The reasons are awaiting in adults. Anemia: Symptoms and Treatment in Adult Women. What is anemia in an adult?

Iron deficiency anemia is a disease characterized by a decrease in the level of hemoglobin in the blood. According to research results, about 2 billion people in the world suffer from this form of anemia of varying severity.

Children and lactating women are most susceptible to this disease: every third child in the world suffers from anemia, almost all lactating women have varying degrees of anemia.

This anemia was first described in 1554, and drugs for its treatment were first used in 1600. It is a serious problem that threatens the health of society, since it has no small effect on performance, behavior, mental and physiological development.

This significantly reduces social activity, but, unfortunately, anemia is often underestimated, because gradually a person gets used to a decrease in iron stores in his body.

Causes of iron deficiency anemia

What it is? Among the causes of iron deficiency anemia, there are several. There is often a combination of reasons.

Iron deficiency is often experienced by people whose body requires an increased dose of this trace element. This phenomenon is observed with increased growth of the body (in children and adolescents), as well as during pregnancy and lactation.

Having enough iron in the body depends a lot on what we eat. If the diet is unbalanced, food intake is irregular, and the wrong foods are consumed, then in aggregate, all this will cause a lack of iron intake into the body with food. By the way, the main food sources of iron are meat: meat, liver, fish. There is relatively much iron in eggs, beans, beans, soybeans, peas, nuts, raisins, spinach, prunes, pomegranate, buckwheat, and black bread.

Why does iron deficiency anemia appear, and what is it? The main reasons for this ailment are as follows:

Insufficient intake of iron with nutrition, especially in newborns.
Violation of absorption processes.
Chronic blood loss.
Increased need for iron during intensive growth in adolescents, during pregnancy and lactation.
Intravascular hemolysis with hemoglobinuria.
Disruption of iron transport.

Even a minimal bleeding of 5-10 ml / day will result in a loss of 200-250 ml of blood per month, which corresponds to approximately 100 mg of iron. And if the source of latent bleeding is not established, which is quite difficult due to the absence of clinical symptoms, then after 1-2 years the patient may develop iron deficiency anemia.

This process occurs faster in the presence of other predisposing factors (impaired iron absorption, insufficient iron intake, etc.).

How is IDA developing?

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

Degrees

The degree of iron deficiency anemia in terms of hemoglobin content:

light - hemoglobin does not drop below 90 g / l;
medium - 70-90 g / l;
severe - hemoglobin below 70 g / l.

Normal level of hemoglobin in the blood:

in women - 120-140 g / l;
in men - 130-160 g / l;
in newborns - 145-225 g / l;
in children 1 month. - 100-180 g / l;
in children 2 months. - 2 years. - 90-140 g / l;
in children 2-12 years old - 110-150 g / l;
in children 13-16 years old - 115-155 g / l.

At the same time, the clinical signs of the severity of anemia do not always correspond to the severity of anemia according to laboratory criteria. Therefore, the proposed classification of anemias according to the severity of clinical symptoms.

1 degree - there are no clinical symptoms;
2 degree - moderate weakness, dizziness;
3 degree - there are all clinical symptoms of anemia, disability;
4 degree - represents a serious condition of precoma;
Grade 5 - is called "anemic coma", lasts several hours and is fatal.

Signs of a latent stage

Latent (latent) iron deficiency in the body can lead to symptoms of sideropenic (iron deficiency) syndrome. They have the following character:

muscle weakness, fatigue;
decreased attention, headaches after mental stress;
gravitation for salty and spicy, spicy foods;
sore throat;
dry pale skin, pallor of the mucous membranes;
fragility and pallor of the nail plates;
dull hair.

Somewhat later, anemic syndrome develops, the severity of which is also due to erythrocytes in the body, as well as the rate of development of anemia (the faster it develops, the more pronounced the clinical manifestations will be), the compensatory capabilities of the body (in children and the elderly, they are less developed) and the presence of concomitant diseases.

Iron deficiency anemia symptoms

Iron deficiency anemia develops slowly, so its symptoms are not always pronounced. With anemia, nails often exfoliate, deform and break, hair splits, the skin becomes dry and pale, weakness, malaise, dizziness, headache, flashes of flies before the eyes, fainting appear, appear.

Very often in patients with anemia, there is a change in taste, an irresistible craving for non-food products such as chalk, clay, raw meat appears. Many are attracted by strong odors, for example, gasoline, enamel paint, acetone. The complete picture of the disease is revealed only after the general one.

IDA diagnostics

In typical cases, the diagnosis of iron deficiency anemia is straightforward. Often, the disease is detected in the tests taken for a completely different reason.

In the hand made, the color index of the blood, and the hematocrit are revealed. When performing the KLA on the analyzer, changes are found in erythrocyte indices, which characterize the hemoglobin content in erythrocytes and the size of erythrocytes.

The identification of such changes is the reason for the study of iron metabolism. More details about the assessment of iron metabolism are disclosed in the article on iron deficiency.

Treatment of iron deficiency anemia

In all cases of iron deficiency anemia, before starting treatment, it is necessary to establish the immediate cause of this condition and, if possible, eliminate it (most often, eliminate the source of blood loss or conduct therapy for the underlying disease, complicated by sideropenia).

