Reasons for waiting in adults. Signs of anemia in women. How iron deficiency manifests itself

Anemia is a common condition in women, the main symptom of pathology is a decrease in the level of hemoglobin in the blood. It cannot be called an independent disease, but rather a syndrome of many diseases and at the same time the cause of many dangerous conditions.

Colloquially, anemia is often referred to as anemia. This is due to a decrease in the number of red blood cells in the blood and the resulting oxygen deficiency. Women are especially susceptible to this pathological condition, both young girls and ladies over 40 years old. Most often this applies to those whose body does not have enough strength for themselves and for the child.

Varieties of anemia

According to the severity of anemia, anemia can be divided into three groups:

• 1 degree, when the deviation of the hemoglobin level from the norm is less than a fifth;
• 2 degree, in which the hemoglobin level is 20 - 40% below normal;
• 3 degrees when the deviation exceeds 40%.

The gradation of severity is expressed in relative terms, because the norm of hemoglobin in the blood is different depending on gender and age.

Depending on the underlying causes of anemia in women, the following types are distinguished:

• iron deficiency;
• aplastic;
• posthemorrhagic;
• hemolytic;
• folic acid deficiency;
• with B12 deficiency.

Iron deficiency anemia is caused by a lack of iron in the body. This may be due to an increased need for it, for example, during the period of active teenage growth or pregnancy. Often it is associated with malnutrition, diets that lead to insufficient intake of this element.

Aplastic anemia is caused by a disease of the hematopoietic system associated with damage to bone marrow cells. This is the most severe form of anemia and is fatal in 80% of cases. But it is extremely rare.

Posthemorrhagic anemia is associated with severe blood loss, which could be caused by internal or external bleeding, resulting from trauma or exacerbation of chronic diseases, such as stomach ulcers. In women, it is often found in gynecological diseases accompanied by uterine bleeding.

Hemolytic anemia is manifested by shortening the life cycle of red blood cells. This type of pathology is very rare and can also be hereditary or acquired.

The last two types of anemia are associated with a deficiency in the body of folic acid and vitamin B12, respectively. The lack of these substances leads to disruption of the normal process of maturation of red blood cells, which is enhanced in the presence of aggravating factors. Such influences include pregnancy, increased physical and mental stress, and chronic diseases.

Causes of anemia

The state of insufficient hemoglobin may accompany, each of which has its own causes and aggravating factors. But there are a number of common causes of anemia that cause disturbances in the body of a woman:

• heredity;
• eating disorders;
• increased mental and physical stress;
• some conditions accompanied by an increased need for nutrition of body cells;
• negative environmental factors, ecology;
• chronic diseases and their exacerbations;
• transferred infectious diseases.

In women after 40 years of age, anemia can be caused by hormonal changes, a slowdown in metabolism, and the development of cancer. During this period, you should be especially attentive to your health and prevent the neglect of existing chronic ailments.

Depending on the severity and nature of the causes of anemia, the manifestation of symptoms and the method of treatment will differ. Both errors in lifestyle and nutrition, and dangerous diseases can lead to a pathological condition. Therefore, when the first suspicious signs appear, you should consult a doctor.

Symptoms of anemia

Anemia for a long time may not have pronounced symptoms, which is why it is easy to confuse it with ordinary malaise and fatigue. A number of forms of anemia have specific symptoms. There are the following common signs of anemia in women:

• weakness and malaise;
• increased fatigue;
• decreased ability to withstand physical activity;
• dizziness;
• drowsiness;
• changes in taste sensations;
• sweating;
• shortness of breath;
• rapid heart rate;
• difficulty in swallowing;
• darkening in the eyes and fainting;
• deterioration in the condition of hair and nails;
• violation of the menstrual cycle;
• decreased appetite.

There are also a number of specific symptoms that occur with certain types of anemia:

• with posthemorrhagic anemia, pallor of the skin, low body temperature, vomiting, and digestive disorders are observed;
• with an iron deficiency type, tinnitus, muscle weakness, skin peeling, cyanosis under the eyes are observed;
• hypoplastic anemia is characterized by ulcers in the mouth, nose, and skin;
• with a hemolytic form, there are signs of a violation of the liver, an increase in the spleen, chills;
• with a deficiency of vitamins in anemia, digestive disorders, poor memory and coordination are expressed.

The severity of symptoms depends on the severity and duration of the pathological condition. Therefore, only professional diagnostics can determine the presence of a problem.

Diagnosis of anemia

If you suspect anemia, you should consult a therapist. He will prescribe a general and biochemical blood test, according to which the presence and severity of the disease will be accurately identified.

To determine the type and causes of the pathology, if necessary, an examination of the digestive tract, skin, study of heredity and medical history is performed.

The type of anemia can only be determined by a doctor based on the analysis of the collected data. Depending on the type and causes, an individual treatment strategy will be selected. In the presence of risk factors for anemia or the facts of the disease in the past, it is necessary to monitor the level of hemoglobin at least once a year.

Anemia treatment

In general, treatment is reduced to the fight against iron deficiency in the body. Sometimes a simple diet is enough for this, and in some cases serious drug therapy is necessary. An important condition for successful treatment is the elimination of the root cause of this condition.

So it comes down to this:

1. Determination of the cause and its elimination, therapy of the underlying disease.
2. Identification of the stage of anemia and the necessary degree of therapeutic intervention.
3. Drawing up a diet and nutrition plan.
4. Appointment of iron preparations and agents that improve its absorption.

Drug therapy usually takes from several months to six months. Iron-containing agents are used in different forms of release. In the most severe cases, injections are recommended.

Nutrition for anemia

Proper nutrition for anemia in women will allow you to cope with a low stage of anemia without the use of special drugs. Iron is found in both meat and plant foods. However, anemia is more common in vegetarians.

• red meat (veal, beef);
• beef liver;
• Fish and seafood;
• eggs and dairy products.

But many plant foods are rich in iron. Legumes and cereals are especially useful: buckwheat, oatmeal, wheat, barley, rice. Fruits and vegetables are useful in whole form and in freshly squeezed juices.

Of particular note are pomegranate and beetroot juices. With the latter, you need to be careful because of its high biological activity. The use of fresh juices must be agreed with a gastroenterologist.

The following types of fruits are rich in iron:

• apples;
• grape;
• Garnet;
• peaches;
• citrus;
• persimmon.

Useful foods include red and orange vegetables: beets, carrots, pumpkins, tomatoes. Berries, nuts and dried fruits are also recommended. It is advisable to use herbal or berry tea, and refuse coffee altogether.

You can not eat junk food, fried, spicy and fatty. It is necessary to adhere to the general recommendations of a healthy diet and lifestyle. It must be remembered that for the absorption of iron entering the body, a sufficient amount of vitamins is necessary. The main vitamins involved in metabolic processes include folic acid, vitamin C, as well as B6 and B12.

Vitamin C plays an important role in the normal functioning of the immune system. Its sources are not only citrus fruits, but also rose hips, greens, cabbage, currants, sea buckthorn, viburnum, kiwi.

Folk remedies for the treatment of anemia

Folk remedies for the treatment of anemia are designed to raise the level of hemoglobin and improve the absorption of iron. They cannot cure serious diseases that are the causes of the disease state. Therefore, they are used as a supplement that increases the effectiveness of the main treatment.

