Iron deficiency anemia development. Iron deficiency anemia: a common danger. Acute posthemorrhagic anemia

Anemia is considered one of the most common pathological conditions among the world's population. Among the types of anemia, several main conditions are distinguished, classifying them according to the causes of anemia:

• Iron-deficiency anemia;
• hemolytic anemia;
• aplastic anemia;
• sideroblastic type of anemia;
• B12 deficiency, resulting from a deficiency of vitamin B12;
• posthemorrhagic anemia;
• sickle cell anemia and other forms.

Approximately every fourth person on the planet, according to expert research, suffers from iron deficiency anemia due to a decrease in iron concentration. The danger of this condition lies in the blurred clinical picture of iron deficiency anemia. Symptoms become pronounced when the level of iron and, accordingly, hemoglobin, decreases to a critical level.

The risk groups for developing anemia among adults include the following categories of the population:

• followers of vegetarian nutrition principles;
• people suffering from blood loss due to physiological reasons (heavy menstruation in women), diseases (internal bleeding, severe stages of hemorrhoids, etc.), as well as donors who donate blood and plasma on a regular basis;
• pregnant and lactating women;
• professional athletes;
• patients with chronic or acute forms of certain diseases;
• categories of the population experiencing nutritional deficiencies or limited diets.

The most common form of iron deficiency anemia is a consequence of iron deficiency, which, in turn, can be triggered by one of the following factors:

• insufficient intake of iron from food;
• increased need for iron due to situational or individual characteristics (developmental pathologies, dysfunctions, diseases, physiological conditions of pregnancy, lactation, professional activity, etc.);
• increased loss of iron.

Mild forms of anemia, as a rule, can be cured by adjusting the diet, prescribing vitamin and mineral complexes, and iron supplements. Moderate and severe forms of anemia require specialist intervention and a course of appropriate therapy.

Causes of anemia in men

Anemia in women

Anemia in women is diagnosed when hemoglobin levels are below 120 g/l (or 110 g/l during pregnancy). Physiologically, women are more prone to anemia.
During monthly menstrual bleeding, the female body loses red blood cells. The average volume of monthly blood loss is 40-50 ml of blood, however, with heavy menstruation, the amount of discharge can reach 100 ml or more over a period of 5-7 days. Several months of such regular blood loss can lead to the development of anemia.
Another form of hidden anemia, common among the female population with a high frequency (20% of women), is triggered by a decrease in the concentration of ferritin, a protein that functions to store iron in the blood and release it when hemoglobin levels decrease.

Anemia in pregnancy

Anemia in pregnant women occurs under the influence of various factors. The growing fetus removes from the maternal bloodstream substances necessary for development, including iron, vitamin B12, folic acid, necessary for the synthesis of hemoglobin. With insufficient intake of vitamins and minerals from food, disturbances in its processing, chronic diseases (hepatitis, pyelonephritis), severe toxicosis of the first trimester, as well as during multiple pregnancy, the expectant mother develops anemia.
Physiological anemia of pregnant women includes hydremia, “thinning” of the blood: in the second half of the gestational period, the volume of the liquid part of the blood increases, which leads to a natural decrease in the concentration of red blood cells and the iron they transport. This condition is normal and is not a sign of pathological anemia if the hemoglobin level does not fall below 110 g/l or is restored on its own in a short time, and there are no signs of deficiency of vitamins and microelements.
Severe anemia in pregnant women threatens miscarriage, premature birth, third trimester toxicosis (preeclampsia, preeclampsia), complications of the delivery process, as well as anemia in the newborn.
Symptoms of anemia in pregnant women include a general clinical picture of anemia (fatigue, drowsiness, irritability, nausea, dizziness, dry skin, brittle hair), as well as perversion of smell and taste (desire to eat chalk, plaster, clay, unprocessed meat, sniff substances with a strong smell among household chemicals, building materials, etc.).
Minor anemia of pregnant and lactating women is restored after childbirth and the end of the lactation period. However, with a short interval between repeated births, the body’s recovery process does not have time to complete, which leads to increased signs of anemia, especially pronounced when the interval between births is less than 2 years. The optimal recovery period for the female body is 3-4 years.

Anemia during lactation

According to research by specialists, lactation anemia is most often diagnosed at a fairly advanced stage of the disease. The development of anemia is associated with blood loss during delivery and lactation against the background of a hypoallergenic diet for nursing mothers. The production of breast milk itself does not contribute to the development of anemia, but if certain important food groups are excluded from the diet, for example, legumes (due to the risk of increased gas formation in the baby), dairy and meat products (due to allergic reactions in the infant) the likelihood of developing anemia increases significantly.
The reason for the late diagnosis of postpartum anemia is considered to be a shift in the focus of attention from the condition of the mother to the child, primarily in the youngest mother. The baby's health concerns her more than her own well-being, and the symptom complex of anemia - dizziness, fatigue, drowsiness, decreased concentration, pale skin - is most often perceived as a consequence of overwork associated with caring for a newborn.
Another reason for the prevalence of iron deficiency anemia in nursing is associated with an incorrect opinion about the effect of iron supplements that pass into breast milk on the functioning of the infant’s gastrointestinal tract. This opinion is not confirmed by specialists, and when diagnosing iron deficiency anemia, medications and vitamin-mineral complexes prescribed by a specialist must be taken.

