular injection

The price of the drug is determined by the pharmacy in accordance with the law, depends on the country of manufacture.

side properties

Adverse reactions depend on individual sensitivity, the form of the drug.

• All iron-containing products, uncoated or in the form of a solution, irritate the digestive system. Epigastric pain, constipation are possible.
• Tablets and liquid preparations can lead to darkening of tooth enamel.
• Intolerance is expressed in various allergic manifestations.

How to determine the effectiveness of treatment

The onset of action of the drugs is detected in the third week of treatment by a slight rise in hemoglobin. Therapeutic measures are considered effective if the normal level can be reached after two months. Then supportive treatment is carried out.

At the same time, the patient needs to eat vegetables and fruits rich in vitamins, juices, a sufficient amount of protein products due to meat, dairy products.

Preparations containing iron should not be chosen independently. This may not give any results, but only lead to side effects and worsen the patient's condition.

Many parents are wary of medications intended for the treatment of their babies. The anxiety of many extends to iron preparations for children. Some even try to refuse the therapy recommended by the doctor, insisting on the use of only natural products to restore chemical indicators.

Such an attitude to treatment often leads to disastrous consequences - the disease progresses and becomes severe. It should be borne in mind that, in addition to iron itself, the child needs vitamins and additional trace elements to absorb the component. Do not forget that with the help of food it is almost impossible to achieve saturation of the child's body with therapeutic doses of iron.

Iron preparations: definition, purpose, indications for use

The benefits of iron for the human body are undeniable. This trace element is part of the hemoglobin of the blood, providing saturation of cells and tissues with oxygen. Without iron, other vital chemical processes are also impossible: the functioning of the circulatory system, the formation of immune cells, the cleansing of liver tissues and cholesterol metabolism.

The lack of a component leads to the development of iron deficiency anemia, which is especially dangerous for pregnant women and children of any age. In the first case, there is a risk of having a child with a number of pathologies. In the second, there is a chance that the baby will develop mental retardation, weakened immunity, reduced learning ability, and fatigue.

Tip: Iron for children in the neonatal and infancy period should be supplied to the child's body along with breast milk. If a nursing mother follows the rules of postpartum nutrition, feeds her baby on demand and does not have bad habits, the risk of anemia will be minimal. Despite the growing fashion for early weaning babies, pediatricians advise women not to follow this trend, which increases the risk of problems in their toddlers.

Iron preparations for children are medications that contain salts or iron complexes in bi and trivalent form. It is strictly forbidden to independently select a suitable remedy for a child, because. taking specialized drugs implies a number of nuances. For example, for the assimilation of ferrous iron, vitamins (in particular, ascorbic acid) are needed. Trivalent iron will not be absorbed without a number of amino acids that will carry the ions of the component to the bone marrow tissue. Very often, iron for children is not prescribed in isolation, but in combination with auxiliary compounds.

With proper therapy, these products restore iron deficiency in the body, promote the synthesis of hemoglobin, and prevent the development of trophic changes in organs and tissues. Compositions often differ in the form of release and the set of active components. Today, products are increasingly being used, which already include vitamins and amino acids necessary for maximum absorption of the main substance.

Parents should be aware that iron plays a more important role for children than for adults. Their growing body may experience an increased need for a microelement during the cold season, during puberty (especially important for girls), years and months of excessively active growth. But this does not mean that therapy can be prescribed and carried out independently. All manipulations and even correction of the usual diet are carried out only after consultation with a pediatrician.

Why the right diet is not able to replace medicines?

“Properly organized nutrition is the best cure for anemia!” Doctors are in a hurry to dispel the myth, firmly established in the minds of modern mothers. Unfortunately, even if the baby is introduced to complementary foods in a timely manner, correctly transferred to an “adult” diet and monitored for his nutrition, there is no guarantee that he will not have problems with iron levels. The presence in the diet of children of meat products, fish, cereals, fruits, legumes, cheeses and nuts will certainly make a useful contribution.