Treatment of iron deficiency anemia in children and adults should be pathogenetically grounded, comprehensive and aimed not only at eliminating anemia as a symptom, but also at eliminating iron deficiency and replenishing its reserves in the body.

The classic treatment regimen for anemia:

elimination of the etiological factor;
organization of proper nutrition;
taking iron supplements;
prevention of complications and relapses of the disease.

With the correct organization of the above procedures, you can count on getting rid of the pathology within a few months.

Iron preparations

In most cases, the iron deficiency state is eliminated with the help of iron salts. The most affordable drug for the treatment of iron deficiency anemia today is iron sulfate in tablets, it contains 60 mg of iron, and it is taken 2-3 times a day.

Other iron salts, such as gluconate, fumarate, lactate, also have good absorption properties. Considering that the absorption of inorganic iron with food decreases by 20-60%, it is better to take such medications before meals.

Possible side effects from iron preparations:

metallic taste in the mouth;
abdominal discomfort;
constipation;
diarrhea;
nausea and / or vomiting.

The duration of treatment depends on the patient's ability to absorb iron and continues until laboratory blood parameters (erythrocyte, hemoglobin, color index, serum iron level and iron-binding capacity) return to normal.

After elimination of the signs of iron deficiency anemia, the use of the same drug is recommended, but in a reduced prophylactic dose, since the main focus of treatment is not so much elimination of signs of anemia, but rather replenishment of iron deficiency in the body.

Diet

The diet for iron deficiency anemia is the consumption of foods rich in iron.

Shown full nutrition with the obligatory inclusion in the diet of foods containing heme iron (veal, beef, lamb, rabbit meat, liver, tongue). It should be remembered that ascorbic, citric, succinic acids contribute to the enhancement of ferrosorption in the gastrointestinal tract. Oxalates and polyphenols (coffee, tea, soy protein, milk, chocolate), calcium, dietary fiber and other substances inhibit the absorption of iron.

However, no matter how much we eat meat, only 2.5 mg of iron will get into the blood from it per day - this is exactly how much the body can assimilate. And from iron-containing complexes, 15-20 times more is absorbed - that is why it is not always possible to solve the problem of anemia with the help of diet alone.

Output

Iron deficiency anemia is a dangerous condition that requires an adequate approach to treatment. Only long-term intake of iron preparations and elimination of the cause of bleeding will lead to getting rid of the pathology.

To avoid serious complications from treatment, laboratory blood tests should be constantly monitored throughout the course of therapy for the disease.

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Anemia is popularly called anemia. It is not a disease in its own right. This term denotes a pathological condition that is determined in a laboratory way and requires further examination and diagnosis. With anemia, there is a reduced concentration of red cells or hemoglobin in the blood, which they contain. Usually, the hemoglobin content per unit of blood volume decreases simultaneously with a decrease in the level of red blood cells. Anemia is more common in women of reproductive age, in children, pregnant women, girls from 14 to 18 years old.

The main role of red blood cells is to transport oxygen to the organs. With anemia, oxygen deficiency develops, which is due to a decrease in the volume of red blood cells. Therefore, the main manifestation of anemia is hypoxia, which is characterized by the following symptoms:

palpitations;
feeling tired;
quickly onset fatigue;
dyspnea;
general weakness;
low efficiency.

The same symptomatology is observed with pulmonary and cardiac pathologies. In the first case, the reason for the lack of oxygen is a violation of gas metabolism, in the second it is due to the fact that red blood cells do not get to the tissues. If signs of hypoxia appear, a complete blood count is required first. Thus, first, the presence of anemia is detected during laboratory tests, then the identification of its causes follows.

Iron-deficiency anemia

Anemia is common and the overwhelming majority is iron deficiency anemia. In women, as mentioned above, it is observed more often than in men. Pregnant women who share iron with the fetus often suffer. According to statistics, more than 15% of all women suffer from anemia, among pregnant women this number exceeds 30%. Iron deficiency anemia is caused by a lack of iron. At risk are women who have heavy periods.

The classification of anemias is rather difficult and still does not exist uniformly. Iron deficiency has several varieties, due to the following reasons:

significant blood loss (post-hemorrhagic chronic anemia);
pregnancy;
insufficient intake of iron from food;
violation of its absorption in the intestine;
violation of the transfer of iron;
increased need for iron.

There is a clinical classification. According to the severity, it is customary to distinguish five forms:

asymptomatic;
with moderate manifestations;
severe symptoms;
precom;
coma anemic.

Symptoms

Pallor of the skin is one of the characteristic signs of iron deficiency anemia

The manifestations of iron deficiency anemia can be common to all forms and specific. Among them are the following:

shortness of breath, chest pain, palpitations;
headache, dizziness;
quickly onset fatigue, weakness, decreased performance;
distortion of taste, desire to eat inedible: chalk, clay, lime, raw cereals, toothpaste, ice;
the smell of fuel oil, gasoline, acetone, etc .; becomes pleasant;
difficulty swallowing food, feeling of a foreign object in the throat;
urinary incontinence;
darkening in the eyes;
pale mucous membranes and skin, the skin becomes flabby and dry, flakes off, acquires a greenish tint;
violations of the cycle of menstruation;
changes in the language of a trophic nature and pain when eating spicy food;
changes in the nail plate: it becomes flat or concave, fragility is noted;
hair changes: dryness, loss, brittleness, dullness;
parasthesia;
muscle weakness (this symptom is absent in other types of anemia);
cold fingers;
loss of appetite, desire to eat salty, sour, spicy foods;
sometimes loss of consciousness;
low hemoglobin levels in blood tests.