Anemia of menopause

Anemia during female menopause is a fairly common phenomenon. Hormonal changes, the consequences of menstruation, gestation, childbirth, various dysfunctional conditions and surgical interventions cause chronic anemia, which worsens against the background of menopausal changes in the body.
Dietary restrictions and unbalanced diets, which are resorted to by women seeking to reduce the rate of weight gain caused by fluctuations in hormonal balance during the premenopausal period and directly during menopause, also play a provocative role.
By the age of menopause, there is also a decrease in ferritin reserves in the body, which is an additional factor in the development of anemia.
Fluctuations in well-being, fatigue, irritability, and dizziness are often perceived as symptoms of the onset of menopause, which leads to a late diagnosis of anemia.

Anemia of childhood

According to research by the World Health Organization (WHO), 82% of children suffer from anemia of varying severity. Low hemoglobin levels and iron deficiency conditions of various etiologies lead to disturbances in the mental and physical development of the child. The main causes of anemia in childhood include:

The need for iron varies in children depending on age, and upon reaching puberty it correlates with gender. Treatment of deficiency anemia in children with a balanced diet is not always effective, so experts prefer regulation with the help of medications that ensure the required dose of microelements enters the child’s body.

Anemia of infancy

A newborn baby is born with a certain supply of iron obtained from the mother’s body during intrauterine development. The combination of imperfection of one's own hematopoiesis and rapid physical growth leads to a physiological decrease in the level of hemoglobin in the blood in healthy children born on time, by 4-5 months of life, and in premature infants - by the age of 3 months.
Artificial and mixed feeding are considered risk factors that increase the likelihood of developing anemia. Hemoglobin deficiency develops especially rapidly when replacing breast milk and/or artificial formulas with cow's, goat's milk, cereals and other products for a period of up to 9-12 months.
Symptoms of anemia in children under one year old include:

• pallor of the skin, since the skin is still very thin, there is increased “transparency” and “bluishness” of the skin;
• anxiety, causeless crying;
• sleep disorders;
• decreased appetite;
• hair loss outside the physiological framework of hair growth;
• frequent regurgitation;
• low weight gain;
• lag first in physical, then in psycho-emotional development, decreased interest, lack of expression of the revitalization complex, etc.

A peculiarity of children of this age is the ability to absorb iron from food at a high level (up to 70%), therefore, not in all cases of anemia, pediatricians see the need to prescribe medications, limiting themselves to correcting the child’s diet, switching to full breastfeeding, and selecting a substitute formula that meets the needs. In cases of severe anemia, iron supplements are prescribed in age-specific dosages, for example, Ferrum Lek or Maltofer in the form of syrup drops.
When diagnosing a severe degree of anemia, the reasons may not be in the diet, but in diseases, pathologies and dysfunctions of the child’s body. Anemia can also be caused by hereditary diseases; some hereditary developmental disorders and diseases are characterized by a decrease in iron concentration, ritrocytopenia, insufficiency of the hematopoietic system, etc. With persistent low hemoglobin levels, mandatory examination of children and correction of the primary disease is necessary.

Anemia in preschool children

A large-scale study conducted in 2010 revealed a high incidence of iron deficiency anemia in preschool children: every second child suffers from a lack of hemoglobin due to low iron levels. The etiology of this phenomenon may involve various factors, but the most common is the consequences of uncorrected anemia in the first year of life.
The second factor that provokes anemia in preschool children is often combined with the first. An insufficiently balanced diet, lack of protein (meat products) and vitamins (vegetables) is often explained by the child’s reluctance to eat meat and vegetables, preferring semi-finished products and sweets. This is solely a matter of parental education and attention to a healthy diet without providing alternative foods from an early age, which also requires transferring family members to a rationally formulated diet.
In the case when nutrition corresponds to age standards, and the child shows signs of anemia (pallor, dry skin, fatigue, decreased appetite, increased fragility of the nail plates, etc.), examination by a specialist is necessary. Despite the fact that in 9 out of 10 preschoolers with diagnosed anemia it is caused by iron deficiency, in 10% of anemia the cause is diseases and pathologies (celiac disease, leukemia, etc.).

Anemia in children of primary school age

The norms for hemoglobin content in the blood of children 7-11 years old are 130 g/l. Manifestations of anemia in this age period increase gradually. Signs of developing anemia include, in addition to symptoms of anemia in preschoolers, decreased concentration, frequent acute respiratory viral and bacterial diseases, increased fatigue, which can affect the results of educational activities.
An important factor in the development of anemia in children attending general education institutions is the lack of ability to control their diet. In this age period, there is still a sufficient level of absorption of iron from food entering the body (up to 10%, decreasing by the age of an adult to 3%), therefore, the prevention and correction of iron deficiency type of anemia is a properly organized meal with dishes rich in vitamins and microelements at its basis. .
Physical inactivity, limited exposure to fresh air, preference for playing games in the house, especially with tablets, smartphones, etc., which dictate a long stay in a static position, also provoke anemia.