The necessary vitamins and microelements will actively enter the tissues, normal digestion will ensure maximum absorption of the constituents by the intestinal villi. But with progressive anemia, only these actions will be useless. Iron that enters the human body with food is trivalent, it needs time and additional components to reach the divalent state.

Experts recommend paying attention to two points that have a serious impact on the level of iron in the body of a child. First, the nutrition of the expectant mother during pregnancy. Do not give up profile drugs if the doctor insists on them. Secondly, the iron index in a child will remain at an optimal level at least until adolescence, if the prevention of infectious diseases that seriously affect children's immunity is carefully carried out.

Popular remedies and their dosage forms

Despite the fact that iron for children, additional drugs and vitamins are prescribed by a pediatrician, it is worth familiarizing yourself with a number of rules, the observance of which will affect the quality of therapy:

1. The course of therapy averages from 6 to 12 weeks. In some cases, these terms are extended.
2. The average daily dose of a trace element depends on the age of the child. Up to a year, it is 4-10 mg, up to 6 years - 10 mg, up to 10 years - 12 mg, up to 17 years in boys - 15 mg, up to 17 years in girls - 18 mg.
3. Treatment with ferrous iron usually begins with a quarter of the recommended dosage for age. It gradually increases to the norm.
4. The average daily dose is usually calculated according to the formula 2-3 mg of iron per kilogram of body weight. It is divided into three single doses.
5. In the first two months of life, most infants need additional iron intake, because. fatal erythrocytes are replaced by normal ones. At the same time, emphasis is placed on vitamins.
6. The normalization of the child's condition at the chemical level is noted only a few weeks after the start of therapy. But the improvement in well-being is manifested quite quickly. It is impossible to stop taking iron against such a background! The course must be completed.

To date, the following iron-containing preparations are most actively used in pediatrics:

• Drops. The best option for children of the most tender age. Children from birth to two years of age are usually prescribed Hemofer, Maltofer, Aktiferrin. They are mixed with juice or tea.

• Syrup. Dosage form for babies aged 2 to 5 years. Ferronal, Aktiferrin, Ferrum Lek are syrups that, thanks to the measuring cap, can be measured in the right doses. The main thing is to strictly follow the doctor's prescription.

• Tablets. Option for older children. Hemofer, Tardiferron, Aktiferrin are completely swallowed and washed down with water. Chewing medicines will stain the teeth black or yellow and increase the risk of irritation of the gastric mucosa.

During the period of therapy, we rely on vitamins in the child's diet. In addition to vegetables and fruits, we enrich the daily menu with meat products.

The nuances of taking iron supplements in childhood

In addition to the listed rules for therapy, there are important nuances of the use of iron-containing drugs in childhood:

1. The baby's feces may turn black. This is not dangerous and will pass after the end of the course of treatment. It is better to immediately warn the child if he is of a conscious age.
2. The medicine is best taken on an empty stomach, at least one hour before meals.
3. If the baby has poor iron absorption or a tendency to side effects, then it is better to give preference to drugs with enveloping additives.
4. Some medicines slow down the absorption of iron. Profile funds are not prescribed at the same time as a number of antibiotics, antacids, calcium preparations.
5. Iron is not recommended to combine with rice, eggs, bread, tea, soy. Dairy products during the period of therapy are allowed to be given to children no more than once a day, 2 hours after taking the medication.

Iron preparations and concomitant vitamins are recommended to be used for at least another month after the normalization of the chemical composition of the blood. But only if it's a doctor's recommendation.

The goal of therapy for iron deficiency anemia (IDA) is to eliminate iron deficiency and restore its reserves in the body. This can only be achieved by eliminating the underlying cause of IDA in the body.

The basic principles of the treatment of IDA were formulated by L.I.Idelson in 1981:

It is impossible to compensate for iron deficiency without medicinal iron-containing preparations.

