Sideropenic syndrome with iron deficiency. Learn all about sideropenic syndrome

22. Topic of the lesson: Iron deficiency anemia

22. Topic of the lesson: Iron deficiency anemia

1. RELEVANCE OF THE THEME

Knowledge of the topic is necessary for drawing up an examination plan for anemia syndrome, correct diagnosis of iron deficiency anemia (IDA), choice of treatment tactics and development of preventive programs in risk groups for developing IDA. In the course of studying the topic, it is necessary to repeat such sections as normal physiology and pathology of erythrocytes, histological aspects of the structure of erythrocytes. Knowledge of the topic is necessary for further study of the issues of differential diagnostic search for anemia syndrome.

2. PURPOSE OF THE LESSON

To study modern approaches to the diagnosis, treatment and prevention of IDA.

3. QUESTIONS TO PREPARE FOR THE LESSON

1. Normal values ​​of peripheral blood parameters.

2. The role of iron in the synthesis of hemoglobin and the functioning of intracellular enzymes.

3. Structure and functions of erythrocytes.

4. Definition, etiology, pathogenesis and classification of IDA.

5. Methods of examination for diagnosis and diagnostic criteria for IDA.

6.Methods of treatment, criteria for the effectiveness of the treatment of IDA.

4. EQUIPMENT OF THE LESSON

1. Test tasks to control the level of knowledge.

2. Clinical tasks.

3. Examples of blood tests illustrating various variants of the hematological syndrome.

5. BASELINE TESTS

Choose one correct answer.

1. The most accurate test for assessing the iron content in the body is:

A. Calculation of the color index.

B. Determination of the number of red blood cells.

B. Determination of hemoglobin level. D. Determination of the level of ferritin.

D. Determination of erythrocyte morphology.

2. The main causes of iron malabsorption include:

A. Hypocarbohydrate diet.

B. Malabsorption syndrome.

B. Obesity.

G. Deficiency of vitamins of group B. D. Helicobacter pre/ol-infection.

3. The main reasons for the increased need for iron include:

A. Taking anabolic steroids. B. Chronic infections.

B. CKD.

G. Lactation.

D. Autoimmune gastritis.

4. The cause of IDA of alimentary origin is:

A. Infancy.

B. High physical activity.

B. Insufficient consumption of fresh vegetables and fruits. D. Insufficient consumption of meat food.

D. Insufficient intake of fruits and vegetables containing iron.

5.Iron absorption accelerates:

A. Phosphoric acid. B. Ascorbic acid.

B. Calcium.

G. Cholesterol. D. Tetracycline.

6. Iron absorption is slowed down:

A. Cysteine. B. Fructose.

B. Calcium.

D. Vitamin B 12.

D. Folic acid.

7. IDA is a disease characterized by:

A. Violation of hemoglobin synthesis due to iron deficiency. B. A decrease in both the concentration of hemoglobin and the amount

erythrocytes.

B. Decrease in hemoglobin concentration and formation of microspherocytes.

D. A decrease in the concentration of hemoglobin in the blood and an increase in its concentration inside the erythrocyte.

D. Decreased activity of enzyme systems, which include iron.

8. Symptoms of IDA include:

A. Angular stomatitis.

B. Change of nails according to the type of "watch glasses".

B. Jaundice.

G. Spots Roth.

D. Funicular myelosis.

9. With IDA, the following are detected:

A. Dryness, pale skin, brittle nails, tachycardia, soft, blowing systolic murmur at the apex.

B. Diffuse cyanosis, accent II tone in the second intercostal space to the left of the sternum.

B. Redness of the skin of the face, décolleté.

D. Three-color change in the skin of the distal parts of the upper and lower extremities in the cold.

D. Urticaria, itching, swelling of the larynx.

10. For the diagnosis of IDA, patients are shown to perform:

A. Determination of leukocyte alkaline phosphatase activity.

B. Studies of the total iron-binding capacity of serum.

B. Ph-chromosome detection.

D. Morphological study of bone marrow biopsy. D. Coombs' tests.

11. The morphological characteristics of erythrocytes in IDA include:

A. Presence of toxogenic granularity. B. Shadows of Botkin-Gumprecht.

B. Macrocytosis.

D. The presence of megaloblasts. D. Anisocytosis.

12. IDA of moderate severity corresponds to the content of hemoglobin in the blood:

A.120-90 g/l.

B. 90-70 g/l.

B. Less than 70 g/l.

G. 60-40 g/l.

D. 140-120 g/l.

13. Sideropenic syndrome manifests itself:

A. Skin itching.

B. Progression of onychomycosis.

B. Changes in the distal phalanges of the fingers like drumsticks.

G. Pica chlorotica.

D. Inclination to salty foods.

14. At the stage of latent iron deficiency, the following can be detected:

A. Decreased hemoglobin level.

B. Circulatory-hypoxic syndrome.

B. Decreased hematocrit.

D. Change in the morphology of erythrocytes. D. Reticulocytosis.

15. Laboratory signs of iron deficiency are:

A. Target erythrocytes. B. Macrocytosis.

B. Microspherocytosis.

G. Decreased total iron-binding capacity of blood serum.

D. Increase in the total iron-binding capacity of blood serum.

16. The main sources of iron for humans are:

A. Meat.

B. Dairy products.

B. Cereals. G. Fruits. D. Water.

17. Treatment of IDA is carried out in compliance with the following rules: A. Mandatory use of drugs with a sufficient amount of ferric iron.

B. Simultaneous administration of iron preparations and B vitamins.

B. Parenteral administration of iron preparations in the alimentary genesis of anemia.

D. Carrying out a saturating course lasting at least 1-1.5 months.

D. No need for maintenance therapy with iron preparations after normalization of hemoglobin levels.

18. Treatment of IDA is carried out in compliance with the following rule:

A. With mild severity, only dietary methods can be used.

B. The highest efficiency of blood transfusion.

B. In severe anemia, the use of vitamins for B 12 is indicated.

D. The iron depot is replenished by any route of administration of iron preparations.

E. Use of short courses of treatment with high doses of iron preparations.

19. The main principles of treatment with iron preparations for oral administration are:

A. The use of iron preparations with a sufficient content of ferrous iron.

B. The use of iron preparations with a sufficient content of ferric iron.

B. The appointment of iron preparations together with phosphoric acid.

D. Prescribing iron supplements together with B vitamins.

D. The duration of the maintenance course of therapy is at least 1 week.

20. Indications for parenteral use of iron preparations are:

A. Patient compliance with vegetarianism. B. Eradication Helicobacter pylori.

B. Resection of the jejunum. D. The desire of the patient.

D. Planned pregnancy.

6. MAIN QUESTIONS OF THE THEME

6.1 Definition

Anemia is a syndrome caused by a decrease in the mass of circulating red blood cells. All anemias are considered secondary and are usually a symptom of an underlying disease.

IDA is a disease in which anemia develops due to iron deficiency in the body, which leads to impaired hemoglobin synthesis.

6.2 Epidemiology

IDA remains a common form of anemia, accounting for 80-95% of all cases of anemia. This disease occurs in 10-30% of the adult population, more often in women.

6.3. Etiology

Chronic blood loss of various localization.

Iron malabsorption.

Increased need for iron.

Violation of iron transport.

Alimentary insufficiency.