Iron deficiency anemia develops slowly and does not always have symptoms. With low hemoglobin in the analysis, any manifestations may be absent, and the woman is not even aware of her pathological condition. Women who lead an active life discover problems more quickly. For example, with significant physical exertion, fatigue, malaise and loss of strength can be noticed more quickly.

Diagnostics

Diagnosis of iron deficiency anemia is quite simple. Its presence is indicated primarily by laboratory tests and characteristic symptoms. In a blood test, red blood cells are often reduced in size and faintly colored in the center. The doctor asks the patient in detail about how long ago the weakness, dizziness appeared, what he associates them with, what chronic and hereditary diseases are, then makes a record and analyzes the anamnesis. The patient is examined, the skin is assessed, the pulse and pressure are checked. If low hemoglobin is found in the blood, additional tests are prescribed to determine the type of anemia. In addition, hardware studies are carried out to clarify the cause of the pathological condition. Be sure to carry out differential diagnosis with other anemias.

Treatment

With iron deficiency anemia, complex treatment is carried out under the supervision of a doctor. Nutrition, general daily regimen and prevention are of great importance. The disease that caused the anemia is eliminated. The goal of the doctor is to eliminate iron deficiency and symptoms.

Eating foods high in iron is the key to successful treatment of iron deficiency anemia

The main treatment is to take iron supplements for a long time. The course can last from four to six months, depending on the severity. The therapy includes vitamins, namely: ascorbic acid, which increases the absorption of iron two to three times, vitamins A, E, B 6, B 1, B 2, as well as antioxidants, cytoprotectors, membrane stabilizers and others. In severe forms of anemia, as well as in case of drug intolerance and gastrointestinal diseases (enteritis, ulcerative colitis), injections are prescribed.

Nowadays, there are many drugs available for the treatment of iron deficiency anemia, which differ in their composition and action. Preference is most often given to products with ferrous iron. The drug is selected individually, taking into account contraindications. The medicine should have as few side effects as possible, have an optimal iron content. In addition, the preparation must contain additional components that enhance the absorption of iron. The effectiveness of medications is judged by changes in the general blood test after taking them. As a rule, after ten days, an increase in hemoglobin levels occurs. Of the preparations containing iron, the following can be called:

Feramide,
Jectofer,
Totem,
Ferrum Lek,
Conferon,
Sorbifer durules,
Ferroplex,
Maltofer.

Treatment for iron deficiency anemia involves special nutrition. The menu should include more meat food, at the same time, you will have to limit dairy products, since the calcium they contain interferes with the absorption of iron. Health food consists of the following products:

meat (beef and pork liver, veal, kidney, turkey, rabbit);
a fish;
egg white;
products from cereals (puddings, cereals);
vegetable food (bread, beans, peas, soybeans, spinach, parsley, prunes, raisins, dried apricots, rice, buckwheat).

Complications and prognosis

Iron deficiency anemia can have the following consequences:

decreased memory and attention;
irritability;
worsening of the condition with existing diseases of the internal organs;
coma as a result of insufficient supply of oxygen to the brain.

The prognosis depends on various factors: the degree of severity, the actions of the doctor, the patient himself. In general, with timely diagnosis and correct therapy, the prognosis is favorable.

Conclusion

Iron deficiency anemia is a serious pathological condition that requires constant medical supervision. Self-treatment is not allowed in this case. For the purpose of prevention, it is necessary to monitor the state of the blood, consume more liver and red meat, take iron preparations, and prevent severe bleeding.

Iron deficiency anemia symptoms, treatment and causes

Iron deficiency anemia (anemia) is a pathological syndrome characterized by a decrease in the number of red blood cells and blood hemoglobin. It is the main hypoxia of tissues and organs, since against the background of a lack of erythroid germ, little oxygen is delivered to the cells.

This condition is especially dangerous for the brain. Nerve cells die during hypoxia, which leads to a gradual degradation of the personality. At the initial stages of the disease, a person feels constant fatigue and decreased performance. If, with these symptoms, a laboratory blood test is performed, it determines a decrease in the level of hemoglobin and red blood cells.

What it is?

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

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

Why iron deficiency causes disease

It has been established that the mechanism of the disease is associated with a deficiency of the iron mineral in the blood. Its role is difficult to exaggerate. Indeed, of the total amount, 70% are directly involved in the construction of hemoglobin. This means that iron is an irreplaceable material for the retention of oxygen molecules by erythrocytes and the subsequent process of transfer from the pulmonary vesicles to the tissue.

Any variant of iron deficiency leads to a decrease in the synthesis of hemoglobin and oxygen starvation of the whole organism.

Other mechanisms affecting iron levels

It is important not only the intake of the mineral with food (iron is not produced in the body), but also the correct process of its assimilation and transfer.