Treatment of IDA should be predominantly with oral iron preparations.

IDA therapy should not be discontinued after normalization of hemoglobin levels.

Blood transfusions with IDA should be carried out only strictly for health reasons.

Previously, there was an opinion that iron deficiency can be eliminated by prescribing a diet containing apples, buckwheat, pomegranates and other plant products containing iron. However, in the 60s. In the 20th century, researchers proved that iron contained in foods in the form of heme (meat, liver, fish) is better absorbed in the body than from other compounds. About 90% of iron is absorbed in the duodenum, the rest - in the upper jejunum. In iron-deficient conditions, the absorption surface of the small intestine increases. Iron is absorbed in 2 forms:

Heme (10%), the sources of which are hemoglobin and myoglobin, which are part of animal products (meat, fish, poultry, liver) (Table 1);

Non-heme (90%), the sources of which are plant products (vegetables, fruits, cereals) (Table 2).

The amount of iron supplied during the day with food contains about 10-12 mg of iron (heme + non-heme), but only 1-1.2 mg of the trace element is absorbed from this amount. It has been established that the bioavailability of heme iron in food products is higher than that of non-heme compounds, and is 25-30%.

The majority of dietary iron is in the non-heme form. The bioavailability of iron from cereals, legumes, tubers, vegetables, and fruits is significantly lower than from heme compounds, and largely depends on the predominance of factors in the diet that inhibit or potentiate intestinal ferroabsorption (Table 3).

Despite the high content of iron in some products of plant origin, they are not able to provide them with the child's body. Substances present in foods of plant origin (tannins, phytins, phosphates) form insoluble compounds with Fe (III) and are excreted with feces. There is also evidence of an adverse effect on the absorption of iron by dietary fiber, which is rich in cereals, fresh vegetables, and fruits. In the intestine, dietary fiber is practically not digested, iron is fixed on their surface and excreted in the feces. On the contrary, ascorbic acid, animal protein (meat, fish) increase the bioavailability of iron, which increase the absorption of the trace element. It should also be noted that products from meat, liver, fish, in turn, increase the absorption of iron from vegetables and fruits with their simultaneous use.

A complete and balanced diet according to the main ingredients only allows you to “cover” the physiological need of the body for iron, but not eliminate its deficiency.

Natural prevention of IDA in children of the first months of life is exclusive breastfeeding up to 4-6 months. It is known that the concentration of iron in women's milk is only 0.2-0.4 mg / l, however, the absorption of iron from it reaches 50%, which meets the needs of the child for the first 4-6 months. By the time the child's body weight has doubled (5-6 months), antenatal iron stores in his body are depleted.

In order to prevent IDA with artificial feeding, it is advisable for children at risk for the development of IDA to use mixtures enriched with iron. They are prescribed for full-term children at risk (from twins, triplets, with a large increase in weight), starting from 3-5 months of life, and for premature babies - from 1.5-2 months. The content of iron in mixtures for artificial feeding of children in the first six months of life is 3-5-8 mg / l of the mixture, and for children in the second half of the year - 10-14 mg / l.

The inclusion of complementary foods enriched with iron in the diet of children (fruit juices, fruit and vegetable purees, instant cereals) significantly increases the amount of iron that enters the child's body with food.

For children aged 4–6 months who are breastfed, and for infants after 6 months of age who do not receive iron-fortified nutrition, it is advisable to prescribe iron supplements at a prophylactic dose of 1–2 mg/kg/day until 12–18 months of age.