6.4 Pathogenesis

The main pathogenetic mechanism for the development of IDA is considered to be a violation of hemoglobin synthesis, since iron is part of the heme. In addition, the lack of iron in the body contributes to the disruption of the synthesis of numerous tissue enzymes (cytochromes, peroxidase, succinate dehydrogenase, etc.), which include iron. In this case, rapidly regenerating epithelial tissues are affected - the mucous membrane of the digestive tract, the skin and its appendages.

6.5 Clinical manifestations

The clinical picture of IDA is represented by a combination of circulatory-hypoxic, sideropenic, due to tissue iron deficiency, and the actual anemic (hematological) syndrome.

6.5.1. Circulatory-hypoxic syndrome

Circulatory-hypoxic syndrome includes symptoms such as:

Weakness, increased fatigue;

dizziness, headaches;

Shortness of breath on exertion;

palpitations;

Flashing "flies" before the eyes;

emotional lability;

Hypersensitivity to cold.

Tolerance to anemia is worse in the elderly and with a rapid rate of anemia. The presence of hypoxia in the elderly can lead to aggravation of symptoms of coronary artery disease, CHF.

6.5.2. sideropenic syndrome

Sideropenic syndrome is caused by a deficiency of tissue enzymes, which include iron (cytochromes, peroxidase, succinate dehydrogenase, etc.), and is observed already at the stage of latent iron deficiency, i.e., before the development of IDA itself. Symptoms of sideropenic syndrome include:

Trophic changes in the skin and its appendages - dryness and peeling of the skin, dryness, brittleness and hair loss, brittleness, layering, transverse striation of the nails, the formation of a concave, spoon-shaped form of nails (koiloichia);

Changes in the mucous membranes - difficulty in swallowing dry and solid food (sideropenic dysphagia), atrophic gastritis;

Sphincter dysfunction - dysuric disorders are observed more often in women and are manifested by urinary incontinence when coughing, nocturnal enuresis;

Addiction to unusual odors (acetone, gasoline) and taste perversion ( pica chlorotica)- desire to eat chalk, dry pasta, tooth powder;

Myocardial injury - amplitude reduction or wave inversion T predominantly in the thoracic regions;

Muscle weakness.

Physical research allows you to identify:

Sideropenic syndrome: trophic changes in the skin and its appendages;

Anemic syndrome: pallor of the skin with an alabaster or greenish tinge (chlorosis);

Circulatory-hypoxic syndrome: tachycardia, systolic murmur over the apex of the heart, "top" noise on the jugular veins.

6.6. Laboratory research

Laboratory and instrumental studies are carried out in order to:

anemic syndrome detection;

Detection of iron deficiency;

Identification of the cause of IDA.

In a clinical blood test, the following are determined:

A decrease in hemoglobin concentration, more pronounced than a decrease in the concentration of erythrocytes, which reflects a low color index;

Hypochromia (decrease in the average hemoglobin content in the erythrocyte and the average concentration of hemoglobin in the erythrocyte);

Microcytosis and poikilocytosis of erythrocytes (decrease in the average volume of erythrocytes).

A biochemical blood test reveals:

A decrease in the concentration of serum iron (should not be determined while taking iron preparations or in the first 6-7 days of a break in taking the drug);

Decreased ferritin concentration less than 30 mcg/l;

Increase in total and latent iron-binding capacity of serum (total iron-binding capacity of serum more than 60 µmol/l);

A significant decrease in the percentage of saturation of transferrin with iron - less than 25%.

In order to detect the source of blood loss, a comprehensive examination is indicated, which should include endoscopic examinations of the gastrointestinal tract (EGDS, colonoscopy), radiography of the stomach, if necessary - with the passage of barium through the small intestine, a study of the volume of blood loss from the digestive tract using radioactive chromium .

In the absence of data indicating an obvious erosive-ulcerative process, an oncological search should be carried out.

6.7 Diagnostic criteria

Low color index.

Hypochromia of erythrocytes, microcytosis.

Decreased serum ferritin content less than 30 mcg / l.

Decreased serum iron levels.

Increasing the total iron-binding capacity of serum more than 60 µmol / l.

Clinical manifestations of sideropenia (non-permanent symptom).

The effectiveness of iron supplements.

IDA is always hypochromic, but not all hypochromic anemias are associated with iron deficiency. A decrease in the color index can be observed with such anemias as sideroahrestic, iron redistributive, some hemolytic anemias, in particular thalassemia.

6.8 Classification

Light: hemoglobin level 120-90 g/l.

Moderate: hemoglobin level 90-70 g/l.

Severe: hemoglobin level less than 70 g/l.

6.9 Formulating a clinical diagnosis

A form of anemia (IDA).

Etiology of anemia.

Anemia severity.

6.10 Treatment

Treatment of IDA involves addressing the cause of the anemia and prescribing iron-containing drugs that are taken orally or parenterally.

Basic principles of treatment with oral iron preparations:

The use of preparations with a sufficient content of ferrous iron;

Appointment of drugs containing substances that enhance the absorption of iron;

The undesirability of the simultaneous intake of nutrients and drugs that reduce the absorption of iron;

The inappropriateness of the simultaneous appointment of B vitamins, folic acid without special indications;

Inexpediency of prescribing iron preparations inside in the presence of signs of impaired absorption;

A sufficient dose of ferrous iron is 300 mg / day;

Iron preparations are taken for at least 1.5-2 months; after normalization of the hemoglobin level and the content of erythrocytes, you should continue taking the drug at a half dose for another 4-6 weeks. It is advisable for women with polymenorrhagia to prescribe short monthly courses of treatment (3-5 days) at an average therapeutic dose after normalization of hemoglobin and erythrocytes;

The need for maintenance therapy with iron preparations after normalization of hemoglobin levels;

The criterion for the effectiveness of treatment is an increase in the number of reticulocytes by 3-5 times (reticulocyte crisis), which is detected on the 7-10th day of treatment.

The reasons for the ineffectiveness of iron therapy for oral administration may be:

Absence of iron deficiency and improper administration of iron preparations;

Insufficient dosage of iron preparations;

Insufficient duration of treatment;

Impaired absorption of iron;

Simultaneous administration of drugs that interfere with the absorption of iron preparations;

The presence of unidentified sources of chronic blood loss;

The combination of iron deficiency with other causes of anemia. Indications for parenteral administration of iron preparations:

Malabsorption in intestinal pathology;

Exacerbation of peptic ulcer of the stomach or duodenum;

Intolerance to iron preparations for oral administration;

The need for faster saturation of the body with iron, for example, during planned surgical interventions.

7. CURATION OF PATIENTS

Curation tasks.

Formation of skills of questioning and examination of patients with IDA.

Formation of skills for making a preliminary diagnosis based on the data of the survey and examination.

Formation of the skill of drawing up a program of examination and treatment, based on a preliminary diagnosis.

8. CLINICAL ANALYSIS OF THE PATIENT

Clinical analysis is carried out by a teacher or students under the direct supervision of a teacher. Tasks of clinical analysis.

Demonstration of methods of examination and questioning of patients with IDA.

Control of students' skills of examination and questioning of patients with IDA.

Demonstration of the method of making a diagnosis based on the data of the survey, examination and examination of patients.

Demonstration of the method of drawing up a plan of examination and treatment.

During the lesson, the most typical cases of IDA are analyzed. At the end of the analysis, a structured preliminary or final diagnosis is formulated, a plan for the examination and treatment of the patient is drawn up.