A special protein (transferrin) is responsible for the absorption of iron molecules from the duodenum. It delivers Fe to the bone marrow, where red blood cells are synthesized. The body forms a "storehouse" in the liver cells for quick replenishment in case of acute deficiency. Stocks are stored as hemosiderin.

If you decompose all the iron-containing forms in parts, you get the following:

2/3 falls on hemoglobin;
for reserves in the liver, spleen and bone marrow in the form of hemosiderin - 1 g;
for the transport form (serum iron) - 30.4 mmol / l;
for the respiratory enzyme cytochrome oxidase - 0.3 g.

Accumulation begins in the prenatal period. The fetus takes some of the iron from the mother's body. Mother's anemia is dangerous for the formation and laying of internal organs in a child. And after birth, the baby should receive it only with food.

The excretion of excess mineral occurs with urine, feces, through the sweat glands. In women from adolescence to menopause, there is still a way of menstrual bleeding.

About 2 g of iron is excreted per day, which means that no less amount should be ingested with food.

The maintenance of the necessary balance to ensure tissue respiration depends on the correct functioning of this mechanism.

Causes of occurrence

A necessary condition for the development of insufficiency is the excess of iron intake by tissues over its intake. Iron deficiency is triggered by the following conditions (listed by prevalence):

Blood loss

chronic (daily blood loss 5-10 ml)

frequent nosebleeds;
stomach and intestinal bleeding;
profuse menstruation;
kidney pathology with characteristic hematuria.

Acute (massive blood loss)

trauma, extensive burns;
uncontrolled donation;
pathological bleeding (for example, uterine bleeding in oncopathology, etc.).

Insufficient iron intake

exhausting diets and starvation;
unbalanced diet;
vegetarianism.

Decreased levels of absorbed iron

gastrointestinal diseases, helminthic invasion;
senile and infant age.

Increasing the level of essential iron

active growth (1-2 years and adolescence);
pregnancy, lactation (the need for iron doubles to 30 mg / day);
the formation of the menstrual cycle;
physical activity, sports;
frequent inflammation (ARVI, etc.).

Congenital anemia in children

premature pregnancy
anemia in a pregnant woman.

Severity

Depending on the depth of iron deficiency, there are 3 degrees of severity of IDA:

Easy - hemoglobin values are in the range of 110 - 90 g / l;
Medium - the Hb content ranges from 90 to 70 g / l;
Severe - the hemoglobin level falls below 70 g / l.

A person begins to feel bad already at the stage of latent deficiency, but the symptoms will become clearly visible only with sideropenic syndrome. Before the appearance of the clinical picture of iron deficiency anemia in full, it will take another 8 - 10 years, and only then a person who is little interested in his health will find out that he has anemia, that is, when hemoglobin decreases noticeably.

Iron deficiency anemia symptoms

The main signs of iron deficiency anemia in women and men:

dyspnea;
violation of taste and smell;
tendency to infectious diseases;
defeat of the tongue;
increased fatigue;
changes in skin (peeling and redness) and nails / hair (stratification, loss);
damage to the mucous membranes (for example, stomatitis-type ulcers may appear in the oral cavity);
violations of intellectual development - concentration of attention decreases, the child begins to poorly assimilate educational material, memory decreases;
muscle weakness.

Moreover, in the clinical picture of iron deficiency anemia, 2 main syndromes are distinguished:

hyposiderosis;
anemic syndrome.

Anemic syndrome

This syndrome is manifested by nonspecific signs characteristic of all anemias:

shortness of breath that occurs with minimal physical exertion;
interruptions in the work of the heart;
dizziness when changing body position;
tinnitus.

The severity of the above symptoms depends on the rate of decrease in hemoglobin. Iron deficiency anemia is chronic, so patients are able to adapt to its manifestations.

In some cases, the first complaints of iron deficiency anemia may be:

fainting;
attacks of angina pectoris;
decompensation of vascular lesions of the brain.

Hyposiderosis

The symptoms of hyposiderosis are associated with a lack of iron in the tissues. This is accompanied by:

deterioration of the hair structure with delamination of the ends;
signs of asthenia;
excessive dryness of the skin, amenable to minimal correction with moisturizing cosmetics;
pathological changes in the nails, transverse striation of the nail plate, a change in its shape;
violation of the protective properties of the body with frequent viral diseases;
the appearance of angular stomatitis, manifested by cracks with areas of inflammation in the corners of the mouth;
signs of inflammatory lesions of the tongue;
discoloration of the skin to a pale greenish tint;
unusual eating habits (desire to eat chalk, ash and other substances);
addiction to unusual smells;
blue sclera due to dystrophic changes in the cornea of the eye against the background of iron deficiency.

According to the latest studies by pediatricians and hematologists, children with tissue iron deficiency have mental retardation. This is due to a violation of the processes of myelination of nerve fibers with a decrease in the electrical activity of the brain. Also, young patients have a high risk of developing heart failure, however, no clear mechanisms of myocardial damage in hyposiderosis have been identified.