IDA in young children has been linked to the early ingestion of high-protein cow or goat milk. It should be noted that the development of IDA in these children is associated not only with a low level of iron in cow's milk, its poor absorption, but also with the loss of iron due to microdiapedetic intestinal bleeding. Numerous studies have noted the relationship between the amount of unadapted product consumed (milk, kefir) and the severity of microdiapedetic intestinal blood loss in infants. It was noted that sensitivity to non-adapted products decreases with age, and after 2 years of life, microdiapedetic intestinal bleeding is not observed while taking cow's milk. The mechanism underlying the increased excretion of hemoglobin in the feces during the intake of non-adapted dairy products in young children is not exactly known. Some authors associate microdiapedetic intestinal bleeding with intolerance to cow's milk proteins.

The choice of a drug for the correction of IDA is of particular importance, since the duration of treatment can be from several weeks to several months. At the same time, not only efficiency is important, but also the absence of side effects and complications, adherence to ongoing therapy, especially in pediatric practice.

Currently, all iron preparations are divided into two groups (Table 4):

Ionic iron-containing preparations (salt, polysaccharide iron compounds);

Non-ionic compounds, which include preparations represented by the hydroxide-polymaltose complex (HPC) of ferric iron.

Therapy of iron deficiency states should be aimed at eliminating the cause and at the same time replenishing iron deficiency with medicinal Fe-containing preparations.

Therapy of iron deficiency states should be carried out mainly with iron preparations for oral administration.

Oral administration of Fe preparations:

Increases the level of hemoglobin only 2-4 days later than with parenteral administration;

Unlike parenteral, it rarely leads to serious side effects;

Even with an incorrect diagnosis, it does not lead to the development of hemosiderosis.

Parenteral administration of iron preparations is indicated only for special indications (impaired intestinal absorption syndrome, condition after extensive resection of the small intestine).

Requirements for oral iron preparations used in pediatric practice:

Good bioavailability;

High security;

Pleasant organoleptic properties;

Various dosage forms, convenient for patients of all ages;

Compliance.

For young children, it is preferable to prescribe iron-containing preparations, produced in the form of drops, syrup. Good for children of this age group Aktiferrin (drops, syrup), Maltofer (drops, syrup), Ferrum Lek (syrup), Hemofer (drops) (Table 5).

For adolescent children, it is best to prescribe iron preparations such as Ferrum Leka (chewable tablets) or Tardiferon and Ferrogradum, which are slowly absorbed, providing a prolonged and uniform absorption of medicinal iron in the intestine. As a rule, these drugs are well tolerated by patients.

After choosing an iron-containing drug and the method of its use, it is necessary to determine the daily daily dose of the drug and the frequency of administration (Table 6).

Iron (III) preparations - HPA are used in children with IDA of different ages at a therapeutic dose of 5 mg / kg / day.

In latent iron deficiency, all iron preparations are used at half the therapeutic dose.

Prophylactic doses of iron preparations:

For children under 3 years old - 1-1.5 mg / kg / day;

For children over 3 years old - 1/2 daily therapeutic dose.

It is known that treatment with saline preparations can be accompanied by stool disorders, and therefore therapy with ferrous iron preparations must be started with a dose equal to 1/4-1/2 of the calculated therapeutic dose, followed by a gradual achievement of the full dose within 7-14 days. The rate of "gradual increase" of the dose to the therapeutic dose depends both on the severity of iron deficiency, and on the state of the gastrointestinal tract and individual tolerability of the drug. This technique allows you to choose an individual dose depending on tolerance and reduce the risk of side effects of therapy with iron salt preparations.

It is well known that iron salt preparations in the intestinal lumen interact with food components, drugs, hindering the absorption of iron. In this regard, iron salt preparations are recommended to be administered 1 hour before a meal. The appointment of drugs Fe (III) - GPA does not require the use of a method of gradual increase in dose. The drugs of this group are prescribed immediately in a full dose, regardless of food, since food does not affect their absorption.