1. Strawberry infusion. It is made from dried berries, which are poured with a glass of boiling water and infused for several hours. After that, it is used once a day.
2. Garlic tincture is made on alcohol, therefore it is not suitable for women during pregnancy and lactation, as well as for children. Garlic has a high biological activity, strengthens the immune system and improves metabolism. A mixture of garlic and alcohol is infused for 3 weeks, after which 15-20 drops are taken, dissolved in a glass of milk.
3. Decoction of wild rose in any form. You can brew self-picked berries or purchase ready-made tea for brewing at the pharmacy.
4. Oatmeal decoction. Groats are boiled at the rate of a glass per liter of water to a mass similar to jelly. After that, it is filtered, diluted with milk and boiled again. Before use, honey is added to it. You need to take not all at once, but two to three times during the day.

Dangerous consequences of anemia

As a result of a long-term pathological condition, negative health consequences of anemia are possible, even if its degree is low:

• lowered immunity and frequent illnesses;
• insomnia;
• susceptibility to stress, emotional instability;
• frequent inflammation of the mucous membranes;
• puffiness;
• disruption of the heart and blood vessels;
• liver disease;
• digestive problems;
• oxygen starvation of the brain;
• dry skin, brittle nails and hair.

These are the consequences of directly reduced hemoglobin. It must also be remembered that this condition can be caused by serious systemic disorders. Therefore, the lack of treatment will lead to their aggravation and in some cases can cause irreversible deterioration in health.

For women, anemia is a common phenomenon, especially often accompanying pregnancy, and gynecological diseases. Anemia is dangerous for its consequences, especially during pregnancy. At the first signs of pathology, it is necessary to correct the diet and lifestyle. Control of these two aspects is the best way to prevent. It is also necessary to lead a healthy lifestyle with sufficient physical activity and spend more time outdoors.

Symptoms iron deficiency anemia, treatment and causes

Iron deficiency anemia (anemia) is a pathological syndrome characterized by a decrease in the number of red blood cells and hemoglobin in the blood. It is the main hypoxia of tissues and organs, since against the background of a lack of an 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. In 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 hemoglobin in the blood. 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 (decrease in hemoglobin content in the erythrocyte) microcytic (decrease in the size of erythrocytes) anemia that 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 mineral iron 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 indispensable material for the retention of oxygen molecules by erythrocytes and the subsequent process of transfer from pulmonary vesicles to tissues.

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

Other Mechanisms Affecting Iron Levels

It is important not only to supply the mineral with food (iron is not produced in the body), but also the correct process of its absorption 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 rapid replenishment in the event of an acute deficiency. Stocks are stored in the form of hemosiderin.

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

• 2/3 falls on hemoglobin;
• for reserves in the liver, spleen and bone marrow in the form of hemosiderin - 1 g;
• on 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. Maternal 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 minerals occurs with urine, feces, through the sweat glands. In women from adolescence to menopause, there is another path of menstrual bleeding.

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

Maintaining the right balance to ensure tissue respiration depends on the correct functioning of this mechanism.

Causes

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

blood loss

chronic (daily blood loss 5-10 ml)

• frequent nosebleeds;
• stomach and intestinal bleeding;
• profuse menstruation;
• pathology of the kidneys with characteristic hematuria.

Acute (massive blood loss)

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

Insufficient supply of iron

• debilitating diets and starvation;
• unbalanced diet;
• vegetarianism.

Decreased levels of absorbed iron

• diseases of the gastrointestinal tract, helminthic invasion;
• old age and infancy.

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 pregnancy.

Severity

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

1. Light - hemoglobin values ​​​​are in the range of 110 - 90 g / l;
2. Average - the content of Hb ranges from 90 to 70 g / l;
3. 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 know that he has anemia, that is, when hemoglobin will noticeably decrease.

Symptoms of iron deficiency anemia

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

• dyspnea;
• violation of taste and smell;
• susceptibility to infectious diseases;
• language loss;
• increased fatigue;
• changes in the skin (flaking and redness) and nails / hair (stratification, loss);
• damage to the mucous membranes (for example, sores of the type of stomatitis may appear in the oral cavity);
• intellectual development disorders - concentration of attention decreases, the child begins to poorly absorb educational material, memory decreases;
• muscle weakness.

At the same time, in the clinical picture of iron deficiency anemia, 2 main syndromes are distinguished:

• hyposiderosis;
• anemic syndrome.

Anemia syndrome

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

• shortness of breath that appears 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 has a chronic course, so patients are able to adapt to its manifestations.

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

• fainting states;
• angina attacks;
• decompensation of vascular lesions of the brain.

Hyposiderosis

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 tips;
• 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;
• a change in the color of the skin to a pale greenish tint;
• unusual eating habits (desire to eat chalk, ashes and other substances);
• addiction to unusual smells;
• blue sclera due to degenerative changes in the cornea of ​​the eye against the background of iron deficiency.

According to recent studies conducted by pediatricians and hematologists, children with tissue iron deficiency experience 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, in young patients, there is 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 determining the degree of its severity, are carried out according to the results of laboratory tests. Iron deficiency anemia is characterized by the following changes:

• 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 mcg / l, for men - 30-310 mcg / l);
• microcytosis (the presence in the blood of abnormally small red blood cells);
• 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);
• decrease in saturation of transferrin with iron (norm - 30%).

For effective treatment of iron deficiency anemia, it is important to establish the cause that caused it. In order to detect the source of chronic blood loss, the following is indicated:

• FEGDS;
• irrigoscopy;
• ultrasound examination of the pelvic organs;
• radiography of the stomach with contrast;
• colonoscopy;
• stool examination for occult blood.

In difficult diagnostic cases, a puncture of the red bone marrow is performed, followed by a histological and cytological examination of the obtained 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 anemia (thalassemia, sideroblastic anemia).

Treatment of iron deficiency anemia

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

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

So, this practice has justified itself well in the treatment of women with chronic posthemorrhagic iron deficiency anemia due to long-term hyperpolymenorrhea with tardiferon - one tablet in the morning and evening for 6 months without a break, then one tablet a day for another 6 months, then for several years every day for a week on menstruation days . This provides an iron load when prolonged heavy periods appear during menopause. A meaningless anachronism is to determine the level of hemoglobin before and after menstruation.

With agastric (gastrectomy for a tumor) anemia, taking the minimum dose of the drug constantly for many years and administering vitamin B12 at 200 micrograms per day intramuscularly or subcutaneously for four consecutive weeks every year for life gives a good effect.

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

Popular iron preparations

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

Some of the most effective medications for increasing iron levels include:

• Ferrum Lek;
• Maltofer;
• Ferroplex;
• Hemopher;
• Ferroceron; (colors urine pink)
• Tardiferon;
• Ferrogradumet;
• Heferol;
• Ferograd;
• Sorbifer-durules.

Preparations for parenteral administration are prescribed for violation of iron absorption in the gastrointestinal tract (gastric resection, peptic ulcer of the stomach 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 hot, 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 drugs is not a guide to action; it is up to the attending physician to prescribe and calculate the dose. Therapeutic doses are prescribed until the hemoglobin level normalizes, then the patient is transferred to prophylactic doses.

How long do I need to take iron supplements?

1. If the treatment is effective, then on the 10-12th day the number of young erythrocytes - reticulocytes - sharply increases in the blood.
2. After 3-4 weeks, hemoglobin rises.
3. Complaints disappear after 1.5-2 months.
4. Iron deficiency in tissues can be eliminated only after 3 months of continuous intake of iron preparations - this is how long 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 tissue changes associated with iron deficiency are hidden. Fortunately, modern drugs can eliminate these problems - provided that the treatment is carried out to the end, and the causes, if possible, are eliminated.

