Iron deficiency anemia – the syndrome caused by insufficiency of iron and leading to violation of a gemoglobinopoez and a fabric hypoxia. Clinical manifestations are presented by the general weakness, the drowsiness lowered by intellectual working capacity and physical endurance, noise in ears, dizzinesses, unconscious states, short wind at loading, heartbeat, pallor. Gipokhromny anemia is confirmed by laboratory data: research of clinical blood test, indicators of serumal iron, OZhSS and ferritin. Therapy includes a medical diet, iron administration of drugs, in certain cases – a transfusion of eritrotsitarny weight.
Iron deficiency anemia
Iron deficiency (mikrotsitarny, gipokhromny) anemia – the anemia caused by shortage of the iron necessary for normal synthesis of hemoglobin. Its prevalence in population depends on gender and age and klimatogeografichesky factors. According to the generalized data, gipokhromny anemia about 50% of children of early age, 15% of women of reproductive age and about 2% of men have. Hidden by fabric zhelezodefitsit comes to light practically at every third inhabitant of the planet. 80–90% of all anemias fall to the share of mikrotsitarny anemia in hematology. As zhelezodefitsit can develop at the most various pathological states, this problem is urgent for many clinical disciplines: pediatrics, gynecology, gastroenterology, etc.
Every day with then, the stake, urine, slushchenny cells of skin lose about 1 mg of iron and approximately as much (2-2,5 mg) comes to an organism with food. The imbalance between the needs of an organism for iron and its receipt from the outside or losses promotes development of iron deficiency anemia. Zhelezodefitsit can arise both under physiological conditions, and as a result of a number of pathological states and to be caused by both endogenous mechanisms, and external influences:
- Blood losses. Most often anemia is caused by chronic loss of blood: plentiful periods, dysfunctional uterine bleedings; gastrointestinal bleedings from erosion mucous a stomach and intestines, gastroduodenal ulcers, gemorroidalny knots, anal cracks, etc. The hidden, but regular blood loss is noted at helminthoses, a gemosideroza of lungs, ekssudativny diathesis at children, etc. The special group is made by persons with blood diseases - hemorrhagic diathesis (hemophilia, Villebrand's disease), a gemoglobinuriya. Development of the post-hemorrhagic anemia caused by one-stage, but massive bleeding at injuries and operations is possible. Gipokhromny anemia can arise owing to the yatrogenny reasons - at the donors who are often taking a blood test; patients from HPN which are on a hemodialysis.
- Violation of receipt, absorption and transport of iron. To factors of an alimentary order anorexia, vegetarianism and following to diets treat with restriction of meat products, bad food; children have an artificial feeding, late introduction of a feeding up. Decrease in absorption of iron is characteristic of intestinal infections, gipoatsidny gastritis, chronic enteritis, a syndrome of malabsorption, a state after a resection of a stomach or a small intestine, a gastrektomiya. Much less often iron deficiency anemia develops owing to violation of transportation of iron from depot at insufficient proteinaceous and synthetic function of a liver – gipotransferrinemiya and gipoproteinemiya (hepatitises, cirrhosis).
- The raised iron expenditure. The daily need for a microcell depends on gender and age. Need for iron at premature, children of early age and teenagers (in connection with high rates of development and growth), women of the reproductive period (in connection with monthly menstrual losses), the pregnant women (in connection with formation and growth of a fruit) feeding mothers is highest (in connection with an expense as a part of milk). These categories are the most vulnerable concerning development of iron deficiency anemia. Besides, increase in requirement and a consumption of iron in an organism is observed at infectious and tumoral diseases.
On the role in ensuring normal functioning of all biological systems iron is the major element. Intake of oxygen to cages, course of oxidation-reduction processes, antioxidant protection, functioning of immune and nervous systems and so forth depends on the level of iron. On average the content of iron is in an organism at the level of 3-4 g. More than 60% of iron (> 2 g) are a part of hemoglobin, 9% - structure of a myoglobin, 1% - composition of enzymes (gemovy and negemovy). Other iron in the form of a ferritin and a gemosiderin is in fabric depot – mainly, in a liver, muscles, marrow, a spleen, kidneys, lungs, heart. About 30 mg of iron continuously circulate in plasma, being partially connected main iron-binding protein of plasma – transferriny.
At development of negative balance of iron the microcell stocks which are contained in fabric depots will be mobilized and are spent. At the beginning it happens enough for maintenance of the adequate level Hb, Ht, serumal iron. In process of exhaustion of fabric reserves eritroidny activity of marrow kompensatorno increases. At a starvation of endogenous fabric iron its concentration begins to decrease in blood, the morphology of erythrocytes is broken, synthesis gem in hemoglobin and ferriferous enzymes decreases. Kislorodtransportny function of blood suffers that is followed by a fabric hypoxia and dystrophic processes in internals (atrophic gastritis, a miokardiodistrofiya, etc.).
Iron deficiency anemia arises not at once. In the beginning prelatent develops zhelezodefitsit, characterized by exhaustion only of reserves of the deposited iron at safety of a transport and gemoglobinovy pool. At a stage of latent deficiency reduction of the transport iron which is contained in blood plasma is noted. Actually gipokhromny anemia develops at reduction of all levels of metabolic reserves of the iron – deposited transport and eritrotsitarny. According to an etiology distinguish anemias: post-hemorrhagic, alimentary, connected with the raised expense, initial deficiency, insufficiency of a resorption and violation of transport of iron. On expressiveness degree iron deficiency anemias are subdivided on:
- Lungs (Hb of 120-90 g/l). Proceed without clinical manifestations or with their minimum expressiveness.