Anemia of puberty

The teenage period is dangerous for the development of anemia, especially in girls with the onset of menstruation, characterized by a periodic decrease in hemoglobin with blood loss. The second factor that provokes the onset of anemia in teenage girls is associated with a concentration on one’s own appearance, the desire to follow various diets and a reduction in the daily diet, excluding foods necessary for health.
Rapid growth rates, intense exercise, poor diet and previous anemia also affect adolescents of both sexes. Symptoms of anemia in adolescence include a blue tint to the sclera of the eyes, changes in the shape of the nails (cup-shaped nail plate), dysfunction of the digestive system, disturbances of taste and smell.
Severe forms of the disease in adolescence require medication therapy. A change in the blood formula is observed, as a rule, no earlier than 10-12 days after the start of the course of treatment; signs of clinical recovery, provided that the specialist’s prescriptions are followed, are observed after 6-8 weeks.

Causes of anemia

Anemia is characterized by a decrease in the concentration of hemoglobin and red blood cells per unit of blood. The main purpose of red blood cells is to participate in gas exchange, transport oxygen and carbon dioxide, as well as nutrients and metabolic products to cells and tissues for further processing.
The red blood cell is filled with hemoglobin, a protein that gives the red blood cell and blood its red color. Hemoglobin contains iron, and therefore its lack in the body causes a high incidence of iron deficiency anemia among all types of this condition.
There are three main factors for the development of anemia:

• acute or chronic blood loss;
• hemolysis, destruction of red blood cells;
• decreased production of red blood cells by the bone marrow.

According to the variety of factors and causes, the following types of anemia are distinguished:

The classification of an anemic condition is based on various signs that describe the etiology, mechanisms of disease development, stage of anemia, and diagnostic indicators.

Classification according to the severity of the condition

The severity of anemia is based on blood test results and depends on age, gender and physiological period.
Normally, in a healthy adult man, hemoglobin levels are 130-160 g/l of blood, in women - from 120 to 140 g/l, during gestation - from 110 to 130 g/l.
A mild degree is diagnosed when the hemoglobin concentration level decreases to 90 g/l in both sexes, with an average level corresponding to the range from 70 to 90 g/l, a severe degree of anemia is characterized by a decrease in the hemoglobin level below the limit of 70 g/l.

Classification of varieties according to the mechanism of development of the condition

In the pathogenesis of anemia, three factors are observed that can act separately or together:

• blood loss of an acute or chronic nature;
• disorders of the hematopoietic system, production of red blood cells by the bone marrow (iron deficiency, renal, aplastic anemia, deficiency anemia due to lack of vitamin B12 and/or folic acid);
• increased destruction of red blood cells before the end of their functioning period (120 days) due to genetic factors, autoimmune diseases.

Classification by color index

The color indicator serves as an indicator of the saturation of red blood cells with hemoglobin and is calculated using a special formula during the blood test.
The hypochromic form with weakened erythrocyte coloring is diagnosed when the color index is below 0.80.
The normochromic form, with a color index within the normal range, is determined by the range of 0.80-1.05.
The hyperchromic form, with excessive saturation with hemoglobin, corresponds to a color index above 1.05.

Classification according to morphological characteristics

The size of red blood cells is an important indicator in diagnosing the cause of anemia. Different sizes of red blood cells may indicate the etiology and pathogenesis of the condition. Normally, red blood cells are produced with a diameter of 7 to 8.2 micrometers. The following varieties are distinguished based on determining the size of the prevailing number of red blood cells in the blood:

• microcytic, red blood cell diameter less than 7 microns, indicates a high probability of iron deficiency;
• normocytic variety, the size of red blood cells is from 7 to 8.2 microns. Normocytosis is a sign of the posthemorrhagic form;
• macrocytic, with a red blood cell size of more than 8.2 and less than 11 microns, as a rule, indicates a deficiency of vitamin B12 (pernicious form) or folic acid;
• megalocytosis, megalocytic (megaloblastic) form, in which the diameter of erythrocytes is more than 11 microns, corresponds to severe stages of some forms, disturbances in the formation of red blood cells, etc.

Classification based on assessment of the bone marrow's ability to regenerate

The degree of erythropoiesis, the ability of red bone marrow to form red blood cells, is assessed by the quantitative indicator of reticulocytes, progenitor cells or “immature” red blood cells, which is considered the main criterion in assessing the ability of bone marrow tissue to regenerate and is an important factor for predicting the patient’s condition and choosing therapy methods . The normal concentration of reticulocytes is 0.5-1.2% of the total number of red blood cells per unit of blood.
Depending on the level of reticulocytes, the following forms are distinguished:

• regenerative, indicating the normal ability of the bone marrow to recover. Reticulocyte level 0.5-1.2%;
• hyporegenerative, with a concentration of immature red blood cells below 0.5%, which indicates a reduced ability of the bone marrow to recover independently;
• hyperregenerative, reticulocyte count more than 2%;
• aplastic anemia is diagnosed when the concentration of immature red blood cells decreases to less than 0.2% among the mass of all red blood cells and is a sign of a sharp suppression of the ability to regenerate.