Diagnostics

Diagnosis of the condition, as well as the determination of the degree of its severity are carried out according to the results of laboratory tests. For iron deficiency anemia, the following changes are characteristic:

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

To effectively treat iron deficiency anemia, it is important to establish the underlying cause. In order to detect the source of chronic blood loss, the following is shown:

FEGDS;
irrigoscopy;
ultrasound examination of the pelvic organs;
X-ray of the stomach with contrast;
colonoscopy;
fecal occult blood tests.

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

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

Treatment of iron deficiency anemia

Treatment of iron deficiency anemia is carried out only by long-term intake of ferric iron preparations inside in moderate doses, and a significant increase in hemoglobin, in contrast to improvement in well-being, will not be quick - after 4-6 weeks.

Usually, any ferrous iron preparation is prescribed - more often it is ferrous sulfate - its better prolonged dosage form, in an average therapeutic dose for several months, then the dose is reduced to a minimum for a few more months, and then (if the cause of anemia is not eliminated), the maintenance minimum is continued. doses for a week, monthly, for many years.

So, this practice has proven itself well in the treatment of women with tardiferon with chronic post-hemorrhagic iron deficiency anemia due to long-term hyperpolymenorrhea - one tablet in the morning and evening for 6 months without interruption, then one tablet a day for another 6 months, then for several years every day for a week on the days of menstruation ... This provides an iron load with the appearance of prolonged, abundant menstruation during menopause. A senseless anachronism is the determination of the hemoglobin level before and after menstruation.

With agastral (gastrectomy for a tumor) anemia, a good effect is given by taking a minimum dose of the drug constantly for many years and the introduction of vitamin B12 at 200 micrograms per day intramuscularly or subcutaneously for four weeks in a row every year for life.

Pregnant women with iron deficiency and anemia (a slight decrease in the level of hemoglobin and the number of red blood cells is physiological due to moderate hydremia and does not require treatment) are prescribed an average dose of iron sulfate by mouth before childbirth and during breastfeeding, if the child does not have diarrhea, which usually happens rarely.

Popular iron supplements

Currently, a wide range of drugs that increase the iron content in the body are presented to the attention of doctors and patients.

The most effective medications for increasing iron concentration include:

Ferrum Lek;
Maltofer;
Ferroplex;
Hemofer;
Ferrocerone; (stains urine pink);
Tardiferon;
Ferrogradumet;
Heferol;
Ferograd;
Sorbifer-durules.

Preparations for parenteral administration are prescribed in case of impaired absorption of iron in the gastrointestinal tract (gastric resection, gastric ulcer and 12 duodenal ulcer in the acute phase, resection of large areas of the small intestine).

When prescribing drugs for intravenous and intramuscular administration, first of all, you need to remember about allergic reactions (feeling of heat, palpitations, pain behind the sternum, in the lower back and calf muscles, metallic taste in the mouth) and the possible development of anaphylactic shock.

The list of ferrum-containing preparations is not a guide to action, prescribing and calculating the dose is the business of the attending physician. Therapeutic doses are prescribed until the hemoglobin level is normalized, then the patient is transferred to prophylactic doses.

How long should I take iron supplements?

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

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

Side effects

Most often, when treating with iron preparations, the following side effects are observed: a metallic taste in the mouth, darkening of the enamel of the teeth, allergic skin rashes, digestive disorders as a result of irritating effects on the mucous membrane of the digestive tract, especially the intestines (loose stools, nausea, vomiting). Therefore, the initial doses of drugs should be 1 / 3–1 / 2 of the therapeutic dose, followed by their increase to the full dose over several days in order to avoid the occurrence of pronounced side effects.

Intramuscular administration of iron preparations is carried out only under strict indications due to the development of pronounced local and systemic side effects. Indications for intramuscular administration of iron preparations are as follows: diseases of the digestive tract (syndrome of impaired intestinal absorption, ulcerative colitis, chronic enterocolitis, gastrointestinal bleeding) and intolerance to iron-containing preparations when taken by mouth.

Contraindications to the appointment of iron preparations are anemias not caused by iron deficiency (hemolytic, aplastic), hemosiderosis, hemochromatosis.

Diet

The International Association of Hematologists claims that with the normalization of the eating behavior of a patient with signs of a mild degree of iron deficiency anemia, it is possible to significantly normalize blood counts and not resort to the use of iron preparations to eliminate the iron deficiency state. Patients with severe anemia are shown to use a specialized diet as an adjunct to the main treatment.

The fundamental principles of nutritional therapy for iron deficiency anemia is a sharp restriction of the intake of fats of both vegetable and animal origin, as well as enrichment with foods containing a large amount of protein. It has been proven that carbohydrates do not affect the absorption of iron by the body in any way, so their consumption should not be limited.

In order to replenish the iron level necessary for normal blood formation, it is necessary to include in the patient's diet a large amount of foods containing iron (liver, beef tongue, lean turkey meat, red sea fish, buckwheat and millet groats, blueberries and peaches). A large percentage of iron is also found in all types of greens, beef and eggs. Among fruits, persimmons, quince and apples, raw or baked, should be preferred.

From the diet of patients with iron deficiency anemia, it is recommended to completely exclude milk products and black tea, as they contain in their composition substances that prevent the absorption of iron. In contrast, synergistic foods that should be consumed in large quantities with iron-containing foods are those that contain a high percentage of vitamin C (sorrel, currants, sauerkraut, freshly squeezed fruit and citrus juices with pulp).