9. SITUATIONAL TASKS

Clinical challenge? one

Patient B., aged 28, complains of weakness, increased fatigue, dizziness, palpitations, shortness of breath with moderate physical exertion, brittle nails, dry skin.

Family history without features.

Gynecological history: menstruation since the age of 13, for 6 days, after 28 days, profuse, painless. Pregnancies - 1, childbirth - 1. Allergological history: not burdened.

From the anamnesis it is known that brittle nails and dry skin have been a concern for many years, but she did not go to the doctors about this, she was not examined. Weakness, fatigue

appeared 12 months ago towards the end of the second trimester of pregnancy. The examination revealed a decrease in hemoglobin level to 100 g/l. The diet was recommended. In connection with the aversion to meat food, the patient increased the content of apples, pomegranates, and buckwheat in the diet. I ate a lot of dairy products. Against this background, the symptoms intensified. After delivery, the hemoglobin level was 80 g/L. Oral iron preparations were prescribed, which the patient took for three weeks. Against this background, the hemoglobin level reached 105 g/l, after which the patient stopped taking the drugs. During the last months, during which the patient is breastfeeding, her condition worsened: dizziness, shortness of breath, flickering of "flies" before her eyes appeared.

On examination: a state of moderate severity. The skin is pale. Nails with transverse striation, exfoliate. Hair is dull and frizzy. Visible mucous membranes are pale. Angular stomatitis. There are no edema. Respiratory rate - 16 per minute, with auscultation of the lungs, vesicular breathing, no wheezing. The boundaries of relative cardiac dullness: right - 1 cm outward from the right edge of the sternum in the fourth intercostal space, left - 0.5 cm inward from the left mid-clavicular line in the fifth intercostal space, upper - the upper edge of the III rib. Heart rate - 94 per minute. Heart sounds are clear, there are no murmurs. BP 100/60 mmHg The abdomen on superficial palpation is soft, painless. Deep palpation revealed no pathology of the colon, liver and spleen. The size of the liver according to Kurlov: 10x 9x 8 cm. The lower edge of the liver is soft, even, painless.

Complete blood count: hemoglobin - 72 g / l, erythrocytes - 3.2x 10 12 / l, color index - 0.67, leukocytes - 6.8x 10 9 / l, leukocyte formula without features, average erythrocyte volume - 73 fl, the average content of hemoglobin in erythrocytes is 22.6 pg, anisocytosis, poikilocytosis.

4.Prescribe a treatment.

Clinical challenge? 2

Patient T., 68 years old, complains of weakness, fatigue, dizziness, flickering of "flies" before her eyes, shortness of breath when walking short distances.

For more than 20 years he has been suffering from osteoarthritis. As prescribed by a rheumatologist, she systematically took diclofenac for 6 months. About 4 months ago, for the first time in my life, unpleasant sensations appeared in the epigastric region, heartburn, belching with air, weakness began to increase. On this occasion, she did not go to the doctor, she was not examined. During the last month, dizziness, shortness of breath when walking, flickering of "flies" began to bother.

On examination: a state of moderate moderate severity. The skin is pale, dry, flaky. Nails with transverse striation, exfoliate. Visible mucous membranes are pale. Angular stomatitis. There are no edema. Respiratory rate - 18 per minute, with auscultation of the lungs, vesicular breathing, no wheezing. The boundaries of relative cardiac dullness: right - 1.5 cm outward from the right edge of the sternum in the fourth intercostal space, left - 1 cm inward from the left mid-clavicular line in the fifth intercostal space, upper - the upper edge of the III rib. Rhythmic heart sounds, heart rate - 96 per minute, clear, no noise. The pulse is rhythmic, without deficit. BP - 130/80 mm Hg. The abdomen on superficial palpation is soft, painless. Deep palpation showed pain in the epigastrium, no pathology of the colon, liver and spleen was detected. The size of the liver according to Kurlov: 10x 9x 8 cm. The symptom of tapping is negative on both sides. The thyroid gland is not enlarged.

Complete blood count: Hb - 83 g / l, erythrocytes - 3.3x 10 12 / l, color index - 0.74, hematocrit - 30.6%, average erythrocyte volume - 71 fl, average hemoglobin content in erythrocytes - 25 pg , anisocytosis, poikilocytosis, otherwise without features.

Biochemical analysis of blood: serum iron - 4.6 µmol/l (normal 6.6-30), total iron-binding capacity of serum - 88.7 µmol/l.

General analysis of urine and feces without features. Benzidine test and Weber reaction are positive.

1. What syndromes are determined in this patient?

2. Formulate a clinical diagnosis.

3. What additional laboratory and instrumental studies should be performed to clarify the diagnosis?

4. Give treatment.

Clinical challenge? 3

Patient V., 74 years old, complains of pressing pain behind the sternum that occurs when walking short distances and passes at rest or against the background of sublingual administration of nitroglycerin, inspiratory dyspnea when walking, severe weakness, fatigue, dizziness, flashing "flies" before eyes.

For 30 years he has been suffering from hypertension. For 15 years, he has been experiencing pain behind the sternum, which is relieved by taking nitroglycerin or at rest. Pain occurs with moderate physical exertion: brisk walking up to 500 m, climbing stairs to the 2nd-3rd floor. Constantly takes acetylsalicylic acid (aspirin *), atenolol, enalapril, isosorbide dinitrate. Against the background of this therapy, the need for sublingual nitroglycerin intake was small (1-2 r/month). In addition, for more than six months, he notes discomfort in the epigastric region, nausea, loss of appetite, weight loss by 5-7 kg. Deterioration of the condition for 4-5 weeks, when there was a pronounced weakness, dizziness, flickering "flies" before the eyes. He drew attention to several episodes of black unformed stools. During the same time, he notes a significant increase in chest pain attacks, an increase in the need for sublingual nitroglycerin intake (up to 2-3 times a day), the appearance of shortness of breath with little physical exertion (climbing one flight of stairs). Hospitalized for examination and treatment.

On examination: a state of moderate severity. The skin and visible mucous membranes are pale. Cross striation of nails. There are no edema. Respiratory rate - 20 per minute, with auscultation of the lungs, breathing is hard, there are no wheezing. The boundaries of relative cardiac dullness: right - 1.5 cm outward from the right edge of the sternum in the fourth intercostal space, left - 1.5 cm outward from the left mid-clavicular line in the fifth intercostal space, upper - the upper edge of the III rib. Heart sounds are muffled, there are no murmurs. Heart rate - 92 beats / min. The pulse is rhythmic. BP - 120/70 mm Hg. The abdomen on superficial palpation is soft, painless. Deep palpation showed pain in the epigastrium; no pathology was found in the colon, liver, and spleen. Liver dimensions according to Kurlov: 10x 9x 8 cm. The lower edge of the liver is soft, even, painless.

In the general blood test: Hb - 70 g / l, erythrocytes - 2.5x 10 12 / l, color index - 0.82, hematocrit - 30.6%, average erythrocyte volume - 70 fl, average hemoglobin content in erythrocytes - 24 .4 pg, anisocytosis, poikilocytosis, leukocytes - 6.8x 10 9 /l, leukocyte formula without features. ESR - 32 mm/h. In a biochemical blood test: serum iron - 4.4 µmol/l (normal 6.6-30), total iron-binding capacity of serum - 89.8 µmol/l.

ECG: sinus rhythm, EOS deviation to the left, no focal changes.