Side effects

Most often, the following side effects are observed during the treatment with iron preparations: a metallic taste in the mouth, darkening of tooth enamel, allergic skin rashes, digestive disorders as a result of an irritating effect 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 an 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 according to 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 anemia not caused by iron deficiency (hemolytic, aplastic), hemosiderosis, hemochromatosis.

Diet

The International Association of Hematology claims that by normalizing the eating behavior of a patient with signs of mild iron deficiency anemia, it is possible to largely normalize blood counts and not resort to the use of iron supplements to eliminate iron deficiency. Patients with severe anemia are shown to use a specialized diet as an addition to the main treatment.

The fundamental principles of therapeutic nutrition for iron deficiency anemia are a sharp restriction in the use 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, so their consumption should not be limited.

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

From the diet of patients with iron deficiency anemia, it is recommended to completely exclude dairy products and black tea, as they contain substances that prevent the absorption of iron. And, on the contrary, synergistic products that should be consumed in large quantities together with iron-containing products are those that contain a large 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 periods of heavy menstruation, as well as the processes of pregnancy and childbirth. However, iron deficiency during the period of bearing a child does not always occur, 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 malnutrition.

Iron deficiency anemia in pregnant women is expressed by symptoms that are easily confused with toxicosis, and only with severe deficiency do the signs become apparent.

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

Complications of iron deficiency anemia

Complications occur with a long 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 puts more stress on the heart and eventually leads to heart failure
• pregnant women have an increased risk of preterm birth and fetal growth retardation,
• in children, iron deficiency causes a delay in growth and development,
• hypoxia due to iron deficiency complicates the course of existing cardiopulmonary diseases (CHD, bronchial asthma, bronchiectasis, and others).

Prevention

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

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

Prevention should be carried out, according to experts from 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 purpose of the primary is to eliminate the main factor contributing to the anemization of the body, the secondary is to identify signs in a timely manner, correctly diagnose and treat the disease in time. The goal of tertiary prevention is to minimize possible complications.

Forecast

In the vast majority of cases, iron deficiency anemia can be successfully corrected, 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 anemia. A correct diagnosis is the key to successful treatment.

Do you feel tired, do not have the strength to work, do you constantly want to sleep? Perhaps the reason for your condition is the lack of iron necessary for our body. What is iron deficiency anemia and what causes it? How to prevent the disease, what are the ways of its treatment and prevention? You will find answers to all questions in this article.

Despite the insignificant proportion of the metal in our body (from 2 g to 5 g), its significance is colossal.

Iron is part of the blood, and more precisely in the protein hemoglobin, which is found in red blood cells - erythrocytes. Hemoglobin supplies the body and each of its cells with oxygen, taking it from the lungs, carries it through the bloodstream, providing oxidation processes accompanied by the release of energy.

Hemoglobin not only saturates the blood with oxygen, but also frees it from carbon dioxide, plays the role of a biological carrier.

Lack of hemoglobin causes oxygen starvation, at the household level, the disease is called "anemia". In scientific circles, a low level of iron in the blood has a medical term - iron deficiency (sideropenic) anemia, hematological syndrome, or abbreviated as IDA.

Iron deficiency anemia: symptoms

Iron deficiency anemia differs from other anemias (Addison-Birmer and hypochromic) by a decrease in the number of red blood cells in the blood.

All symptoms of IDA are classified as sideropenic syndrome characteristic of IDA and anemic syndrome, the same for all anemias.

sideropenic syndrome, occurs due to a sharp decrease in red blood cells - erythrocytes in the blood:

• the nail plate becomes brittle and flat with transverse stripes
• hair split, fall out, become dull
• skin is pale, tans poorly in the sun, has an unhealthy appearance
• perverse taste, desire arises, there is coal, earth, chalk, clay
• crimson tongue, smooth, shiny
• red cracks in the corners of the mouth (jammed)
• perverted preferences for smells, desire to sniff kerosene, exhaust fumes, gasoline, paint

Anemia syndrome associated with a lack of hemoglobin in the blood

• drowsiness and fatigue
• shortness of breath with minor physical exertion
• palpitations, tachycardia
• goosebumps before the eyes
• pale skin, sometimes with a bluish or greenish tinge
• pastosity (swelling) of the limbs
• constant colds and infectious diseases.

The occurrence of certain symptoms makes you think about your health and consult a doctor for examination.

Iron deficiency anemia: causes

Anemia caused by iron deficiency in the human body is a common disease. Some scientists believe that such a disease does not exist in nature - these are symptoms of other diseases that affect the human condition. To bring the amount of hemoglobin in the blood back to normal, it is necessary to find out the root cause of iron deficiency by consulting a doctor.

After studying the medical history and summarizing the data, the scientists identified the factors and groups of people who are at an increased risk of developing IDA.

Insufficient intake of iron from food:

• refusal of animal food - vegetarianism (iron is more easily absorbed from animal foods than plant foods)
• starvation, strict diets
• in the products that a person consumes per day, insufficient iron content

As a result of blood loss:

• period after surgery, condition after injury, with extensive burns
• uncontrolled donation and blood transfusion
• bleeding in the digestive organs and hemorrhoidal
• uterine and heavy menstrual bleeding
• kidney disease with increased excretion of red blood cells in the urine

The need for increased levels of iron (Fe):

• infants from 1 to 2 years old, children in the period of active growth, in adolescence
• for people who are actively involved in sports or physical labor
• for pregnant women and during lactation
• in a newborn with congenital anemia

Iron (Fe) is poorly absorbed into the blood through the intestinal wall:

• old age
• Crohn's disease
• intolerance to certain foods - celiac disease
• some drugs block iron absorption

Degrees of iron deficiency anemia

According to statistics, from 15 to 20% of the world's population suffer from a latent form of anemia, they do not know about their illness until they donate blood for analysis.

Statistics show that among patients with anemia, 20% are women, 50% are pregnant, and only 3% are men. Such indicators are not surprising, because men, as representatives of the stronger sex, eat a lot of meat and do not lose blood every month at reproductive age (for biological reasons), like a woman.

IDA stages

1. Mild IDA- mild symptoms (hemoglobin less than 110 g / l).
2. Medium to moderate anemia- the patient complains of headache, poor sleep, appetite. Hair and nails become dull and brittle. Persistent colds that last a long time in a severe form. Pale skin, cracks in the tongue, in the corners of the lips - seized (hemoglobin from 70 g / l to 90 g / l).
3. Severe form of IDA- tachycardia, shortness of breath not only during movement, but also at rest. The pallor of the skin becomes bluish over time, a mental disorder (hemoglobin below 70 g / l).
4. Coma (hypoxic) with IDA- limbs are motionless, a sharp drop in blood pressure, vomiting, fainting.

By contacting a doctor at the first signs indicating a lack of iron in the blood, you can avoid severe consequences and complications caused by IDA.

iron deficiency anemia during pregnancy

The most common anemia in pregnant women is iron deficiency. According to WHO, the incidence of IDA in women at different stages of fetal development ranges from 20% to 80%.

Iron is extremely necessary for pregnant women - with its lack, fatigue occurs, complications arise in the work of internal organs, frequent colds are possible, which negatively affects her well-being and the condition of the fetus. The symptoms of anemia in a pregnant woman are the same as in all those suffering from a lack of iron in the blood.

Why is anemia dangerous during pregnancy? Oxygen starvation of the fetus, which affects intrauterine development and its survival during childbirth. The amount of hemoglobin in a pregnant woman should not fall below 110 g / l.

In a woman's body, on average, 4 g of Fe, which not only enters, but is also excreted through the skin, with urine, during breastfeeding, and menstruation. A non-pregnant woman consumes up to 1.5 mg Fe per day.