Iron deficiency anemia (IDA)

The iron deficiency form accounts for up to 90% of all types of anemic conditions. According to research by the World Health Organization, this form affects one in 6 men and every third woman in the world.
Hemoglobin is a complex protein compound containing iron that is capable of reversible communication with oxygen molecules, which is the basis for the process of transporting oxygen from the lungs to the body’s tissues.
The iron deficiency form is hypochromic anemia, with signs of microcytosis, the presence in the blood formula of red blood cells with a diameter less than normal, which is associated with a deficiency of iron, the basic element for the formation of hemoglobin, which fills the cavity of the red blood cell and gives it a red color.
Iron is a vital trace element involved in many metabolic processes, nutrient metabolism, and gas exchange in the body. During the day, an adult consumes 20-25 mg of iron, while the total reserve of this element in the body is about 4 g.

Reasons for the development of IDA

The reasons for the development of this form of the condition include factors of various etiologies.
Iron deficiency:

• unbalanced diet, strict vegetarianism without compensation for iron-containing foods, fasting, dieting, taking medications, drugs and other substances that suppress hunger, appetite disturbances due to diseases of physical or psycho-emotional etiology;
• socio-economic causes of malnutrition, food shortages.

Disturbances in the process of absorption and assimilation of iron:

• diseases of the gastrointestinal tract (gastritis, colitis, gastric ulcer, resection of this organ).

Imbalance of iron consumption and intake due to increased need of the body:

• pregnancy, lactation period;
• age of pubertal growth spurts;
• chronic diseases that provoke hypoxia (bronchitis, obstructive pulmonary disease, heart defects and other diseases of the cardiovascular system and respiratory organs);
• diseases accompanied by purulent-necrotic processes: sepsis, tissue abscesses, bronchiectasis, etc.

Loss of iron by the body, acute or chronic posthemorrhagic:

• for pulmonary bleeding (tuberculosis, tumor formations in the lungs);
• for gastrointestinal bleeding accompanying gastric ulcer, duodenal ulcer, cancer of the stomach and intestines, severe erosion of the gastrointestinal mucosa, varicose veins of the esophagus, rectum, hemorrhoids, helminthic infestation of the intestine, ulcerative colitis and others;
• with uterine bleeding (heavy menstruation, cancer of the uterus, cervix, fibroids, placental abruption during the gestational period or during childbirth, ectopic pregnancy during expulsion, birth injuries of the uterus and cervix);
• bleeding localized in the kidneys (tumor formations in the kidneys, tuberculous changes in the kidneys);
• bleeding, including internal and hidden, due to injuries, blood loss due to burns, frostbite, during planned and emergency surgical interventions, etc.

Symptoms of IDA

The clinical picture of the iron deficiency form consists of anemic and sideropenic syndrome, caused primarily by insufficient gas exchange in the tissues of the body.
Symptoms of anemic syndrome include:

• general malaise, chronic fatigue;
• weakness, inability to tolerate prolonged physical and mental stress;
• attention deficit disorder, difficulty concentrating, rigidity;
• irritability;
• headache;
• dizziness, sometimes fainting;
• drowsiness and sleep disturbances;
• shortness of breath, increased heart rate both during physical and/or psycho-emotional stress and at rest;
• black color of stool (with bleeding of the gastrointestinal tract).

Sideropenic syndrome is characterized by the following manifestations:

• perversion of taste preferences, craving for eating chalk, clay, raw meat, etc.;
• distortion of the sense of smell, the desire to smell paint, household chemicals, substances with a strong odor (acetone, gasoline, washing powder, etc.);
• fragility, dry hair, lack of shine;
• white spots on the nail plates of the hands;
• dry skin, peeling;
• pallor of the skin, sometimes blue sclera;
• the presence of cheilitis (cracks, “jams”) in the corners of the lips.

In severe stages of IDA, neurological symptoms are noted: “pins and needles” sensations, numbness of the limbs, difficulty swallowing, weakened bladder control, etc.

Diagnosis of IDA

The diagnosis of iron deficiency anemia is based on external examination data, assessment of the results of laboratory blood tests and instrumental examination of the patient.
During an external medical examination and history taking, attention is paid to the condition of the skin, mucous surfaces of the mouth, corners of the lips, and also the size of the spleen is assessed upon palpation.
A general blood test in the classic clinical picture of IDA shows a decrease in the concentration of red blood cells and hemoglobin relative to age and gender norms, the presence of red blood cells of different sizes (poikilocytosis), reveals microcytosis, the presence, in severe forms, the predominance of red blood cells with a diameter of less than 7.2 microns, hypochromic , weakly expressed color of erythrocytes, low color index.
The results of a biochemical blood test for IDA have the following indicators:

• the concentration of ferritin, a protein that acts as an iron depot in the body, is reduced relative to normal limits;
• low serum iron levels;
• increased iron-binding capacity of blood serum.