Features of anemia during pregnancy

The reasons for the development of iron deficiency anemia in women are considered periods of heavy menstruation, as well as the processes of pregnancy and childbirth. However, iron deficiency does not always occur during the period of bearing a child, there are special prerequisites for this:

chronic anemia in a woman;
diseases of internal organs;
frequent pregnancies and childbirth;
carrying twins or triplets;
acute toxicosis or unhealthy diet.

Iron deficiency anemia in pregnant women is expressed by symptoms that can be easily confused with toxicosis and only with a pronounced deficiency do the signs become apparent.

With an asymptomatic course of the disease, a blood test will help to identify anemia, and in severe stages its symptoms are: dizziness, shortness of breath, pallor and dry skin, changes in taste and hair loss. Anemia does not always go away on its own after childbirth; it often has to be treated even during pregnancy. Treatment for a pregnant woman is prescribed by a doctor, taking into account the reasons for the deficiency. Women are prescribed a course of ferrous iron preparations in combination with folic acid.

Complications of iron deficiency anemia

Complications occur with prolonged course of anemia without treatment and reduce the quality of life.

decreased immunity,
a rare and severe complication is hypoxic coma,
increased heart rate, which leads to greater stress on the heart and ultimately to heart failure,
pregnant women have an increased risk of premature birth and fetal growth retardation,
in children, iron deficiency leads to a delay in growth and development,
hypoxia due to iron deficiency complicates the course of existing cardiopulmonary diseases (coronary artery disease, bronchial asthma, bronchiectasis and others).

Prevention

WHO experts formulated the main dogmas of preventive measures aimed at reducing the prevalence of iron deficiency anemia among the population. The main ways to achieve this goal are:

eating food enriched with an easily digestible form of iron;
the use of agents that improve the absorption of iron (the various vitamins mentioned above);
treatment of chronic foci of infections.

Prevention should be carried out, according to experts of the World Health Organization, at the population level, since early signs of iron deficiency anemia are observed in almost 25% of the world's population. And this is far from a small figure, and the consequences of the disease are very unpleasant.

In addition, the prevention of iron deficiency anemia is divided into primary, secondary and, accordingly, tertiary. The primary goal is to eliminate the main factor contributing to the anemization of the body, the secondary goal is to timely identify the signs, correctly diagnose and treat the disease in time. The goal of tertiary prevention is to minimize possible complications.

Forecast

In the overwhelming majority of cases, iron deficiency anemia is successfully corrected, the signs and symptoms of anemia recede. However, if left untreated, complications develop and the disease progresses.

If you have a low hemoglobin level, then you need to undergo a complete clinical and laboratory examination and identify the cause of the anemia. A correct diagnosis is the key to successful treatment.

Iron deficiency anemia is a syndrome caused by iron deficiency and leading to impaired hemoglobinopoiesis and tissue hypoxia. It occurs, as a rule, with chronic blood loss or insufficient intake of iron in the body. Manifestations of iron deficiency are present in 60% of the adult population after 50 years. The latent period symptoms of iron deficiency anemia are often overlooked or mistaken for other illnesses.

Causes

Iron deficiency anemia (IDA) used to be better known as anemia. It is the most common pathology of the blood system and the most common.

Code for the international classification of diseases ICD-10: iron deficiency anemia - D50.

According to the WHO (World Health Organization), more than 2 billion people on the planet are deficient in iron in their bodies. Iron is part of most enzymes and is the main constituent of hemoglobin. Without it, the hematopoietic process and respiration, various vital oxidative and reducing reactions are impossible.

The development of iron deficiency and subsequent anemia can be due to various mechanisms. Most often, iron deficiency anemia is caused by chronic blood loss:

heavy menstruation
dysfunctional uterine bleeding;
gastrointestinal bleeding from erosions of the mucous membrane of the stomach and intestines,
gastroduodenal ulcers,
hemorrhoids,
anal fissures, etc.

The main reasons for the deficiency in the body are:

unbalanced nutrition (malnutrition can lead to the development of iron deficiency anemia in both children and adults);
lack of vitamins;
increased requirements for iron;
diseases of the gastrointestinal tract.

Congenital iron deficiency in the body can be caused by:

severe iron deficiency anemia in the mother;
multiple pregnancy;
prematurity.

With long-term chronic infections (tuberculosis,), iron molecules are captured by immune cells, and a deficiency is found in the blood.

Elderly people are more likely to suffer from a lack of iron in the body, and this is understandable: there is a natural degradation of hematopoietic functions, in addition, various diseases cause blood loss - for example, infections and inflammation, ulcers and erosion.

The role of iron in the human body

Among the trace elements necessary for the life of our body and complete health, iron is one of the most important. Without iron, the formation of hemoglobin and myoglobin - red blood cells and muscle pigment - cannot occur.

The function of iron is to carry oxygen from the lungs through the circulatory system to all organs and tissues of the body. With a lack of this trace element, the body as a whole suffers.

A deficiency of this substance in the body can occur in the case of the development of changes in the digestive system, for example, it can be with low acidity or dysbiosis.

The main sites of iron content in the body are:

erythrocyte hemoglobin - 57%;
muscles - 27%;
liver - 7 - 8%.