For a woman who is expecting a child, Fe intake increases in each trimester of pregnancy.

• in the first trimester, the daily dose is increased by 1 mg
• in the second - 2 mg
• the third - by 3 mg

16-20 weeks in the development of the fetus is characterized by the formation of blood flow and blood elements, this time accounts for the largest consumption of iron in the body of a woman.

Specific Causes of IDA in Pregnant Women

In addition to the factors listed above that cause anemia, for pregnant women there are specific ones associated with its position. Women at risk are:

• who gave birth many times or gave birth with a short period between births
• previous pregnancies were interrupted artificially
• with postpartum bleeding
• twin and twin pregnancy
• early pregnancy (under 17) or late pregnancy (after 30)
• toxicosis (gestosis) at different stages of pregnancy
• premature abruption of the placenta associated with bleeding
• women with low blood pressure

If a pregnant woman has been diagnosed with iron deficiency anemia of 3-4 degrees, experts advise terminating the pregnancy before the 12-week period.

Prevention of anemia in a pregnant woman

To give birth to a healthy child is the main task of a woman. With IDA, the risk of miscarriage and childbirth with complications increases. If you have a latent (latent) form of anemia, you need to restore your hemoglobin levels to normal and take steps to avoid getting sick during pregnancy.

When planning a child, a woman should:

1. Full examination and complete blood count- the main task of a woman, allowing to prevent any disease.
2. From the beginning of bearing a child to the end of feeding, the mother's body loses from 800 to 950 g of iron in order to women need 4-5 years to recover after childbirth. When planning a pregnancy, you should pay attention to this fact in order to avoid iron deficiency anemia.
3. Balanced Diet during pregnancy, rich in protein and plant foods with a high content of easily digestible iron - maintains normal hemoglobin.
4. In the menu, consider the compatibility and incompatibility of products, which contribute to or hinder the enrichment of the blood with iron, otherwise the diet will not be beneficial.
5. The WHO recommends that women take drugs rich in iron during the II and III trimester of gestation and six months of breastfeeding (on the recommendation of a doctor). Excess iron in the blood causes complications during pregnancy.

Observing all the rules, a woman will be able to bear a healthy child and not get sick with iron deficiency anemia herself.

Iron deficiency anemia in children

If your baby was born premature, weak, and you suffered from a lack of hemoglobin during gestation, you need to carefully monitor the health of the newborn. Congenital anemia is possible, which is fortunately extremely rare.

If you notice a change in the behavior of the child, in his appearance, you should seek the advice of a pediatrician. Based on laboratory blood tests, the doctor will make the correct diagnosis.

Signs of anemia in a child:

• the baby constantly cries, is naughty, it is difficult to put him to sleep
• lips, inner eyelids and skin are pale (gypsum-colored)
• the child has no appetite, but he pulls earth, sand, clay, chalk into his mouth
• the baby lags behind in development from his peers, motor skills of speech and movement are not fixed

If your child is switched to artificial formulas, they should be rich in iron. As complementary foods, we choose animal products with a high content of iron, which are better absorbed (rabbit meat, beef liver, veal).

Let's give dairy products some time after iron-containing ones, since calcium in milk is an iron antagonist.

Apples and other fruits rich in iron and other trace elements should be given to babies in the form of juice or puree.

Phytopreparations

The gifts of nature are an excellent replenishment of the child's body not only with iron, but with vitamins and other microelements. It is recommended to make decoctions and infusions of chamomile, rose hips, mint for children - they will help increase hemoglobin and cope with colds.

Vitamins with iron content used only on the recommendation of a pediatrician.

Diagnosis of iron deficiency anemia

To find out the amount of hemoglobin in the blood, it is necessary to do a clinical (general) blood test and a biochemical one.

In people with anemia, there are deviations in the hemogram of a healthy person.

Complete blood count for anemia:

1. As a result of the research, amount of hemoglobin in one unit of blood volume (decreases with IDA).
2. If the IDA test is positive, then number, shape, size of erythrocytes will differ from the norm.
3. RBC staining normal - pink, monochrome, less saturated in the center. Hemoglobin in anemia stains red blood cells unevenly, chaotically.
4. Install white blood cell count, they should be normal, if there are more of them - this indicates health problems.

Biochemical blood test

If there is not enough hemoglobin in the blood, then an analysis for iron deficiency anemia will show:

• less serum ferritin(not enough iron, the body takes it from ferritin)
• less iron in serum(due to deficiency)
• decreased binding of transferrin to iron(transferrin protein does not tolerate blood iron).

When confirmed in the IDA analysis, an extended analysis is performed to rule out another type of anemia so that no error occurs.

Iron deficiency anemia: treatment

The diagnosis of IDA can be confirmed or denied by a therapist or hematologist. These experts will work with you to develop a step-by-step course of treatment.

Treatment for IDA includes:

• We treat chronic diseases that are associated with large blood loss (gastric ulcer, hemorrhoids, fibroids, heavy menstruation)
• A diet high in iron
• Taking medicinal vitamin complexes rich in trace elements, preparations that contain Fe
• Traditional medicine, herbal medicine
• Quitting smoking, drinking alcohol, exercising
• If you have a low level of hemoglobin in your blood and you are taking iron supplements, you should limit your intake of coffee and tea.
• Juices from citrus fruits, apple and pomegranate will help iron to be absorbed
• Healthy sleep, rest

Diet for iron deficiency anemia

If you do not feel a lack of iron, and the doctor said that a blood test showed a slight deviation of hemoglobin from the norm, you should not aggravate the situation, it is better to prevent the further development of the disease. Supplement your diet with well-known iron foods.

Heme iron(in products of animal origin), absorbed by 15% -35%

Rich in heme iron foods (4 mg or more of Fe per 100 g):

• liver (veal, pork, chicken)
• rabbit meat
• brains, heart, kidneys, beef tongue
• egg yolk
• seafood (oysters, mussels, clams)

Saturated with heme ironfoods (2.5 to 4 mg Fe):

• meat (lamb, beef, turkey, chicken)
• chicken egg

Good heme iron content products (from 1 mg to 2.5 Fe):

• Red caviar
• river fish (carp, burbot)
• sea ​​fish (perch, mackerel)

Non-heme Fe(in products of plant origin) is absorbed by 2% -20%.

Products with excellent content of non-heme iron (more than 6 mg per 100 g):

• apricot, dried apricots, prunes
• dried fruits (apples, pears)
• dried mushrooms
• nuts (cashews, peanuts, almonds)
• legumes (lentils, peas, beans)
• pumpkin seeds
• cocoa powder
• buckwheat
• sea ​​kale (kelp)

Products with good content of non-heme iron (from 2.5 to 6 mg):

• oatmeal
• fruits (apples, pears, peach, plum)
• berries (dogwood, currant)
• vegetables (beets, carrots)
• greens (lettuce, spinach, nettle)

Fortunately, the products around us contain a sufficient amount of iron, it is a pity that the body absorbs it partially. When compiling the menu, remember that some trace elements in foods prevent the absorption of iron into the blood.

Tannin is in antagonism with iron, the substance is present in large quantities in coffee and tea. Do not drink drinks together or after foods containing iron.

Helps iron molecules to enter the bloodstream:

• ascorbic acid (citrus fruits, rose hips, sauerkraut)
• all types of plants from the cruciferous family
• strawberries and sea buckthorn
• all kinds of greens (lettuce, spinach, parsley, dill) green onions

A pregnant woman should eat a balanced diet, get proteins, carbohydrates and fats. Food rich in iron is useful for her, it has a beneficial effect on the fetus, but the liver is not recommended - vitamin A in it has a bad effect on the development of the fetus.