Diagnosis of IDA is not limited to identifying iron deficiency. To effectively correct the condition, after collecting an anamnesis, the specialist, if necessary, prescribes instrumental studies to clarify the pathogenesis of the disease. Instrumental studies in this case include:

• fibrogastroduodenoscopy, examination of the condition of the mucous membrane of the esophagus, walls of the stomach, duodenum;
• ultrasound examination of the liver, kidneys, female reproductive organs;
• colonoscopy, examination of the walls of the large intestine;
• computed tomography methods;
• X-ray examination of the lungs.

Treatment of anemia of iron deficiency etiology

Depending on the stage and pathogenesis of IDA, therapy is chosen by adjusting the diet, medication, surgery to eliminate the causes of blood loss, or a combination of methods.

Therapeutic diet for iron deficiency

Iron that comes into the body from food is divided into heme iron, which is of animal origin, and non-heme iron, which is of plant origin. The heme variety is absorbed much better and its lack of nutrition, for example, in vegetarians, leads to the development of IDA.
Products recommended for correcting iron deficiency include the following:

• heme group in descending order of iron amount: beef liver, beef tongue, rabbit, turkey, goose, beef, some types of fish;
• non-heme group: dried mushrooms, fresh peas, buckwheat, rolled oats and oats, fresh mushrooms, apricots, pears, apples, plums, cherries, beets, etc.

Despite the seemingly high iron content in vegetables, fruits, and products of plant origin when studying the composition, the digestibility of iron from them is insignificant, 1-3% of the total volume, especially when compared with products of animal origin. Thus, when eating beef, the body is able to absorb up to 12% of the essential element contained in the meat.
When correcting IDA using diet, you should increase the content of foods rich in vitamin C and protein (meat) in the diet and reduce the consumption of eggs, table salt, caffeinated drinks and foods rich in calcium due to the effect on the absorption of dietary iron.

Drug therapy

In moderate and severe forms, the therapeutic diet is combined with the administration of medications that supply iron in an easily digestible form. Medicines differ in the type of compound, dosage, release form: tablets, dragees, syrups, drops, capsules, injection solutions.
Preparations for oral use are taken one hour before meals or two hours after due to the nature of iron absorption, while it is not recommended to use caffeine-containing drinks (tea, coffee) as a liquid to facilitate swallowing, as this impairs the absorption of the element. The interval between taking doses of drugs should be at least 4 hours. Self-prescription of medications can cause both side effects from an incorrectly selected form or dosage, as well as iron poisoning.
The dosage of drugs and the form of release are determined by a specialist, focusing on the age, stage of the disease, causes of the condition, general clinical picture and individual characteristics of the patient. Doses may be adjusted during the course of treatment based on the results of intermediate or control blood tests and/or the patient’s well-being.
Iron supplements in the course of treatment are taken from 3-4 weeks to several months with periodic monitoring of hemoglobin levels.
Among the iron-supplying drugs taken orally, there are medications with di- and trivalent forms of iron. At the moment, according to research, ferrous iron is considered the more preferable form for oral administration due to its higher ability to be absorbed in the body and its gentle effect on the stomach.
For children, iron-containing products are produced in the form of drops and syrups, which is determined both by the age-related characteristics of taking the drugs and by a shorter course of therapy than in adults, due to the increased absorption of iron from food. If it is possible to take capsules, dragees and tablets, as well as for long courses, preference should be given to solid forms of medicines containing iron, since liquid ones with prolonged use can have a negative effect on tooth enamel and cause its darkening.
The most popular tablet forms include the following medications: Ferroplex, Sorbifer, Actiferrin, Totema (ferrous form of iron) and Maltofer, Ferrostat, Ferrum Lek with ferric iron.
Oral forms are combined with vitamin C (ascorbic acid) in the dosage prescribed by the doctor for better absorption.
Intramuscular and intravenous injections of iron supplements are prescribed in limited situations, such as:

• severe stage of anemia;
• ineffectiveness of a course of taking oral forms of drugs;
• the presence of specific diseases of the gastrointestinal tract, in which taking oral forms can worsen the patient’s condition (acute gastritis, gastric ulcer, duodenal ulcer, nonspecific ulcerative colitis, Crohn’s disease, etc.);
• with individual intolerance to oral forms of iron-containing drugs;
• in situations where there is a need to urgently saturate the body with iron, for example, with significant blood loss due to injury or before surgery.

The administration of iron preparations intravenously and intramuscularly can lead to an intolerance reaction, which is why such a course of therapy is carried out exclusively under the supervision of a specialist in a hospital or clinical setting. Negative side effects of intramuscular administration of iron-containing liquids include deposition of hemosiderin subcutaneously at the injection site. Dark spots on the skin at the injection sites can last from one and a half to 5 years.
Iron deficiency anemia responds well to drug therapy, provided the prescribed dose and duration of treatment are followed. However, if the etiology of the condition involves primary serious diseases and disorders, therapy will be symptomatic and have a short-term effect.
To eliminate causes such as internal bleeding, in the hemorrhagic form, iron deficiency anemia is treated with surgical methods. Surgical intervention eliminates the main factor of acute or chronic bleeding and stops blood loss. For internal bleeding of the gastrointestinal tract, fibrogastroduodenoscopic methods or colonoscopy are used to identify the area of ​​bleeding and measures to stop it, for example, cutting off a polyp, coagulating an ulcer.
For internal bleeding of the peritoneal and reproductive organs in women, a laparoscopic intervention method is used.
Emergency treatment methods include transfusion of donor red blood cells to quickly restore the concentration of red blood cells and hemoglobin per unit of blood.
Prevention of iron deficiency is considered to be a balanced diet and timely diagnostic and therapeutic measures to maintain health.