- Medium-weight (Hb of 90-70 g/l). Are followed circulator and hypoxemic, sideropenichesky, hematologic by syndromes of moderate degree of expressiveness.
- Heavy (Hb
The circulator and hypoxemic syndrome is caused by violation of synthesis of hemoglobin, transport of oxygen and development of a hypoxia in fabrics. It finds the expression in feeling of constant weakness, increased fatigue, drowsiness. Patients noise in ears, flashing of "front sights" before eyes pursues, the dizzinesses passing into faints. Complaints to heartbeat, the short wind arising at physical activity, hypersensibility to low temperatures are characteristic. Circulator and hypoxemic violations can aggravate a current of the accompanying IBS, chronic heart failure.
Development of a sideropenichesky syndrome is connected with insufficiency of fabric ferriferous enzymes (a catalase, peroxidase, tsitokhrom, etc.). Emergence of trophic changes of integuments and mucous membranes is explained by it. Most often they are shown by dryness of skin; ischerchennost, fragility and deformation of nails; the raised hair loss. From mucous membranes atrophic changes are typical that is followed by the phenomena of a glossit, angulyarny stomatitis, a dysphagy, atrophic gastritis. There can be an addiction to pungent smells (gasoline, acetone), taste distortion (desire is clay, chalk, tooth-powder and so forth). Also paresteziya, muscular weakness, dispepsichesky and dizurichesky frustration are sideropeniya signs. Astenovegetativny violations are shown by irritability, emotional instability, decrease in intellectual working capacity and memory.
As in the conditions of a zhelezodefitsit of IgA loses the activity, patients become subject to frequent incidence of a SARS, intestinal infections. Patients are pursued by chronic fatigue, breakdown, decrease in memory and concentration of attention. The long course of iron deficiency anemia can lead to development of the miokardiodistrofiya distinguished on inversion of teeth of T on the ECG. At extremely heavy zhelezodefitsit the anemichesky prekoma (drowsiness, short wind, sharp pallor of skin with a tsianotichny shade, tachycardia, hallucinations), and then – a coma with loss of consciousness and lack of reflexes develops. At massive prompt blood loss there is gipovolemichesky shock.
Can point appearance of the patient to existence of iron deficiency anemia: pale, with an alabaster shade skin, pastosity of the person, shins and feet, edematous "bags" under eyes. At an auskultation of heart tachycardia, dullness of tones, quiet systolic noise, sometimes – arrhythmia is found. For the purpose of confirmation of anemia and definition of its reasons laboratory examination is conducted
- Laboratory tests. In favor of the iron deficiency nature of anemia decrease in hemoglobin, a gipokhromiya, micro and in the general blood test testifies. At assessment of biochemical indicators decrease in level of serumal iron and concentration of a ferritin (60 µmol/l), reduction of saturation of a transferrin is noted by iron (
- Tool techniques. For establishment of the reason of chronic blood loss endoscopic examination of a GIT (EGDS, a kolonoskopiya), radiodiagnosis (an irrigoskopiya, a stomach X-ray analysis) has to be conducted. Inspection of bodies of reproductive system at women includes ultrasonography of a small pelvis, survey on a chair, according to indications - hysteroscopy with RDV.
- Research of a punktat of marrow. The microscopy of dab (miyelogramm) shows the considerable decrease in quantity of sideroblast characteristic of gipokhromny anemia. Differential diagnostics is directed to an exception of other types of iron deficiency states - sideroblastny anemia, a talassemiya.
Elimination of etiologichesky factors, correction of a food allowance, completion of a zhelezodefitsit in an organism belong to the basic principles of therapy of iron deficiency anemia. Etiotropny treatment is appointed and carried out by experts gastroenterologists, gynecologists, proctologists, etc.; pathogenetic – hematologists. At iron deficiency states good nutrition with obligatory inclusion in a diet of the products containing gemovy iron (veal, beef, mutton, meat of a rabbit, a liver, language) is shown. It is necessary to remember that strengthening of a ferrosorbtion in a GIT is promoted ascorbic, lemon, amber acid. Oxalates and polyphenols (coffee, tea, a soy protein, milk, chocolate), calcium, food fibers, etc. substances inhibit iron absorption.
At the same time, even the balanced diet is not able to eliminate already developed iron defect therefore replacement therapy of a ferropreparatama is shown to patients with gipokhromny anemia. Medicines of iron are appointed a course not less than 1,5-2-h months, and after normalization of the Hb level the supporting therapy within 4-6 weeks is carried out by a half dose of medicine. For pharmacological correction of anemia medicines of bivalent and trivalent iron are used. In the presence of vital indications resort to haemo transfusion therapy.
Forecast and prevention
In most cases gipokhromny anemia moves successful correction. However at not removed cause zhelezodefitsit can recur and progress. Iron deficiency anemia can cause a delay of psychomotor and intellectual development (ZPR) in children of early and younger age. For prevention of a zhelezodefitsit annual control of parameters of clinical blood test, good nutrition with the sufficient content of iron, timely elimination of sources of blood loss in an organism is necessary. It is necessary to consider that the iron which is contained in meat and a liver in shape gem is best of all acquired; negemovy iron from vegetable food is practically not acquired – in this case it at first has to be restored to gemovy with the participation of ascorbic acid. Preventive reception of ferriferous medicines to destination of the expert can be shown to faces of risk groups.
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