Iron deficiency anemia: treatment drugs

Hemolytic iron preparations for anemia are prescribed by a doctor. There are over-the-counter corrective drugs that increase the level of iron in the blood of patients suffering from mild to moderate anemia.

Ferretab composite

• A medicine based on iron salts and folic acid, helps to increase hemoglobin in the blood, is involved in the formation of red blood cells in the human body.
• One or two capsules per day for an adult with latent IDA.
• The drug has a prolonged (long-term) effect on the composition of the blood.

Sorbifer Durules

• Sulphate salt of ferrous iron with ascorbic acid, which improves the absorption of the drug into the blood
• For pregnant women in the II and III trimester, one tablet per day, after the birth of a child and lactation, 2 tablets

Totem

• Gluconate Fe, Cu, Mg in the form of capsules with a dark liquid
• Used 1-2 capsules inside for an adult
• One of the rare drugs that can be given to children after consulting with a pediatrician
• The dose for a child is calculated according to its weight.

Fenyuls

• A complex of vitamins B and C, with a high percentage of ferrous salt
• In capsules it is in the form of a small, multi-colored dragee
• The course of treatment is one capsule 30 days
• Not recommended for children

Ferroplex

• Compound of ferrous sulfate with ascorbic acid in the form of dragees.
• Adults need 6 tablets per day with equal intervals between doses. For children, 1 tablet 3 times is enough. We take dragees without chewing.

Prevention of iron deficiency anemia and treatment with folk remedies

We are surrounded by useful plants, herbs that will cope with a low level of hemoglobin no worse than medicines, and will prevent the appearance of iron deficiency anemia.

• Summer is just beginning, indulge yourself to the fullest with a variety of berries, fruits, vegetables, herbs.
• If you are the owner of your own house or cottage, do not be lazy, stock up on dried fruits for the winter. Freeze the harvest in the freezer.
• The forest gives us herbs, berries, mushrooms. We collect the gifts of the forest, dry, freeze, cook jam, and in winter we support immunity and a normal level of hemoglobin with our preparations. Our ancestors cooked nettle soup, which, according to herbalists, contains the most non-heme iron.
• If you have a breakdown, squeeze a glass of beetroot juice, and drink half a glass every day on an empty stomach. You can cook and use carrot, pomegranate, cabbage juice (from sauerkraut).

Tea, it is better to brew with herbs (melissa, oregano), lime blossom, rose hips.

If you have chronic IDA, hemoglobin is constantly below normal, cook food in a cast iron, like our ancestors. This unusual way to combat iron deficiency anemia was adopted by a doctor from Canada. He came up with a banal, but effective tool - an iron fish.

Around the globe, 2 billion people suffer from iron deficiency anemia. People in poor, underdeveloped countries survive on plant foods, from which iron is absorbed much worse than from meat and fish. There are religions that forbid eating the meat of slaughtered animals.

The scientist offered such people an iron fish: it needs to be boiled for 20 minutes in water or with soup, it saturates the contents of the pan with iron ions. Thus, a person replenishes 75% of the daily iron requirement.

Iron deficiency anemia is a disease that is quite common in society. This is facilitated by food poor in nutrients and an imbalance in the diet. In this article, we have given the main products and drugs that will help prevent iron deficiency anemia and its negative consequences for the body.

Video: How to treat iron deficiency anemia with folk remedies?

The main thing in the treatment of anemia is the treatment of the underlying disease, the elimination of the cause of anemia.

Iron metabolism in the body

Iron is an essential biometal that plays an important role in the functioning of cells in many body systems. The biological significance of iron is determined by its ability to reversibly oxidize and reduce. This property ensures the participation of iron in the processes of tissue respiration. Iron makes up only 0.0065% of body weight. The iron content in the body of a woman weighing 60 kg is approximately 2.1 g (35 mg/kg of body weight).

There are two types of iron: heme and non-heme. Heme iron is part of hemoglobin. It is contained only in a small part of the diet (meat products), is well absorbed (by 20-30%), its absorption is practically not affected by other food components. Non-heme iron is in free ionic form - ferrous (Fe II) or ferric (Fe III). Most dietary iron is non-heme iron (found mainly in vegetables). The degree of its assimilation is lower than that of heme, and depends on a number of factors. From food, only divalent non-heme iron is absorbed. To “turn” ferric iron into ferrous, a reducing agent is needed, the role of which in most cases is played by ascorbic acid (vitamin C). In the process of absorption in the cells of the intestinal mucosa, ferrous iron Fe2 + is converted into oxide Fe3 + and binds to a special carrier protein - transferrin, which transports iron to hematopoietic tissues and iron deposition sites.

The accumulation of iron is carried out by the proteins ferritin and hemosiderin. If necessary, iron can be actively released from ferritin and used for erythropoiesis. Hemosiderin is a ferritin derivative with a higher iron content. From hemosiderin, iron is released slowly. Beginning (prelatent) iron deficiency can be identified by a reduced concentration of ferritin even before the exhaustion of iron stores, while still maintaining normal concentrations of iron and transferrin in the blood serum.
What provokes / Causes of Iron deficiency anemia:

The main etiopathogenetic factor in the development of iron deficiency anemia is iron deficiency. The most common causes of iron deficiency in women are:

• iron loss in chronic bleeding (the most common cause, reaching 80%);
• insufficient absorption of iron;
• increased need for iron;
• insufficient intake of iron from food.

Symptoms of iron deficiency anemia

Patients with iron deficiency anemia note general weakness, fatigue, difficulty in concentrating, and sometimes drowsiness. There is a headache, dizziness. With severe anemia, fainting is possible. These complaints, as a rule, do not depend on the degree of decrease in hemoglobin, but on the duration of the disease and the age of the patients.

Iron deficiency anemia in women is also characterized by changes in the skin, nails, and hair. The skin is usually pale, sometimes with a slight greenish tint (chlorosis) and with an easy blush of the cheeks, it becomes dry, flabby, flaky, cracks easily. Hair loses its luster, becomes gray, thinner, breaks easily, thins and turns gray early. Nail changes are specific: they become thin, dull, flatten, easily delaminate and break, striation appears. With pronounced changes, the nails acquire a concave, spoon-shaped shape (koilonychia). In patients with iron deficiency anemia, muscle weakness occurs, which is not observed in other types of anemia. It is referred to as a manifestation of tissue sideropenia. Atrophic changes occur in the mucous membranes of the digestive canal, respiratory organs, and genital organs. Damage to the mucous membrane of the digestive canal is a typical symptom of iron deficiency conditions.

There is a decrease in appetite. There is a need for sour, spicy, salty foods. In more severe cases, there are perversions of smell, taste (pica chlorotica): eating chalk, lime, raw cereals, pogophagy (an attraction to eating ice). Signs of tissue sideropenia quickly disappear after taking iron supplements.