The reasons for iron deficiency are many: strict diets, refusal to eat meat, intense physical activity, sports training, pregnancy and breastfeeding. The body experiences a sharp lack of iron during blood loss, surgical interventions.

The body of an adult contains about 4 grams of iron. This figure varies by gender and age.

Normal blood iron levels are:

in babies up to 24 months - from 7.00 to 18.00 μmol / l;
for adolescents 14 years old - from 9.00 to 22.00;
for adult men - from 11.00 to 31.00;
for adult women - from 9.00 to 30.00.

In order not to provoke iron deficiency anemia, it is enough only to ensure the intake of iron with food in the amount of 2 g per day, since it is this amount of iron that is excreted from the body every day.

Babies and young children need a lot of iron because they grow quickly. Iron deficiency can lead to anemia.

The causes of iron deficiency in a child can be:

pathology of pregnancy, in which the supply of iron to the fetus is impaired (toxicosis, threat of interruption, illness or anemia of the mother during pregnancy);
prematurity, multiple pregnancy;
early artificial feeding, feeding with cow or goat milk, unbalanced nutrition of the baby;
increased growth rates (in premature babies, children with large body weight at birth, in the second half of the year and in the second year of life);
bleeding (including in some girls during the formation of the menstrual cycle) or malabsorption in the intestine (chronic enteritis, hereditary syndromes).

Iron deficiency anemia symptoms

All clinical manifestations of iron deficiency anemia are based on iron deficiency, which develops when iron losses exceed its intake with food (2 mg / day). Initially, iron stores in the liver, spleen, and bone marrow decrease, which is reflected in a decrease in the level of ferritin in the blood.

According to the time of development of iron deficiency anemia, there are:

Congenital form, the symptoms of which appear from the first days of life and worsen with age.
Acquired form, the manifestations of which develop after the action of etiological factors.

During the period of latent iron deficiency, many subjective complaints and clinical signs appear, characteristic of iron deficiency anemias. Patients note:

general weakness
malaise,
decreased performance.

Already during this period, there may be a perversion of taste, dryness and tingling of the tongue, impaired swallowing with a sensation of a foreign body in the throat, palpitations, shortness of breath.

If a patient has a moderate decrease in the amount of iron, then he remains able to work for a long time and certain symptoms appear only with excessive physical activity.

In addition to the general signs characteristic of anemia, IDA manifests itself:

low blood pressure against the background of a rapid pulse;
pallor and dryness of the skin;
peculiar taste preferences, expressed in eating raw meat and chalk;
brittle nails and hair loss.

In the presence of the above symptoms, it is necessary to consult a specialist and pass general and biochemical blood tests.

Stages and degrees

In the formation of iron deficiency states, the rate of development of the process, the stage of the course of the disease and the degree of compensation are of great importance, because IDA has different causes and can come from another disease (for example, repeated bleeding with or duodenal ulcer, gynecological pathology or chronic infections).

Iron deficiency anemia is:

with a mild degree, the hemoglobin index is reduced, but about 90 g / l remains;
with an average degree, hemoglobin is kept in the range from 90 to 70 g / l;
in severe hemoglobin is less than 70 g / l.

In order to more adequately determine the severity of the disease, a classification has been adopted:

No clinical symptoms;
Moderate severity;
Severe anemic syndrome;
Precom;
Coma.

The symptoms of iron deficiency anemia depend on the stage of the disease:

Stage 1

At the first stage of iron deficiency, clinical manifestations are absent.

Latent stage

The latent stage is observed with a decrease in the concentration of the serum trace element. Laboratory blood tests show in such a situation an increase in the level of transferrin with a decrease in the number of bone marrow sideroblasts.

The hemoglobin level at this stage remains quite high, and clinical signs are characterized by a decrease in exercise tolerance.

With the progression of iron deficiency, the symptoms are aggravated:

increasing weakness (possible development of urinary incontinence);
morning dizziness up to fainting (fainting conditions can occur with prolonged non-severe iron deficiency);
perversion of taste (desire to eat chalk, earth, ash, smell paint, gasoline, etc.);
palpitations, shortness of breath (develop even after minimal exertion).

Stage 3 IDA

Severe clinical manifestations that combine the two previous syndromes. Clinical manifestations occur due to oxygen starvation of tissues, and are found in the form of:

tinnitus
tachycardia,
fainting conditions
dizziness
asthenic syndrome, etc.

Complications

Complications occur with prolonged course of anemia without treatment and reduce the quality of life. The following complications may develop:

lag in growth and development, which is especially characteristic of childhood;
anemic coma;
complications of an infectious nature;
failure of internal organs.

Diagnostics

A doctor of any specialty can suspect a person's anemia based on the external manifestations of the disease. However, the establishment of the type of anemia, the identification of its cause and the appointment of appropriate treatment should be dealt with by a hematologist.

General examination (the color of the skin is determined (pallor is possible); the pulse may be quickened, arterial (blood) pressure - reduced).

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

Blood test

A decrease in the number of erythrocytes (red blood cells, the norm is 4.0-5.5x10 9 / liter), a decrease in the level of hemoglobin (a special compound inside erythrocytes that carries oxygen, the norm is 130-160 g / l) can be determined.