Endoscopy: in the body of the stomach there is an ulcer 0.8-1.2 cm in size, with hematin deposits on the bottom, the gastric mucosa is pale, atrophic.

1. What syndromes are determined in this patient?

2. Formulate a clinical diagnosis.

3. What additional laboratory and instrumental studies should be performed to clarify the diagnosis?

4.Prescribe a treatment.

10. STANDARDS OF ANSWERS

10.1. Answers to test tasks of the initial level

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Internal diseases: a guide to practice. classes in faculty therapy: textbook. allowance A. A. Abramov; ed. Professor V. I. Podzolkov. - 2010. - 640 p.: ill.

Iron-deficiency anemia. Sideropenic syndrome Caused by a decrease in the activity of iron-containing enzymes Degenerative changes in the skin and its appendages (dry skin and hair, layering, change in the shape of nails, atrophic changes in the mucous membranes, dysphagia) Perversion of taste and smell (the desire to eat earth, the smell of gasoline seems pleasant) Muscular hypotension ( enuresis, urinary incontinence). Anemic syndrome Due to the development of anemic hypoxia Pallor of the skin and mucous membranes Decrease in appetite Increased fatigue, decreased performance Dizziness, tinnitus Prolonged iron deficiency leads to a delay in psychomotor and physical development, an increased susceptibility to infectious diseases, reduced ability to learn, cognitive activity.

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Blood diseases

"Chronic leukemia" - The cervical and supraclavicular lymph nodes are usually enlarged first, then the axillary ones. Forecast. Clinical forms of CLL. The cervical and axillary lymph nodes are the first to enlarge. Symptoms develop gradually over a long period of time. RAI - classification of chronic lymphocytic leukemia. Chronic leukemias differ from acute ones in the differentiation of tumor cells and a longer staging course.

"DIC-syndrome" - Acute DIC syndrome. Acute bleeding. Assessment of the severity of acute massive blood loss. Hypocoagulation phase of DIC. hypercoagulable phase. hypocoagulation phase. Treatment. Classification. Disseminated intravascular coagulation. Hypercoagulable phase of DIC. Transfusion of a solution of crystalloids.

"Myeloma" - Such kidneys are called "myeloma shriveled kidneys". Myeloma cell infiltrates are noted in the internal organs. "Flaming" (fuchsile) myeloid cells. Bone lesion Clinical picture. Assessment of the degree of disability of patients. Results of instrumental examination of patients.

"Paraproteinemic hemoblastoses" - Paraproteinemic hemoblastoses: a group of neoplastic diseases. Anemia, swollen lymph nodes. Franklin's disease. Alpha heavy chain disease. The disease is very rare. General symptoms. Plasmapheresis. What changes in the bone marrow punctate will be in case of illness. interactive questions.

"Anemia in children" - Sideroblastic anemia. Asymptomatic carrier. Anemia Diamond. Coombs test. Diagnostics. Important for determining blood compatibility. inclusions in erythrocytes. Acquired hemolytic anemia. Acquired autoimmune hemolytic anemia. hereditary spherocytosis. Congenital aplastic anemia.

Anemia is a condition characterized by a decrease in the amount of hemoglobin per unit volume of blood, often with a simultaneous decrease in the number of red blood cells. Anemia is considered to be a decrease in the content of hemoglobin in the blood less than 100 g/l, erythrocytes less than 4.0×10 12 /l and serum iron less than 14.3 µmol/l. The exceptions are iron deficiency anemia and thalassemia, in which the number of red blood cells is normal.

There are different classifications of anemia:

1. According to the morphology of erythrocytes, microcytic, normocytic and macrocytic anemias are distinguished. The main criterion for this subdivision is the average erythrocyte volume ( SEA):
   • microcytosis - SEA less than 80 fl.,
   • normocytosis - SEA - 80-95 fl.,
   • macrocytosis - SEA more than 95 fl.
2. Hypochromic and normochromic anemias are determined by the degree of saturation with hemoglobin. The second part of the term - "chromic" - refers to the color of red blood cells.

According to these classifications, there are:

• hypochromic microcytic anemia (small, pale red blood cells; low SEA);
• macrocytic anemia (large red blood cells; increased SEA).
• normochromic normocytic anemia (cells of normal size and appearance, normal SEA).

According to the severity of anemia are:

• mild degree (hemoglobin 91 - 119 g / l),
• moderate severity (hemoglobin 70 - 90 g / l),
• heavy (hemoglobin less than 70 g/l).

There is a pathogenetic classification of anemia:

1. Anemia caused by impaired hemoglobin synthesis and iron metabolism, characterized by microcytosis and hypochromia (iron deficiency anemia, anemia in chronic diseases, sideroblastic anemia, thalassemia).
2. Anemia caused by a violation of DNA synthesis in conditions of deficiency of vitamin B 12 or folic acid (macrocytic anemia).
3. Normochromic normocytic anemias that do not have a common pathogenetic mechanism and are subdivided depending on the reaction of the bone marrow into hypoplastic and aplastic, hemolytic and posthemorrhagic anemias.

It should be noted the existence of conditions that are characterized by signs of anemia, but are not accompanied by a decrease in hemoglobin or erythrocytes, but are manifested by a violation of the ratio between the number of erythrocytes and plasma volume (pregnancy hydremia, overhydration in heart failure, CRF) and a decrease in plasma volume (dehydration, peritoneal dialysis, diabetic acidosis).

In anemia, hypoxia of organs and tissues with the possible subsequent development of dystrophic processes has the main pathogenetic significance. There are compensatory mechanisms aimed at reducing and eliminating the consequences of hypoxia. These include hyperfunction of the cardiovascular system, due to the action of underoxidized products on the centers of regulation of the cardiovascular system. In patients, the heart rate and minute volume increase, the total peripheral resistance increases.

Also, compensatory mechanisms include: an increase in the physiological activity of erythrocytes, a shift in the oxyhemoglobin dissociation curve, and an increase in the permeability of the vascular wall for blood gases. It is also possible to increase the content and activity of iron-containing enzymes (cytochrome oxidase, peroxidase, catalase), which are potential oxygen carriers.

The clinic of anemic syndrome is characterized by general anemic complaints of general weakness, dizziness, a tendency to faint, palpitations, shortness of breath, especially during physical exertion, and stabbing pains in the region of the heart. With a decrease in hemoglobin less than 50 g / l, signs of severe heart failure appear.

During the examination, pallor of the skin, tachycardia, a slight increase in the left border of relative cardiac dullness, systolic murmur at the apex, and "top noise" in the jugular veins are revealed. An ECG can reveal signs of left ventricular hypertrophy, a decrease in the height of the T wave.

sideropenic syndrome

This syndrome is characterized by a decrease in the iron content in the blood, which leads to a decrease in the synthesis of hemoglobin and its concentration in erythrocytes, as well as a decrease in the activity of iron-containing enzymes, especially α-glycerophosphate dehydrogenase.

Clinically, the syndrome is manifested by a change in taste, an addiction to eating chalk, toothpaste, clay, raw cereals, raw coffee, unpeeled sunflower seeds, starched linen (amylophagia), ice (pagophagia) and smells of clay, lime, gasoline, acetone, printing ink .

Dryness and atrophy of the skin, fragility of nails and hair, hair loss are noted. The nails are flattened, sometimes have a concave (spoon-shaped) shape (koilonychia). The phenomena of angular stomatitis, atrophy of the papillae of the tongue and its redness develop, swallowing is disturbed (sideropenic dysphagia, Plummer-Vinson syndrome).