Diagnosis of iron deficiency anemia

The main guidelines in the laboratory diagnosis of iron deficiency anemia are as follows:

1. The average content of hemoglobin in the erythrocyte in picograms (normal 27-35 pg) is reduced. To calculate it, the color index is multiplied by 33.3. For example, with a color index of 0.7 x 33.3, the hemoglobin content is 23.3 pg.
2. The average concentration of hemoglobin in the erythrocyte is reduced; normally, it is 31-36 g / dl.
3. Hypochromia of erythrocytes is determined by microscopy of a smear of peripheral blood and is characterized by an increase in the zone of central enlightenment in the erythrocyte; Normally, the ratio of central enlightenment to peripheral darkening is 1:1; with iron deficiency anemia - 2 + 3: 1.
4. Microcytosis of erythrocytes - a decrease in their size.
5. Coloring of erythrocytes of different intensity - anisochromia; the presence of both hypo- and normochromic erythrocytes.
6. A different form of erythrocytes is poikilocytosis.
7. The number of reticulocytes (in the absence of blood loss and the period of ferrotherapy) with iron deficiency anemia remains normal.
8. The content of leukocytes is also within the normal range (with the exception of cases of blood loss or oncopathology).
9. The content of platelets often remains within the normal range; moderate thrombocytosis is possible with blood loss at the time of examination, and the platelet count decreases when blood loss due to thrombocytopenia is the basis of iron deficiency anemia (for example, with DIC, Werlhof's disease).
10. A decrease in the number of siderocytes up to their disappearance (a siderocyte is an erythrocyte containing iron granules). In order to standardize the production of peripheral blood smears, it is recommended to use special automatic devices; the resulting monolayer of cells improves the quality of their identification.

Blood chemistry:

1. Decreased iron content in the blood serum (normal in men 13-30 µmol/l, in women 12-25 µmol/l).
2. TIBC is increased (reflects the amount of iron that can be bound by free transferrin; TIBC is normal - 30-86 µmol / l).
3. Study of transferrin receptors by enzyme immunoassay; their level is increased in patients with iron deficiency anemia (in patients with anemia of chronic diseases - normal or reduced, despite similar indicators of iron metabolism.
4. The latent iron-binding capacity of the blood serum is increased (determined by subtracting the serum iron content from the FIA ​​values).
5. The percentage of saturation of transferrin with iron (the ratio of the serum iron index to the total body fat; normally 16-50%) is reduced.
6. The level of serum ferritin is also reduced (normally 15-150 mcg/l).

At the same time, in patients with iron deficiency anemia, the number of transferrin receptors is increased and the level of erythropoietin in the blood serum is increased (compensatory reactions of hematopoiesis). The volume of erythropoietin secretion is inversely proportional to the oxygen transport capacity of the blood and is directly proportional to the oxygen demand of the blood. It should be borne in mind that the level of serum iron is higher in the morning; before and during menstruation, it is higher than after menstruation. The content of iron in the blood serum in the first weeks of pregnancy is higher than in its last trimester. The level of serum iron increases on the 2nd-4th day after treatment with iron-containing drugs, and then decreases. Significant consumption of meat products on the eve of the study is accompanied by hypersideremia. These data must be taken into account when evaluating the results of a serum iron study. It is equally important to observe the technique of laboratory research, the rules of blood sampling. Thus, the test tubes in which blood is collected must first be washed with hydrochloric acid and bidistilled water.

The study of the myelogram reveals a moderate normoblastic reaction and a sharp decrease in the content of sideroblasts (erythrokaryocytes containing iron granules).

The iron stores in the body are judged by the results of the desferal test. In a healthy person, after intravenous administration of 500 mg of desferal, 0.8 to 1.2 mg of iron is excreted in the urine, while in a patient with iron deficiency anemia, iron excretion decreases to 0.2 mg. The new domestic drug defericolixam is identical to desferal, but circulates in the blood longer and therefore more accurately reflects the level of iron stores in the body.

Based on the level of hemoglobin, iron deficiency anemia, like other forms of anemia, is divided into severe, moderate and mild anemia. With mild iron deficiency anemia, the hemoglobin concentration is below normal, but more than 90 g / l; with moderate iron deficiency anemia, the hemoglobin content is less than 90 g / l, but more than 70 g / l; with severe iron deficiency anemia, the hemoglobin concentration is less than 70 g / l. However, clinical signs of the severity of anemia (symptoms of a hypoxic nature) do not always correspond to the severity of anemia according to laboratory criteria. Therefore, a classification of anemia according to the severity of clinical symptoms has been proposed.

According to clinical manifestations, 5 degrees of severity of anemia are distinguished:

• anemia without clinical manifestations;
• anemic syndrome of moderate severity;
• severe anemic syndrome;
• anemic precoma;
• anemic coma.

Moderate severity of anemia is characterized by general weakness, specific signs (for example, sideropenic or signs of vitamin B12 deficiency); with a pronounced degree of severity of anemia, palpitations, shortness of breath, dizziness, etc. appear. Precomatous and comatose states can develop in a matter of hours, which is especially characteristic of megaloblastic anemia.

Modern clinical studies show that laboratory and clinical heterogeneity is observed among patients with iron deficiency anemia. So, in some patients with signs of iron deficiency anemia and concomitant inflammatory and infectious diseases, the level of serum and erythrocyte ferritin does not decrease, however, after the elimination of the exacerbation of the underlying disease, their content drops, which indicates the activation of macrophages in the processes of iron consumption. In some patients, the level of erythrocyte ferritin even increases, especially in patients with a long course of iron deficiency anemia, which leads to ineffective erythropoiesis. Sometimes there is an increase in the level of serum iron and erythrocyte ferritin, a decrease in serum transferrin. It is assumed that in these cases, the process of iron transfer to hemosynthetic cells is disrupted. In some cases, a deficiency of iron, vitamin B12 and folic acid is determined simultaneously.

Thus, even the level of serum iron does not always reflect the degree of iron deficiency in the body in the presence of other signs of iron deficiency anemia. Only the level of TIBC in iron deficiency anemia is always elevated. Therefore, not a single biochemical indicator, incl. TIA cannot be considered as an absolute diagnostic criterion for iron deficiency anemia. At the same time, the morphological characteristics of peripheral blood erythrocytes and computer analysis of the main parameters of erythrocytes are decisive in the screening diagnosis of iron deficiency anemia.

Diagnosis of iron deficiency conditions is difficult in cases where the hemoglobin content remains normal. Iron deficiency anemia develops in the presence of the same risk factors as in iron deficiency anemia, as well as in individuals with an increased physiological need for iron, especially in premature babies at an early age, in adolescents with a rapid increase in body height and weight, in blood donors, with nutritional dystrophy. At the first stage of iron deficiency, there are no clinical manifestations, and iron deficiency is determined by the content of hemosiderin in bone marrow macrophages and by the absorption of radioactive iron in the gastrointestinal tract. At the second stage (latent iron deficiency), there is an increase in the concentration of protoporphyrin in erythrocytes, a decrease in the number of sideroblasts, morphological signs appear (microcytosis, hypochromia of erythrocytes), a decrease in the average content and concentration of hemoglobin in erythrocytes, a decrease in the level of serum and erythrocyte ferritin, saturation of transferrin with iron. The level of hemoglobin in this stage remains quite high, and clinical signs are characterized by a decrease in exercise tolerance. The third stage is manifested by clear clinical and laboratory signs of anemia.

Examination of patients with iron deficiency anemia

To exclude anemia that has common features with iron deficiency anemia, and to identify the cause of iron deficiency, a complete clinical examination of the patient is necessary:

1. Complete blood count with the obligatory determination of the number of platelets, reticulocytes, the study of the morphology of erythrocytes.
2. Biochemical blood test: determination of the level of iron, OZhSS, ferritin, bilirubin (bound and free), hemoglobin.
3. In all cases, it is necessary to examine the bone marrow punctate before prescribing vitamin B12 (primarily for differential diagnosis with megaloblastic anemia).

To identify the cause of iron deficiency anemia in women, a preliminary consultation with a gynecologist is required in order to exclude diseases of the uterus and its appendages.