Anemia due to cobalamin or vitamin B12 deficiency

Deficiency forms are not limited to iron deficiency anemia. Pernicious anemia is a condition that occurs against the background of malabsorption, insufficient intake, increased consumption, abnormalities in the synthesis of protective proteins, or liver pathologies that prevent the accumulation and storage of cobalamin. In ptogenesis of this form, a frequent combination with folic acid deficiency is also noted.
Among the reasons for this deficiency form are the following:

The clinical picture of vitamin B12 and folic acid deficiency includes anemic, gastrointestinal and neuralgic syndromes.
Particularly the anemic symptom complex for this type of deficiency includes such specific symptoms as jaundice of the skin and sclera and increased blood pressure. Other manifestations are also characteristic of IDA: weakness, fatigue, dizziness, shortness of breath, rapid heartbeat (situational), tachycardia, etc.
Manifestations associated with the functioning of the gastrointestinal tract include the following symptoms of atrophy of the mucous membranes of the gastrointestinal tract and oral cavity:

• red, “glossy” tongue, often with complaints of a burning sensation on its surface;
• phenomena of aphthous stomatitis, ulceration of the oral mucosa;
• Appetite disturbances: decrease to complete absence;
• feeling of heaviness in the stomach after eating;
• the patient's immediate history of weight loss;
• disturbances, difficulties in defecation, constipation, pain in the rectum;
• hepatomegaly, enlarged liver.

Neuralgic syndrome due to vitamin B12 deficiency consists of the following manifestations:

• feeling of weakness in the lower extremities with severe physical activity;
• numbness, tingling, “goosebumps” on the surface of the arms and legs;
• decreased peripheral sensitivity;
• atrophy of muscle tissue of the legs;
• convulsive manifestations, muscle spasms, etc.

Diagnosis of cobalamin deficiency

Diagnostic measures include a general medical examination of the patient, medical history, laboratory blood tests and, if necessary, instrumental examination methods.
During a general blood test, the following changes are noted:

• lower levels of red blood cells and hemoglobin relative to the age norm;
• hyperchromia, increased color index of red blood cells;
• macrocytosis of erythrocytes, their size exceeding 8.0 microns in diameter;
• poikilocytosis, the presence of red blood cells of different sizes;
• leukopenia, insufficient concentration of leukocytes;
• lymphocytosis, exceeding the normal level of lymphocytes in the blood;
• thrombocytopenia, an insufficient number of platelets per unit of blood.

Biochemistry studies of blood samples reveal hyperbilirubinemia and vitamin B12 deficiency.
To diagnose the presence and severity of atrophy of the mucous membranes of the stomach and intestines, as well as to identify possible primary diseases, instrumental methods of examining patients are used:

• fibrogastroduodenoscopic examination;
• analysis of biopsy material;
• colonoscopy;
• irrigoscopy;
• Ultrasound of the liver.

Treatment methods

In most cases, B12 deficiency anemia requires hospitalization or treatment in a hospital setting. For therapy, first of all, a diet with foods rich in cobalamin and folic acid (liver, beef, mackerel, sardines, cod, cheese, etc.) is prescribed; secondly, drug support is used.
In the presence of neurological symptoms, injections of Cyanocobalamin are prescribed intramuscularly at an increased dose: 1000 mcg daily until the neurological signs of deficiency disappear. Subsequently, the dosage is reduced, however, if a secondary etiology is diagnosed, the drugs are most often prescribed on a lifelong basis.
After discharge from a medical institution, the patient is required to undergo regular preventive examinations with a therapist, hematologist and gastrologist.

Aplastic anemia: symptoms, causes, diagnosis, treatment

Aplastic anemia can be either a congenital or acquired disease, developing under the influence of internal and external factors. The condition itself occurs due to bone marrow hypoplasia, a decrease in the ability to produce blood cells (erythrocytes, leukocytes, platelets, lymphocytes).

Reasons for the development of aplastic form

In aplastic, hypoplastic forms of anemia, the causes of this condition may be the following:

• stem cell defect;
• suppression of the process of hematopoiesis (blood formation);
• insufficiency of factors stimulating hematopoiesis;
• immune, autoimmune reactions;
• deficiency of iron, vitamin B12 or their exclusion from the process of hematopoiesis due to dysfunction of hematopoietic tissues and organs.