In laboratory studies, a decrease in serum iron (less than 12 μmol / l), an increase in total iron-binding capacity (more than 85 μmol / l), a decrease in the content of ferritin in the blood are revealed. The number of sideroblasts in the bone marrow decreases.

Hemorrhagic syndrome

Hemorrhagic syndrome is a pathological condition characterized by a tendency to internal and external bleeding and the appearance of various sizes of hemorrhages. The reasons for the development of hemorrhagic syndrome are changes in the platelet, plasma and vascular components of hemostasis. Accordingly, there are three groups of diseases manifested by hemorrhagic syndrome.

The first group of diseases

The first group includes diseases in which the number and functional properties of platelets are changed (thrombocytopenia, thrombocytopathy). The clinic of this group of diseases is characterized by the appearance on the skin and mucous membranes of "bruises" of various sizes and small punctate hemorrhages (petechiae). Also characteristic is the development of spontaneous bleeding - nasal, gingival, gastrointestinal, uterine, hematuria. The intensity of bleeding and the amount of blood lost are usually insignificant. This type of bleeding is typical, for example, for Werlhof's disease (thrombocytopenic purpura) and is accompanied by an increase in the duration of bleeding, impaired retraction of the blood clot, a decrease in the retention index (adhesiveness) and platelet count. Symptoms of tourniquet and pinch and cuff test are positive.

The second group of diseases

The second group includes diseases in which bleeding is caused by hereditary or acquired deficiency of procoagulants or an increased content of anticoagulants, leading to clotting disorders (hemophilia, hypo- and afibrinogenemia, dysprothrombinemia). Patients develop massive hemorrhages in soft tissues and joints (hemarthrosis). There are no petechiae. Prolonged nosebleeds, bleeding from the gums after extraction of teeth and bleeding after open injuries of the skin and soft tissues are possible. Laboratory signs - prolongation of blood clotting time, changes in autocoagulation test parameters.

The third group of diseases

The third group consists of diseases in which vascular permeability is changed (Randu-Osler hereditary telangiectasia, Shenlein-Genoch hemorrhagic vasculitis). Randu-Osler disease is characterized by telangiectasias on the lips and mucous membranes and may present with hemoptysis, intestinal bleeding, and hematuria. In Shenlein-Genoch disease, a small-dotted hemorrhagic rash appears on an inflammatory background. The rash slightly rises above the surface of the skin and gives a slight sensation of volume on palpation. There may be hematuria. Standard coagulation tests have not been changed.

hemolytic syndrome

The syndrome includes diseases that are characterized by a decrease in the number of erythrocytes and the concentration of hemoglobin in the blood due to increased hemolysis of erythrocytes.

Increased destruction of red blood cells is due to the following factors:

• changes in the metabolism and structure of membranes, erythrocyte stroma and hemoglobin molecules;
• damaging effect of chemical, physical and biological factors of hemolysis on the erythrocyte membrane;
• slowing down the movement of erythrocytes in the intersinus spaces of the spleen, which contributes to their destruction by macrophages;
• increased phagocytic activity of macrophages.

Indicators of hemolysis are:

• an increase in the formation of free bilirubin and a corresponding change in pigment metabolism;
• change in osmotic resistance of erythrocytes;
• reticulocytosis.

Iron deficiency anemia is a hypochromic microcytic anemia, which is the result of an absolute decrease in iron stores in the human body. According to WHO, this syndrome occurs in every sixth man and every third woman, that is, about two hundred million people are affected by it in the world.

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, as it has a significant impact on performance, behavior, mental and physiological development. This noticeably reduces social activity, but, unfortunately, anemia is often underestimated, because gradually a person gets used to a decrease in iron stores in his body.

IDA is very common in adolescents, preschoolers, infants, and women who are of childbearing age. What are the reasons for such a deficiency of iron in the human body?

The reasons

Blood loss is a very common cause of iron deficiency anemia. This is especially true for long-term and permanent blood loss, even if insignificant. In this case, it turns out that the amount of iron that enters the human body with food is less than the amount of iron that is lost by him. Even if a person consumes a lot of foods containing iron, this may not make up for its deficiency, since the possibilities of physiological absorption of this element from food are limited.

The usual daily diet assumes an iron content of about 18 grams. In this case, only about 1.5 grams are absorbed, or 2 if the body has increased needs for this element. It turns out that iron deficiency occurs when more than two grams of this element is lost per day.

Iron loss is different in men and women. In men, the losses that occur with sweat, feces, urine and outgoing epithelium are not higher than one milligram. If they consume enough iron with food, then they will not develop an iron deficiency. In women, iron loss is greater, as there are additional factors for this, such as pregnancy, childbirth, lactation and menstruation. Therefore, in women, the need for iron is often greater than its absorption. So, let's look at the causes of iron deficiency anemia in more detail.

1. Pregnancy. It is worth noting that if there was no iron deficiency before pregnancy or lactation, then these facts most likely will not lead to a decrease in the reserves of this element. However, in the event that the pregnancy occurred a second time, and the gap between the first and second pregnancy was small, or iron deficiency had already developed before it, it will become even larger. Each pregnancy, childbirth and lactation results in a loss of about 800 mg of iron.
2. Blood loss from the urinary tract. This is a rare cause, but it does occur. Iron deficiency occurs due to the constant excretion of red blood cells in the urine. Also, this element can be lost, not being a component of erythrocyte hemoglobin. We are talking about hemoglobinuria and hemosiderinuria in patients with Marchiafava-Micheli disease.

1. Bleeding from the gastrointestinal tract. It is the most common cause of anemia in men and is the second cause in women. These blood loss can occur due to peptic ulcer of the duodenum or stomach, helminth invasions of tumors of the intestines or stomach, and other diseases.
2. Blood loss in closed cavities with impaired iron recycling. This form of iron deficiency anemia includes anemia that occurs with isolated pulmonary siderosis. This disease is characterized by constant blood loss in the lung tissue.

Newborns and infants are prone to iron deficiency anemia for the following reasons:

• blood loss with placenta previa;
• intestinal bleeding accompanying some infectious diseases;
• damage to the placenta during caesarean section;

Such a condition in childhood is fraught with serious dangers, since the child's body is most sensitive to iron deficiency. By the way, anemia can develop in a child due to malnutrition, which can be expressed in malnutrition or a monotonous diet. Also in children, as in some adults, the cause can be helminthic intoxication, due to which the production of red cells and all hematopoiesis is inhibited.

Symptoms

The set of symptoms for anemia depends on how severe the iron deficiency is and how quickly this condition continues to develop. The symptoms of iron deficiency anemia are best considered in terms of two important syndromes. But before that, let's briefly mention several stages and degrees of severity of anemia. There are two stages in total:

1. At the first stage, the deficiency does not have a clinic, such anemia is called latent;
2. At the second stage, anemia has a detailed clinical and laboratory picture.

In addition, the classification of iron deficiency anemia involves the division of the disease according to severity.

1. The first degree of severity is considered mild. The Hb content is between 90 and 120 g/l.
2. The second, medium, severity suggests an Hb content ranging from 70 to 90.
3. In severe cases, the Hb content does not exceed 70.

And finally, most importantly, the division of iron deficiency anemia, depending on the clinical manifestations. There are two important syndromes, each of which has its own characteristics.