There are cases of extragenital endometriosis, for example in the respiratory tract. In these cases, hemoptysis is observed; fibrobronchoscopy with histological examination of the biopsy of the bronchial mucosa allows you to establish a diagnosis.

The examination plan also includes X-ray and endoscopic examination of the stomach and intestines in order to exclude ulcers, tumors, incl. glomic, as well as polyps, diverticulum, Crohn's disease, ulcerative colitis, etc. If pulmonary siderosis is suspected, radiography and tomography of the lungs are performed, sputum examination for alveolar macrophages containing hemosiderin; in rare cases, a histological examination of a lung biopsy is necessary. If a kidney pathology is suspected, a general urinalysis, a blood serum test for urea and creatinine are necessary, and, if indicated, an ultrasound and X-ray examination of the kidneys. In some cases, it is necessary to exclude endocrine pathology: myxedema, in which iron deficiency can develop a second time due to damage to the small intestine; polymyalgia rheumatica is a rare connective tissue disease in older women (less often in men), characterized by pain in the muscles of the shoulder or pelvic girdle without any objective changes in them, and in the blood test - anemia and an increase in ESR.

Differential diagnosis of iron deficiency anemia

When making a diagnosis of iron deficiency anemia, it is necessary to make a differential diagnosis with other hypochromic anemias.

Iron-redistributive anemia is a fairly common pathology and, in terms of frequency of development, ranks second among all anemias (after iron deficiency anemia). It develops in acute and chronic infectious and inflammatory diseases, sepsis, tuberculosis, rheumatoid arthritis, liver diseases, oncological diseases, ischemic heart disease, etc. The mechanism for the development of hypochromic anemia in these conditions is associated with the redistribution of iron in the body (it is located mainly in the depot) and violation mechanism for the recycling of iron from the depot. In the above diseases, the activation of the macrophage system occurs, when macrophages, under conditions of activation, firmly retain iron, thereby disrupting the process of its reutilization. In the general blood test, a moderate decrease in hemoglobin is noted (<80 г/л).

The main differences from iron deficiency anemia are:

• elevated serum ferritin, indicating an increased iron content in the depot;
• serum iron levels may remain within normal limits or be moderately reduced;
• TIBC remains within normal limits or decreases, which indicates the absence of serum Fe-starvation.

Iron-saturated anemia develops as a result of impaired heme synthesis, which is due to heredity or may be acquired. Heme is formed from protoporphyrin and iron in erythrokaryocytes. With iron-saturated anemia, there is a violation of the activity of enzymes involved in the synthesis of protoporphyrin. The consequence of this is a violation of heme synthesis. Iron that has not been used for heme synthesis is deposited in the form of ferritin in bone marrow macrophages, as well as in the form of hemosiderin in the skin, liver, pancreas, and myocardium, resulting in secondary hemosiderosis. Anemia, erythropenia, and a decrease in color index will be recorded in the general blood test.

Indicators of iron metabolism in the body are characterized by an increase in the concentration of ferritin and the level of serum iron, normal indicators of TIBC, and an increase in the saturation of transferrin with iron (in some cases it reaches 100%). Thus, the main biochemical indicators that allow assessing the state of iron metabolism in the body are ferritin, serum iron, TIBC, and % saturation of transferrin with iron.

The use of indicators of iron metabolism in the body allows the clinician to:

• identify the presence and nature of iron metabolism disorders in the body;
• identify the presence of iron deficiency in the body at the preclinical stage;
• conduct differential diagnosis of hypochromic anemia;
• evaluate the effectiveness of the therapy.

Treatment of iron deficiency anemia

In all cases of iron deficiency anemia, 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 treat the underlying disease complicated by sideropenia).

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

Treatment program for iron deficiency anemia:

• elimination of the cause of iron deficiency anemia;
• medical nutrition;
• ferrotherapy;
• relapse prevention.

Patients with iron deficiency anemia are recommended a varied diet, including meat products (veal, liver) and vegetable products (beans, soybeans, parsley, peas, spinach, dried apricots, prunes, pomegranates, raisins, rice, buckwheat, bread). However, it is impossible to achieve an antianemic effect with diet alone. Even if the patient eats high-calorie foods containing animal protein, iron salts, vitamins, microelements, iron absorption can be achieved no more than 3-5 mg per day. It is necessary to use iron preparations. Currently, the doctor has a large arsenal of iron preparations, characterized by different composition and properties, the amount of iron they contain, the presence of additional components that affect the pharmacokinetics of the drug, and various dosage forms.

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

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

According to the recommendations developed by WHO, when prescribing iron preparations, preference is given to preparations containing ferrous iron. The daily dose should reach 2 mg/kg of elemental iron in adults. The total duration of treatment is at least three months (sometimes up to 4-6 months). An ideal iron-containing preparation should have a minimum number of side effects, have a simple regimen of administration, the best ratio of effectiveness / price, optimal iron content, preferably the presence of factors that enhance absorption and stimulate hematopoiesis.

Indications for parenteral administration of iron preparations occur with intolerance to all oral preparations, malabsorption (ulcerative colitis, enteritis), peptic ulcer of the stomach and duodenum during an exacerbation, with severe anemia and the vital need for rapid replenishment of iron deficiency. The effectiveness of iron preparations is judged by changes in laboratory parameters over time. By the 5th-7th day of treatment, the number of reticulocytes increases by 1.5-2 times compared with the initial data. Starting from the 10th day of therapy, the hemoglobin content increases.

Taking into account the prooxidant and lysosomotropic effect of iron preparations, their parenteral administration can be combined with intravenous drip administration of rheopolyglucin (400 ml once a week), which allows protecting the cell and avoiding overload of macrophages with iron. Taking into account significant changes in the functional state of the erythrocyte membrane, activation of lipid peroxidation and a decrease in the antioxidant protection of erythrocytes in iron deficiency anemia, it is necessary to introduce antioxidants, membrane stabilizers, cytoprotectors, antihypoxants, such as a-tocopherol up to 100-150 mg per day (or ascorutin, vitamin A, vitamin C, lipostabil, methionine, mildronate, etc.), and also combined with vitamins B1, B2, B6, B15, lipoic acid. In some cases, it is advisable to use ceruloplasmin.

Symptomatically, women are prescribed: a diet rich in protein, iron, vitamins (meat, cottage cheese, liver, berries, fresh fruits, greens); iron preparations: hemostimulin, ferrocal, ferkoven, ferrum-lek; vitamins B1, B12. In severe cases, transfusion of blood or red blood cells is indicated.

Anemia, also called anemia, is a collection of hematological syndromes, the main symptom of which is low hemoglobin, against which there is a decrease in the number of red blood cells. Anemia is a phenomenon that can be a symptom of various diseases. Many diseases of the internal organs, especially the liver, intestines and spleen, are accompanied by anemia. Therefore, the diagnosis of anemia itself requires additional research, since the correct treatment depends on its cause.

The main syndrome of anemia is low hemoglobin

Depending on the causes that caused the disease, anemia can be:

• Hypoplastic. It is caused by disorders of the bone marrow, due to which the process of blood formation changes.
• Hemolytic. Red blood cells are destroyed much faster than new ones are created.
• Posthemorrhagic. It is caused by severe blood loss as a result of injury or trauma.
• Scarce. Such anemia is caused by a lack of important trace elements, most often iron.

Features of iron deficiency anemia

This type of anemia is the most common and affects mainly women. Approximately 30% of women of reproductive age have signs of mild anemia, but do not attach any importance to it, taking it for mild fatigue. A decrease in hemoglobin for a long time may not be noticeable, since anemia in women develops gradually. In the vast majority of cases, it is caused by too much blood loss during or due to gynecological diseases.