The development of disorders that provoke the aplastic or hypoplastic form include the following factors:

• hereditary diseases and genetic pathologies;
• taking certain medications from the groups of antibiotics, cytostatics, non-steroidal anti-inflammatory drugs;
• poisoning with chemicals (benzenes, arsenic, etc.);
• infectious diseases of viral etiology (parvovirus, human immunodeficiency virus);
• autoimmune disorders (systemic lupus erythematosus, rheumatoid arthritis);
• severe deficiencies of cobalamin and folic acid in the diet.

Despite the extensive list of causes of the disease, in 50% of cases the pathogenesis of the aplastic form remains unidentified.

Clinical picture

The severity of pancytopenia, a decrease in the number of basic types of blood cells, determines the severity of symptoms. The clinical picture of the aplastic form includes the following signs:

• tachycardia, rapid heartbeat;
• pallor of the skin, mucous membranes;
• headache;
• increased fatigue, drowsiness;
• shortness of breath;
• swelling of the lower extremities;
• bleeding gums;
• petechial rash in the form of small red spots on the skin, a tendency to bruise easily;
• frequent acute infections, chronic diseases as a result of decreased general immunity and leukocyte deficiency;
• erosions, ulcers on the inner surface of the oral cavity;
• yellowness of the skin and sclera of the eyes as a sign of incipient liver damage.

Diagnostic procedures

To establish a diagnosis, laboratory methods for studying various biological fluids and tissues and instrumental examination are used.
A general blood test reveals a reduced number of red blood cells, hemoglobin, reticulocytes, leukocytes, platelets, while the color index and hemoglobin content in red blood cells correspond to the norm. The results of a biochemical study indicate an increase in serum iron, bilirubin, lactate dehydrogenase, and saturation of transferrin with iron by 100% of the possible level.
To clarify the diagnosis, a histological examination of the material removed from the bone marrow during puncture is carried out. As a rule, the results of the study indicate underdevelopment of all sprouts and replacement of bone marrow with fat.

Treatment of aplastic form

Anemia of this type cannot be treated by correcting the diet. First of all, a patient with aplastic anemia is prescribed selective or combined use of drugs from the following groups:

• immunosuppressants;
• glucocorticosteroids;
• immunoglobulins of antilymphocyte and antiplatelet action;
• anti-metabolic drugs;
• stimulators of erythrocyte production by stem cells.

If drug therapy is ineffective, non-drug treatment methods are prescribed:

• bone marrow transplantation;
• transfusion of red blood cells and platelets;
• plasmaphoresis.

Aplastic anemia is accompanied by a decrease in general immunity due to a deficiency of leukocytes, therefore, in addition to general therapy, an aseptic environment, antiseptic surface treatment, and no contact with carriers of infectious diseases are recommended.
If the listed treatment methods are insufficient, the patient is prescribed splenectomy and removal of the spleen. Since it is in this organ that the breakdown of red blood cells occurs, its removal can improve the general condition of the patient and slow down the development of the disease.

Anemia: methods of prevention

The most common form of the disease, iron deficiency anemia, can be prevented through a balanced diet with an increase in the amount of iron-containing foods during critical periods. An important factor is also the presence of vitamin C, cobalamin (vitamin B12), and folic acid in food products.
If you are at risk of developing this form of anemia (vegetarianism, age-related growth periods, pregnancy, lactation, prematurity in infants, heavy menstrual bleeding, chronic and acute diseases), regular medical examination, blood tests for quantitative and qualitative indicators of hemoglobin, red blood cells and additional taking medications as prescribed by specialists.

Iron deficiency anemia (IDA) is one of the most frequently diagnosed pathological conditions of the circulatory system, and indeed the most common type.

Statistical studies have shown that about 2.5 billion patients worldwide have this diagnosis.

In order to stop the progression of the disease and avoid complications, it is necessary to identify the root causes of its occurrence and begin treatment in a timely manner.

What is iron deficiency anemia?

Anemia is characterized by a reduced content of red blood cells - erythrocytes - in the human circulatory system, and, as a result, a drop in hemoglobin.

If the low level of these elements is associated with a lack of iron in the body, then in this case we are talking about iron deficiency anemia (IDA).

As a rule, pathology is not an independent disease. In most cases, iron deficiency anemia occurs following some other negative changes in the human body.

FOR REFERENCE! The average amount in the body for adults is about 4 grams. For men and women at different ages, this indicator may have different meanings. For example, iron deficiency anemia in adults is much more common in the fairer sex. First of all, this is due to regular blood loss that occurs during menstruation. And the strongest concentration of iron is observed in newborn babies, since they have an increased supply of this trace element in the womb.

Iron deficiency has a negative impact on human vitality in general. In addition, the development of this deficiency is fraught with disruptions in the formation of red blood cells, as well as disruption of oxidation and reduction reactions, the mechanism of cell division and the normal course of some other reactions.

Iron is the basis of hemoglobin, which performs the function of supplying oxygen to all tissues and organs in the human body, and also plays an important role in the synthesis of protein and hormones. If iron deficiency is not replenished for a long time, the patient begins to develop anemic syndrome.