The therapeutic effect of oral iron appears gradually. Initially, there is a clinical improvement, and only after some time does the normalization of hemoglobin occur. The first positive clinical sign that appears during treatment with iron preparations is the disappearance or reduction of muscle weakness. The latter is due to the fact that iron is part of the enzymes involved in the contraction of myofibrils. On the 10-12th day from the start of treatment, the content of reticulocytes in the peripheral blood increases. The increase in hemoglobin can be gradual or abrupt. Most often, the beginning of the rise in hemoglobin levels occurs 3-4 weeks after the start of therapy. As numerous studies have shown, the disappearance of the clinical manifestations of the disease is noted by 1-2 months of therapy, and the disappearance of tissue sideropenia occurs at 3-6 months of treatment. The daily dose of elemental iron after normalization of the hemoglobin level should correspond to 1/2 of the therapeutic dose (Table 7). Early discontinuation of iron therapy usually results in relapses of IDA. The duration of the main course of treatment with iron preparations is 6-10 weeks, depending on the severity of the identified iron deficiency anemia. The duration of the prophylactic course with iron preparations in order to create an iron depot in the body is:

With mild anemia - 1.5-2 months;

With moderate anemia - 2 months;

With severe anemia - 2.5-3 months.

Criteria for the effectiveness of treatment with iron preparations:

The appearance of a reticulocyte crisis on the 7-10th day of treatment;

Increase in hemoglobin level - 10 g/l per week;

The refractoriness of iron deficiency anemia is due to the inadequacy of the prescribed therapy or anemia not associated with iron deficiency!

Parenteral drugs in the treatment of iron deficiency anemia should be used only under strict indications!

Indications for parenteral administration of iron preparations:

Short bowel syndrome.

Malabsorption Syndrome.

Nonspecific ulcerative colitis.

Chronic enterocolitis.

Parenteral preparations are best used not daily, but at intervals of 1-2 days. In this case, half the dose can be used in the first 1-3 injections.

Given the duration of ferrotherapy, the choice of drugs for the correction of IDA in young children requires special attention. Both iron salt preparations and preparations of Fe(III)-HPA of the polymaltose complex are effective in the treatment of WDN. Side effects and adverse events in oral ferrotherapy of IDA are mainly associated with excess recommended doses and are more often manifested by dyspepsia. Adverse reactions and adverse effects that may develop with ferrotherapy in children are summarized in Table 8.

Parenteral iron preparations should be used only strictly for special indications.

Transfusions of blood or red blood cells in IDA are carried out extremely rarely and strictly for health reasons. The criteria for hemotransfusion is a decrease in hemoglobin below a critical level in combination with signs of impaired central hemodynamics, hemorrhagic shock, anemic precoma, and hypoxic syndrome (Table 9). Hemotransfusion can also be carried out at hemoglobin and hematocrit values ​​above critical if massive acute blood loss occurs.

The effect of blood transfusions in IDA is short-lived. A negative effect of blood transfusions on erythropoiesis was noted. In addition, there is a high risk of transfusion infection of the recipient. In the presence of vital indications for replacement blood transfusion, preference is given to erythrocyte mass or washed erythrocytes at the rate of 10-15 ml/kg of mass. Older children are usually transfused from 150 to 250 ml. Whole blood has not been used in pediatric practice in recent years.

Prevention of IDA in children includes:

1. Antenatal prophylaxis:

For all women in the second half of pregnancy, it is advisable to prophylactically prescribe oral ferropreparations or multivitamins enriched with iron.

2. Postnatal prophylaxis:

Natural feeding with the timely introduction of complementary foods (meat puree from 6-7 months);

For children who are bottle-fed, from 2-3 months the introduction of mixtures enriched with iron (12 mg / l);

Premature, children from multiple pregnancies, born with a large body weight, having a rapid rate of weight and growth increase, from the 3rd month to the end of the first half of the year, it is recommended to take prophylactic iron preparations at a dose equal to 1/3-1/2 of the daily therapeutic dose of an elementary iron (1.0-1.5 mg / kg / day).

Vaccination of children with IDA is carried out after the normalization of hemoglobin levels.

Removal from the dispensary registration is carried out in a year.