Blood chemistry

With the development of IDA, the biochemical blood test will record:

a decrease in the concentration of serum ferritin;
a decrease in the concentration of serum iron;
increased TIBC;
decrease in transferrin saturation with iron.

Treatment

The main principles of therapy for iron deficiency anemia include the elimination of etiological factors, correction of the diet, and replenishment of iron deficiency in the body. Etiotropic treatment is prescribed and carried out by gastroenterologists, gynecologists, proctologists, etc .; pathogenetic - by hematologists.

Iron deficiency anemia treatment program:

elimination of the cause of the disease;
health food;
ferrotherapy;
relapse prevention.

The intake of iron from food can only compensate for its normal daily loss. The use of iron preparations is a pathogenetic method for the treatment of iron deficiency anemia. Currently, preparations containing ferrous iron (Fe ++) are used, since it is much better absorbed in the intestine. Iron preparations are usually taken by mouth.

Mandatory prescription of iron preparations: in the first three months of treatment for anemia - in therapeutic doses, subsequently - in preventive doses. Iron preparations are prescribed internally between meals, washed down with fresh fruit juices or water, you can not drink milk.

Iron supplements should not be taken with milk, tea or coffee - these products bind iron and reduce its entry into the blood. Iron supplementation can cause:

nausea
vomiting
stomach ache,
constipation,
blackening of the teeth (if drugs are used in the form of drops).

List of drugs that are used in the treatment of iron deficiency anemia:

Jectofer;
Conferon;
Maltofer;
Sorbifer durules;
Tardiferon (Tardiferon);
Feramide (Ferramidum);
Ferro-gradumet;
Ferroplex;
Ferroceronum;
Ferrum lek.
Totem (tothema)

Side effects from taking medications are:

metallic taste in the mouth;
darkening of teeth and gums;
epigastric pain;
dyspeptic disorders due to irritation of the gastrointestinal mucosa (nausea, belching, vomiting, diarrhea, constipation);
dark staining of the stool;
allergic reactions (often like urticaria);
necrosis of the intestinal mucosa (in case of overdose or poisoning with saline AF).

Severe iron deficiency anemia, which is treated in a hospital, requires establishing the cause of iron loss. Simultaneously with the elimination of the causes, the pathological symptoms of the disease are eliminated.

Injection drugs are used exclusively in a hospital (it is necessary to be able to provide anti-shock care), are contraindicated during pregnancy and lactation.

venofer (the solution is strictly for intravenous administration, the calculation of the dose and rate of administration is made individually).
cosmofer (solution for intravenous and intramuscular administration, the calculation of the dose and the method of administration is made individually).
ferrinject (solution for administration in / in or into the dialysis system).

Nutrition and diet for IDA

The goal pursued by medical nutrition for anemia is to provide the body with all nutrients, vitamins and trace elements, in particular, iron, which is necessary to increase the level of hemoglobin.

This diet increases the body's defenses, restores its functions and improves the patient's quality of life.

The body may lack both heme and non-heme iron:

Heme iron - found in animal products. From these products, our body assimilates up to 35% of the required trace element.
Non-heme iron is legumes, seeds and nuts (pumpkin, sesame), dried fruits (raisins, dried apricots), dark vegetables, iron-fortified breakfast cereals.

Foods containing heme iron	Iron (mg / 100 g of product)	Foods containing non-heme iron	Iron (mg / 100 g of product)
Mutton	10,5	Soy	19,0
Liver	4,0-16,0	Poppy	15,0
Kidney	4,0-16,0	Wheat bran	12,0
Liver paste	5,6	Jam assorted	10,0
Rabbit meat	4,0	Fresh rose hips	10,0
Turkey meat	4,0	Mushrooms (dried)	10,0
Duck or goose meat	4,0	Dry beans	4,0-7,0
Ham	3,7	Cheese	6,0
Beef	1,6	Sorrel	4,6
Fish (trout, salmon, chum salmon)	1,2	Currant	4,5
Pork	1,0	Cereals	4,5
		Chocolate	3,2
		Spinach	3,0
		Cherry	2,9
		"Gray" bread	2,5
		Eggs (yolk)	1,8

Ascorbic and lactic acid improves the absorption of iron from fruits and cereals, therefore, the simultaneous intake of foods such as meat, legumes or cereals, fruits and vegetables is recommended. Sometimes diet is a complete treatment for the initial forms of iron deficiency anemia.

The diet of children and adolescents should be varied, healthy and tasty; it is necessary to ensure that it always contains products of animal and plant origin, containing a sufficient amount of iron.

Do not try to treat iron deficiency anemia in children with diet or dietary supplements.

Herbal medicine is acceptable as an adjunct to treatment, but not a substitute for iron supplementation. In fees, the following are most often used:

nettle - it increases blood clotting and reduces bleeding;
strawberries - the microelements included in its composition stimulate hematopoiesis;
rose hips - contain a large amount of vitamin C, which improves the absorption of iron; for the same purpose, beet, pomegranate, black currant juice is used.

Prevention of iron deficiency anemia

A very important point is the prevention of anemia in childhood. It includes: the correct daily regimen, rational feeding, preventive courses of iron supplementation for up to 1.5 years.