After 40, the signs of illness in women become most noticeable, since at this age women rarely take care of themselves carefully, fatigue accumulates and the desire to be in time everywhere affects. Unfortunately, in our women, this condition is considered the norm, not the exception. The “inability” of the body to distribute iron and make reserves also affects. At a young age, girls rarely suffer from anemia, do not think about their diet, but pregnancy, diet, possible vegetarianism, stress, fatigue consume iron in the body, for its needs the body begins to take it from the tissues (hidden iron deficiency), and then from the blood . Thus, at the age of 40, a woman often feels unwell due to iron deficiency, which has been formed over the years.

After 50 years, when menopause occurs, anemia often disappears, as the woman no longer loses blood during.

Causes of iron deficiency anemia in women

Iron deficiency anemia develops under the influence of various factors. These include:

• Gynecological diseases accompanied by blood loss: fibroids, too long menstruation (hypermenorrhea),;
• Wrong, inadequate nutrition;
• Hereditary features;
• Intestinal. This is one of the most annoying factors, as it can be difficult to detect. In contrast, in the intestines they may not give painful sensations, and they can be identified only by the changed color of the stool. Usually, few people pay attention to such trifles, because of which a person can lose 10-20 ml per day daily.

In addition to direct causes, there are also risk factors that increase the likelihood of developing the disease:

• A diet low in folic acid, iron, and vitamin B-12. Typically, this picture is observed in women who refuse to eat meat or animal food in general, while not choosing the right vegetarian diet.
• Frequent bowel movements that interfere with the absorption of beneficial substances. Especially contributes to the reduction of hemoglobin.
• Pregnancy. During pregnancy, the body consumes more iron than in the normal state, as it is necessary to ensure the blood circulation of the fetus. For this reason, the expectant mother needs to regularly check the level of hemoglobin in the blood in order to take action in time. Also, anemia can be observed during breastfeeding and in the first time after childbirth.
• lingering illnesses. , diseases of the liver, intestines and spleen, ulcers slowly but surely lead to constant blood loss, and as a result - to anemia.
• Family history. Some types of anemia (sickle cell anemia) are inherited.
• Lifestyle. Bad habits, constant stress, heavy workload, insufficient rest and sleep can cause this disease.
• Donation. A one-time blood donation is not dangerous for a healthy person, but systematic donation can lead to anemia, especially if the food is not enhanced at this time.

Signs of anemia in women

Anemia is a disease whose symptoms are often mistaken for banal fatigue or lack of sleep. If a woman has had at least half of the signs listed below for a long time, then this is a reason to see a doctor.

• Weakness, general fatigue, decreased performance.
• Sometimes, for no apparent reason, subfebrile temperature appears.
• Spasms of the legs and arms, goosebumps and numbness.
• Impaired coordination of movements, trembling, muscle weakness.
• Violation of the heart rhythm, shortness of breath even with minimal exertion.
• , darkening in the eyes, it is difficult to concentrate on anything.
• Nausea, lack of appetite, vomiting, stomach pain, belching, feeling of weakness.
• Unexpected preferences in tastes and smells - a person tries to eat dry cereals and pasta, he wants to eat clay, he likes the smell of paint and acetone, etc.
• Sensation of a foreign body in the throat, difficulty breathing and swallowing. There is a change in epithelial cells, which causes dryness and irritation in the mouth, small sores in the corners of the mouth, itching and dryness in the vagina.

Anemia has pronounced characteristic symptoms

• Nails become dry and brittle, noticeably flattened. If anemia has developed for a long time, then the nails acquire a concave shape.
• Pale skin with a marble effect (vessels are visible through the skin). Sometimes the skin may have a greenish tint.

Consequences of anemia

Even though none of the symptoms look frightening, treatment of anemia in women is necessary, as the consequences of this disease can be dire. Reduced hemoglobin leads to oxygen starvation of all tissues and organs, including the brain.

Anemia without treatment can lead to the following results:

• violation of the work of all internal organs, the appearance of edema, digestive disorders;
• work disturbances, emotional instability, insomnia, mental decline;
• disruption of the heart. Trying to compensate for the lack of red blood cells, it starts to work in a more intensive mode, wears out quickly and also experiences oxygen starvation. As a result, with severe anemia, cardiac arrest is not uncommon;
• reduction and susceptibility to various infectious diseases. The likelihood of autoimmune diseases increases.

How to treat anemia

Let our grandmothers forgive us, but the usual recommendation in the spirit of “eat well”, especially buckwheat porridge, apples White pouring and pomegranates, frankly, is not enough. As a preventive measure - for health, but in the form of treatment - no. Especially when the anemia is already “aged”, neglected (hemoglobin figures for the mild stage are 90-100 g / l, the average is 80-90 g / l, the severe one is below 80 g / l).

It is not necessary, guided by inner instinct, to buy iron-containing preparations and vitamins in pharmacies for anemia and use them without any control:

• firstly, such drugs have side effects, among which it turns out to be the most harmless
• secondly, in any case, anemia is treated taking into account personal specifics, and you have every chance of drinking a “not your own” drug, which, even if it does not cause harm, will not be able to help.

Important! In no case should you buy iron supplements at random and drink them just like that at any time of the day at your own peril and risk.

To determine the “own” drug in order to begin the treatment of iron deficiency, it is necessary to pass many different tests and tests. There are many aspects to the treatment of this disease that differ from person to person. How exactly your treatment will take place is dictated only by the general condition of your body, but it is also determined by numerous (and sometimes very complex) laboratory tests and studies. Be patient and go through them all. This will greatly help your doctor to make a diagnosis: anemia is not treated at random, this process involves understanding the full picture of your illness.

To inspire you a little, we will share with you the forecasts of doctors: with the right treatment (if the doctor is competent, and the patient, in turn, is patient), iron deficiency anemia will be defeated, maybe even in a year. And in this case, a pleasant discovery awaits you: a completely full-blooded life with a complete absence of anemia. With timely and effective treatment, the prognosis is usually favorable.

Prevention of anemia

Prevention measures (aka anemic prophylaxis) are initially aimed at preventing the formation of anemia in principle, and only after that at restoring the iron index in the body during the initial stages of the disease. Preventive measures to cure iron deficiency anemia of the third stage (severe) will not work, no matter how hard you try. But in "alliance" with the treatment of the disease, you can also be prescribed proper nutrition.

Proper nutrition is the key to successful treatment and prevention of anemia

The human body can absorb iron from two main sources: animal products (chicken, beef, fish) and plant products (lentils, beans, spices). It is necessary to eat two types of food, of course, unless for some reason your doctor prescribes the opposite.

The daily dose of iron is determined by sex and age:

• Children (ages 1 to 10): 7-10 mg daily.
• Women (ages 19 to 50): 18 mg daily.
• Pregnant women: 27 mg daily.
• Men (age 19 and older): 8 mg daily.

This article is posted solely for the general educational purposes of visitors and is not scientific material, universal instructions or professional medical advice, and does not replace a doctor's appointment. For diagnosis and treatment, contact only qualified doctors.

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I am a general practitioner and general practitioner. My competence includes issues of early diagnosis of patients and treatment of many diseases of the gastrointestinal tract, lungs and respiratory tract, liver, kidneys, cardiovascular and genitourinary systems, skin diseases, metabolic disorders, etc. 15 years of experience as a general practitioner in polyclinics Moscow, 5 of which worked in one hospital in St. Petersburg .. I will be happy to answer questions from readers of my blog.

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