Anemia syndrome

It is characterized by a decrease in the number of red blood cells, hemoglobin content, as well as inadequate provision of tissues with oxygen. All this is manifested in non-specific syndromes. A person complains of increased fatigue, general weakness, dizziness, palpitations, flies, tinnitus, shortness of breath during physical exertion, fainting, drowsiness, decreased mental performance and memory. Subjective manifestations initially disturb a person during a load of the physical plane, and later at rest. An objective examination reveals the pallor of the skin and visible mucous membranes. In addition, pastosity may appear in the face, feet and legs. In the morning there are swelling under the eyes. It is worth noting that not all of these symptoms appear immediately and in one person.

With anemia, the syndrome of myocardial dystrophy develops. It is accompanied by symptoms such as tachycardia, shortness of breath, arrhythmia, deafness of heart sounds, moderate expansion of the left borders of the heart and a soft systolic murmur, manifested in auscultatory points. If anemia is long and severe, this syndrome can lead to severe circulatory failure. Iron deficiency anemia does not develop abruptly. This happens gradually, because of which the human body adapts and the manifestations of anemic syndrome are not always pronounced.

sideropenic syndrome

It is also called hyposiderosis syndrome. This condition is due to tissue iron deficiency, which reduces the activity of many enzymes. Sideropenic syndrome has many manifestations. Symptoms of iron deficiency anemia in this case are:

• addiction to sour, salty, spicy or spicy foods;
• dystrophic changes in the skin, as well as its appendages, which manifests itself in dryness, flaking, hair loss, early graying, brittleness, dullness of nails, and so on;
• a perversion of taste, manifested in an irresistible desire to eat something inedible and unusual, such as clay, chalk;
• perversion of the sense of smell, that is, addiction to smells that are perceived by the majority as unpleasant, for example, gasoline, paints, and so on;
• angular stomatitis;
• imperative urge to urinate, inability to control sneezing, coughing or laughing;
• atrophic changes in the mucous membrane of the gastrointestinal tract;
• glossitis, characterized by pain and a bursting feeling in the region of the tongue;
• a clear predisposition to infectious and inflammatory processes;
• sideropenic subfebrile condition, when the body temperature rises to subfebrile values.

Diagnostics

In order to prescribe an effective treatment, it is necessary to distinguish iron deficiency anemia from other types of hypochromic anemia that develop for other reasons, which include many pathological conditions caused by impaired hemoglobin formation processes. The main difference is that other types of anemia occur in the case of a high concentration of iron ions in the blood. Its reserves are completely stored in the depot, and therefore, there are no symptoms of tissue deficiency of this element.

Further diagnosis of iron deficiency anemia is to find out the reasons that led to the development of this disease. We discussed the reasons above. You can identify them in different ways.

Differential diagnosis includes:

• methods for determining lost blood in women during menstruation;
• x-ray studies of the intestines and stomach;
• studies that exclude or confirm uterine fibromyoma;
• laboratory methods that examine blood, bone marrow and determine indicators of iron metabolism; for example, it is not easy for a doctor to identify bleeding that occurred in the digestive tract and its causes, but a diagnosis can be made by counting the number of reticulocytes; an increase in the number of these elements is a sign of bleeding;
• gastroscopy; irrigoscopy; colonoscopy and sigmoidoscopy; these studies are carried out even with frequent nosebleeds and other conditions that are associated with blood loss;
• diagnostic laparoscopy; that minor surgical intervention, which is performed if there is proven blood loss from the gastrointestinal area, but it is not possible to identify the source of such bleeding; thanks to this method, you can visually examine everything that happens in the abdominal cavity itself.

Treatment

Treatment of iron deficiency anemia is aimed at treating the pathology due to which iron deficiency has developed. A very important point is the use of iron-containing preparations that help restore iron stores in the body. Routine administration of iron-containing preparations is unacceptable, as it is expensive, ineffective, and often leads to diagnostic errors.

It is very important for people with anemia to eat right. The diet includes a sufficient amount of meat products that contain iron in the heme composition. It is absorbed more efficiently. However, nutrition alone will not improve the situation in the body due to anemia.

Iron deficiency anemia is treated with iron-containing oral preparations. Parenteral agents are used in case of special indications. Today there are quite a lot of medicines that contain iron salts, for example, orferon, ferroplex. Preparations that have two hundred milligrams of ferrous sulfate are considered cheap and convenient, it turns out that in one tablet there are fifty milligrams of elemental iron. For adults, an acceptable dose is one or two tablets three times a day. An adult patient should receive at least two hundred grams per day, that is, three milligrams per kilogram, meaning elemental iron.

Sometimes, in connection with the intake of iron-containing drugs, adverse events may occur. It is most often associated with irritation that occurs in the gastrointestinal tract. This usually concerns the lower parts of it and manifests itself in diarrhea or severe constipation. This is usually not related to the dosage of the drug. However, the irritation that occurs in the upper sections is just related to the dosage. This is expressed in pain, discomfort and nausea. In children, adverse events are rare, and are expressed in the temporary darkening of the teeth. To prevent this from happening, the drug is best given to the root of the tongue. It is also recommended to brush your teeth more often and drink the medicine with liquid.

If adverse events are too severe and associated with the upper gastrointestinal tract, you can take the drug after meals, and you can also reduce the dose taken at a time. If such phenomena persist, the doctor may prescribe drugs that contain less iron. If this method does not help, it is advised to switch to slow-acting drugs.

The main reason for treatment failure is ongoing bleeding. Identifying and stopping bleeding is the key to successful therapy.

We list the main reasons that lead to treatment failure:

• combined deficiency, when not only iron is lacking, but also folic acid or vitamin B12;
• misdiagnosis;
• taking drugs that act slowly.

To get rid of iron deficiency, it is necessary to take medicines containing this element for at least three months and even more. The use of oral preparations will not overload the body with iron, since absorption decreases sharply when the reserves of this element are restored.

The main indications for the use of parenteral drugs are as follows:

• the need to quickly compensate for iron deficiency, for example, before surgery or in case of significant blood loss;
• iron malabsorption due to damage to the small intestine;
• side effects from taking oral medications.

Parenteral administration may produce undesirable effects. It can also cause iron to accumulate in the body in undesirable amounts. The most severe side effect from taking parenteral drugs is an anaphylactic reaction. It can occur both with intramuscular injection and with intravenous administration. This reaction occurs rarely, but parenteral drugs should in any case be used only in a specialized medical institution, where emergency care can be provided at any time.

Effects

Any disease, if not treated on time, will not lead to anything good. The same is the case with anemia. In this state, the body experiences a kind of stress, which can be expressed in loss of consciousness. In this condition, a person can go to the hospital, where doctors will conduct a variety of examinations to understand the cause. This includes a blood test, gastroscopy, and so on.

For example, it may turn out that a person has gastritis with a low acidity of the stomach, which is why a reduced amount of iron is observed in his body. In this case, vitamin B12 is often prescribed for a course of twenty days. But this does not eliminate the cause of anemia, since a person has a diseased intestine or stomach. Therefore, doctors will give such a patient recommendations related to his illness, and also advise him to examine the blood every few months.

Prevention

Prevention of iron deficiency anemia includes four main ways.

1. Taking iron supplements for the prevention of those people who are at risk.
2. The use of foods containing iron in large quantities.
3. Regular blood monitoring.
4. Elimination of sources of blood loss.

A very important point is the prevention of anemia in childhood. It includes:

• correct daily routine;
• rational feeding;
• preventive courses of taking iron preparations up to 1.5 years.

If breastfeeding is breastfeeding, timely introduction of complementary foods is considered prevention. If feeding is artificial, then children are advised to give milk formulas that are close in properties to breast milk and contain forms of iron that are easy to digest.

It is important to carefully monitor the diet of the child in the second half of the year. At this time, their own iron reserves are already depleted, so there is an urgent need to replenish its reserves. The protein part of the diet helps to do this, since protein and iron are components of red blood cells. These foods include eggs, meat, fish, cheese, cereals and vegetable dishes.

It is also necessary to ensure that such important trace elements as manganese, copper, nickel, B vitamins and so on enter the child's body. Therefore, the diet should include foods such as beef, beets, green peas, potatoes, tomatoes, and so on.

As you can see, it is important for both adults and children to monitor their diet and lifestyle in order to prevent anemia. However, if any of the symptoms that we also talked about in this article occur, you should immediately go to the doctor and prevent your body from getting used to such a painful condition. Timely treatment of anemia returns a person to his activity and prolongs life!

Iron is one of the elements without which the human body is not able to fully function. Nevertheless, there is a risk of violation of its reserves due to the influence of various factors and processes. One of the most common problems is iron deficiency anemia (IDA). It can develop in both children and adults, and even pregnant women are at risk. Given all the destructive potential of this disease, it is worth learning more about it.

What is meant by iron deficiency anemia?

Before studying sideropenic syndrome in iron deficiency anemia, it is necessary to touch on the essence of the problem associated with the lack of this trace element. Anemia of this type is a pathological condition that is characterized by a decrease in the level of hemoglobin in the blood due to a noticeable deficiency of iron in the body. The deficiency itself appears directly due to a violation of its intake and assimilation, or due to pathological losses of this element.

Iron deficiency anemia (aka sideropenic) differs from most other anemias in that it does not cause a decrease in red blood cells. In most cases, it is detected in women of reproductive age, pregnant women and children.

Causes of the disease

Initially, it is worth identifying risk factors for which iron deficiency may occur. Increased iron expenditure followed by anemia can be caused by repeated pregnancy, heavy menses, lactation, and rapid growth during puberty. Older people may have impaired iron utilization. Also, in old age, the number of diseases increases significantly, against the background of which anemia (renal failure, oncopathology, etc.) develops.

It is also worth worrying about such a problem as iron deficiency in the case when the absorption of this element at the level of erythrokaryocytes is disturbed (due to insufficient intake of iron along with food). As the cause of the development of iron deficiency anemia, it makes sense to consider any disease that leads to blood loss. These can be tumor and ulcerative processes in the gastrointestinal tract, endometriosis, chronic hemorrhoids, etc. In rare cases, there may be blood loss from the Meckel diverticulum of the small intestine, where a peptic ulcer develops due to the formation of peptin and hydrochloric acid.

Causes of iron deficiency anemia can be associated with glomic tumors in the lungs, pleura and diaphragm, as well as in the mesentery of the intestine and stomach. These tumors, which have a direct connection with the trailing arteries, can ulcerate and become a source of bleeding. The fact of blood loss is sometimes established in the case of acquired or hereditary pulmonary siderosis, which is complicated by hemorrhage. As a result of this process, iron in the human body is released, followed by its deposition in the lungs in the form of hemosiderin without the possibility of subsequent utilization. Loss of iron in the urine may be the result of a combination of diseases, such as acquired having an autoimmune nature.

Sometimes the causes of iron deficiency anemia, associated with the loss of iron along with the blood, are directly related to the influence of helminths, which, penetrating into the intestinal wall, cause damage to it and, as a result, microblood loss that can lead to the development of IDA. The risk of this type of anemia is real for those donors who donate blood frequently. And as another cause of blood loss worthy of attention, one can determine the hemangioma of the internal organs.

Iron in the human body can be poorly absorbed due to diseases of the small intestine, which occur in conjunction with intestinal dysbacteriosis and resection of a part of the small intestine. Previously, quite often it was possible to meet the opinion that atrophic gastritis, which has a reduced secretory function, should be considered as the real cause of iron deficiency anemia. In fact, such a disease can only have an auxiliary effect.

Latent iron deficiency (hidden, without clinical signs) can be detected at the biochemical level. Such a deficiency is characterized by the absence or a sharp decrease in the deposits of this microelement in bone marrow macrophages, which can be detected using special staining. It is worth repeating that at this stage, the loss of iron can only be recorded in the laboratory.

Another sign that allows you to detect a deficiency is a decrease in the content of ferritin in the blood serum.

Symptoms characteristic of iron-containing anemia

In order to make the symptoms more understandable, it makes sense to divide the process of formation of iron deficiency into 3 stages.

Speaking about the first stage, it is worth noting that it is not accompanied by clinical signs. It can be detected only by determining the amount of absorption of radioactive iron in the gastrointestinal tract and the amount of hemosiderin, which is contained in bone marrow macrophages.

The second stage can be characterized as a latent iron deficiency. It manifests itself through a decrease in exercise tolerance and significant fatigue. All these signs clearly indicate a lack of iron in the tissues due to a decrease in the concentration of iron-containing enzymes. In this state, two processes occur simultaneously: a decrease in the level of ferritin in erythrocytes and blood serum, as well as insufficient saturation of transferrin with iron.

The third stage should be understood as the clinical manifestation of IDA. The main symptoms of this period include trophic disorders of the skin, nails, hair, sideropenic signs and general weakness), an increase in muscle weakness, shortness of breath and signs of cerebral and heart failure (tinnitus, dizziness, pain in the heart, fainting).

The sideropenic symptoms during the third stage include the desire to eat chalk - geophagia, dysuria, urinary incontinence, craving for the smell of gasoline, acetone, etc. As for geophagy, in addition to iron deficiency, it may indicate a lack of magnesium and zinc in the body.

Describing the general signs of iron deficiency, you need to pay attention to symptoms such as weakness, loss of appetite, syncope, palpitations, headaches, irritability, low blood pressure flickering "flies" before the eyes, poor sleep at night and drowsiness during the day, a gradual increase in temperature, a decrease in attention and memory, as well as tearfulness and nervousness.

Influence of sideropenic syndrome

It is important to understand that iron is a component of many enzymes. For this reason, when its deficiency occurs, the activity of enzymes decreases and the normal course of metabolic processes in the body is disturbed. Thus, sideropenic syndrome is the cause of many symptoms:

1. Skin changes. When iron deficiency occurs, you may notice flaking and dry skin, which cracks over time. The occurrence of cracks is possible on the palms, in the corners of the mouth, on the feet and even in the anus. Hair with this syndrome turns gray early, becomes brittle and actively falls out. Approximately a quarter of patients are faced with brittleness, thinning and transverse striation of the nails. Tissue iron deficiency is actually a consequence of a lack of tissue enzymes.
2. Muscular changes. Iron deficiency leads to a lack of enzymes and myoglobin in the muscles. This leads to rapid fatigue and weakness. In adolescents, as well as in children, a lack of iron in enzymes provokes a delay in physical development and growth. Due to the fact that the muscular apparatus is weakened, the patient feels an imperative urge to urinate, difficulty with holding urine during laughter and coughing. Girls with iron deficiency often have to deal with bedwetting.

Sideropenic syndrome also leads to changes in the mucous membranes of the intestinal tract (cracks in the corners of the mouth, angular stomatitis, increased susceptibility to caries and periodontal disease). There is also a change in the perception of smells. With a similar syndrome, patients begin to like the smell of shoe polish, fuel oil, gasoline, gas, naphthalene, acetone, damp earth after rain, varnishes.

Changes also affect taste sensations. We are talking about a strong desire to taste such non-food products as tooth powder, raw dough, ice, sand, clay, minced meat, cereals.

With a disease such as sideropenic syndrome, the mucous membranes of the lower and upper membranes of the respiratory tract change. Such changes lead to the development of atrophic pharyngitis and rhinitis. The vast majority of people with iron deficiency develop blue sclera syndrome. As a result of a violation of the hydrocollation of lysine, a failure occurs in the process of collagen synthesis.

With a lack of iron, there is a risk of changes in the immune system. We are talking about lowering the level of certain immunoglobulins, B-lysines and lysozyme. There is also a violation of the phagocytic activity of neutrophils and cellular immunity.

With such a problem as sideropenic syndrome, the appearance of dystrophic changes in internal organs is not excluded. These include secondary anemic sideropenic myocardial dystrophy. It manifests itself by strengthening the first tone at the apex of the heart and expanding the border of percussion dullness.

With iron deficiency, the condition of the digestive tract can also change. These are symptoms such as sideropenic dysphagia, dryness of the esophageal mucosa and, possibly, its destruction. Patients begin to feel difficulty in the process of swallowing in the evening or in a state of overwork. Perhaps a violation of tissue respiration, leading to a gradual atrophy of the gastric mucosa, in which atrophic gastritis develops. Sideropenic syndrome can also lead to a decrease in gastric secretion, which can result in achilia.

Why does iron deficiency anemia develop in pregnant women?

In women who are carrying a child, iron deficiency may be due to the appearance of extragenital and gynecological diseases before pregnancy, as well as a high need for iron during fetal development.

Many factors can affect the occurrence of a disease such as anemia. Iron deficiency in pregnant women usually develops for the following reasons:

• the chronic ones mentioned above (heart defects, duodenal and stomach ulcers, atrophic gastritis, kidney pathology, helminthic invasions, liver diseases, diseases that are accompanied by nosebleeds, and hemorrhoids);
• exposure to a woman's body of various chemicals and pesticides that can interfere with the absorption of iron;
• congenital deficiency;
• violations of the process of iron absorption (chronic pancreatitis, enteritis, resection of the small intestine, intestinal dysbacteriosis);
• malnutrition, which is not able to ensure the supply of this microelement to the body in the required amount.

iron deficiency in children

Throughout the entire period of pregnancy in the child's body, the formation of the basic composition of this microelement in the blood takes place. However, in the third trimester, one can observe the most active intake of iron through the placental vessels. In a full-term baby, the normal level of its content in the body should be 400 mg. At the same time, in those children who were born before the required time, this indicator does not rise above 100 mg.

It is also important to take into account the fact that mother's milk contains enough of this trace element to replenish the reserves of the child's body before the age of 4 months. Therefore, if breastfeeding is stopped too soon, the baby may develop an iron deficiency. The causes of IDA in children may be associated with the prenatal period. We are talking about various infectious diseases of the mother during pregnancy, with late and early toxicosis, as well as hypoxia syndrome. Factors such as multiple pregnancies in fetal transfusion syndrome, chronic iron deficiency anemia during pregnancy, and uteroplacental bleeding may also affect iron depletion.

In the intranatal period, the danger is massive bleeding during delivery and premature ligation of the umbilical cord. As for the postpartum period, at this stage, iron deficiency can be the result of an accelerated growth rate of the child, early feeding with whole cow's milk and diseases that are accompanied by a violation of the absorption function of the intestine.

Blood test to detect IDA

This diagnostic method is necessary in order to determine the low level of hemoglobin and red blood cells. It can be used to identify hemolytic and iron deficiency anemia by fixing the morphological characteristics of erythrocytes and erythrocyte mass.

In the case of the development of IDA, a biochemical blood test will necessarily show a decrease in the concentration of serum ferritin, an increase in TIBC, a decrease in concentration, and a significantly lower saturation of this transferrin microelement compared to the norm.

It is important to know that you should not drink alcohol the day before the test. You should not eat 8 hours before the diagnosis, only clean water without gas is allowed.

Differential Diagnosis

In this case, the medical history can significantly help in making a diagnosis. Iron deficiency anemia often develops along with other diseases, so this information will be extremely useful. As for the differential approach to the diagnosis of IDA, it is carried out with those diseases that can cause iron deficiency. At the same time, thalassemia is characterized by clinical and laboratory signs of erythrocyte shemolysis (an increase in the size of the spleen, an increase in the level of indirect bilirubin, reticulocytosis and a high iron content in the depot and blood serum).

Treatment methods

In order to overcome such a problem as a lack of iron in the blood, it is necessary to correctly approach the recovery strategy. An individual approach should be shown to each patient, otherwise it is difficult to achieve the desired level of effectiveness of therapeutic measures.

With such a problem as iron deficiency in the body, treatment primarily involves the impact on the factor that provokes the occurrence of anemia. Correction of this condition with the help of medications also plays an important role in the recovery process.

Attention should also be paid to nutrition. The diet of patients with IDA should include foods that contain heme iron. These are rabbit meat, veal, beef. Do not forget about succinic, citric and ascorbic acids. To compensate for iron deficiency, the use of dietary fiber, calcium, oxalates and polyphenols (soy protein, tea, coffee, chocolate, milk) will help.

Regarding the topic of drug treatment in more detail, it is worth noting that iron preparations are prescribed in a course of 1.5 to 2 months. After the level of Hb is normalized, maintenance therapy is indicated with a half dose of the drug for 4-6 weeks.

Iron-containing drugs for anemia are taken at the rate of 100-200 mg / day. After the dosage is reduced to 30-60 g (2-4 months). The following drugs can be attributed to the most popular: "Tardiferon", "Maltofer", "Totema", "Ferroplex", "Sorbifer", "Ferrum Lek". As a rule, medication is taken before meals. The exception is patients diagnosed with gastritis and ulcers. The above medicines should not be washed down with products that can bind iron (milk, tea, coffee). Otherwise, their effect will be nullified. It is worth initially being aware of the harmless side effect that iron-containing drugs can produce in case of anemia (meaning the dark color of the teeth). You should not be afraid of such a reaction. As for the unpleasant consequences of drug treatment, gastrointestinal disorders (constipation, abdominal pain) and nausea may occur.

The main way to administer drugs for iron deficiency is by mouth. But in the case of the development of intestinal pathology, in which the absorption process is disturbed, parenteral administration is indicated.

Prevention

In the vast majority of cases, with the help of drug treatment, doctors manage to correct iron deficiency. Nevertheless, the disease can recur and develop again (extremely rare). To avoid such a development of events, prevention of iron deficiency anemia is necessary. This means annual monitoring of the parameters of a clinical blood test, the rapid elimination of any causes of blood loss and good nutrition. For those who are at risk, the doctor may prescribe the necessary medications for preventive purposes.

Obviously, the lack of iron in the blood is a very serious problem. Any medical history can confirm this. Iron deficiency anemia, no matter what the patient is, is a prime example of a highly devastating disease. Therefore, at the first symptoms of a deficiency of this microelement, it is necessary to consult a doctor and undergo a course of treatment in a timely manner.