Causes of iron deficiency anemia

The reasons for the development of iron deficiency anemia may be a lack of iron entering the body from the outside, or failures in the processes that consume it, because the human body cannot produce this microelement on its own. They could be:

• unbalanced diet: poorly chosen diet, refusal to eat meat (vegetarianism);
• regular significant blood loss . In addition to menstruation in women, chronic blood loss can be associated with the presence of various diseases: decaying tumors and others. This also includes blood donation, which occurs more often than 3-4 times in one year;
• congenital factors that arose during intrauterine development: the presence of iron deficiency anemia in the mother, multiple pregnancy, prematurity;
• malfunctions of the gastrointestinal tract, as a result of which the process of iron absorption in the duodenum is disrupted. This may be due to the presence of various (enteritis, stomach cancer, etc.);
• leading to disturbances in the production of transferrin – a protein that performs transport functions: microelements supplied with food are not distributed throughout the body, which causes iron deficiency. Transferrin synthesis occurs in liver cells;
• taking medications that affect the absorption and processing of iron in excess doses. These may include: antacids, iron-binding drugs. People with a predisposition to iron deficiency anemia should consult a doctor before using these types of medications.

Iron deficiency anemia in children can develop as a result of various pathologies during pregnancy, early transition to artificial feeding, accelerated growth rate (in case of prematurity).

Provoking factors of IDA

The body's increased need for iron is the main provoking factor for the development of iron deficiency anemia. It can be associated with such life processes as:

• pregnancy. During pregnancy, a woman needs almost twice as much iron for normal fetal development as in normal life;
• breast-feeding. As during pregnancy, during breastfeeding the female body consumes much more iron than it can receive.

Stages of development of IDA

The pathogenesis of this type of anemia is expressed in two main periods:

1. Latent (hidden) period characterized by a decrease in iron reserves in the body, resulting in a decrease in ferritin levels. However, other laboratory parameters may remain within normal limits. The body tries to compensate for the lack of a microelement by more active absorption in the intestines and the production of transport protein. Due to this, IDA has not yet occurred at this stage, although the prerequisites for it are already present.
2. Direct iron deficiency anemia occurs at the moment when the level of red blood cells decreases so much that they can no longer sufficiently provide their functions. At this stage, the main symptoms and characteristic features of the disease begin to appear more clearly.

Types of iron deficiency anemia

Classification of the disease according to its causes distinguishes the following types:

• anemia resulting from excessive blood loss;
• iron deficiency anemia, which appeared as a result of malfunctions of red blood cells;
• chronic iron deficiency anemia;
• hemolytic anemia (increases with a high degree of destruction of red blood cells).

Classification according to hemoglobin level divides the disease into types depending on severity:

• mild severity (hemoglobin content more than 90 g/l);
• moderate severity (70-90 g/l);
• high severity (below 70 g/l).

Symptoms of iron deficiency anemia

The degree of IDA increases gradually in the body and at first may hardly make itself felt. The latent period of the disease is characterized by the manifestation of sideropenic syndrome.

Later, a general anemic syndrome begins to appear, the clarity of which is determined by the severity of anemia and the body’s ability to resist. The presence of the following signs in a patient may indicate iron deficiency anemia:

• fatigue and chronic muscle fatigue. With iron deficiency in the body, a person's muscles become weaker. Their daily work requires a lot of energy, which is no longer produced in the required quantity due to a decrease in the level of red blood cells. As a result, a person gets tired much faster even with small everyday loads. Iron deficiency anemia in children can manifest itself in the child's desire for less active play, lethargic behavior and drowsiness;
• the appearance of shortness of breath. With IDA, it is difficult to supply the heart with oxygen due to deterioration of blood circulation. For this reason, the patient may experience shortness of breath;
• deterioration of the condition of the skin, nails and hair. Iron deficiency becomes noticeable externally (see photo above), when the skin becomes dry and cracked, and pallor appears. Nails weaken, break and become covered with specific transverse cracks. In some cases, the nail plate may bend in the opposite direction. The hairline is thinning. Hair changes its structure, gray hair appears prematurely;
• damage to the mucous membranes. One of the early symptoms of IDA is damage to the mucous membranes, because these tissues most acutely feel the lack of iron due to disruption of various cellular processes:
  • Damage to the mucous membranes is most clearly noticeable in changes in the appearance of the tongue. It becomes smooth, covered with cracks and areas of redness. Pain and burning sensations are added. In some cases there are sharp;
  • dryness and areas of atrophy appear in the oral cavity. There is discomfort when eating food and pain when swallowing. Cracks form on the lips;
  • atrophy of the intestinal mucosa caused by iron deficiency anemia is accompanied by the appearance of pain syndromes in the abdomen, constipation, and diarrhea. The ability of the gastrointestinal tract to absorb nutrients deteriorates;
  • damage to the mucous membranes of the genitourinary system is characterized by pain during urination and (usually in childhood). The risk of contracting various infections increases;
• susceptibility to various infections. A lack of iron in the body also affects the work of leukocytes - blood cells responsible for freeing the body from pathogens of various infections. As a result, the patient experiences a general weakening of the immune system and increases susceptibility to bacterial and viral infections;
• difficulties with intellectual activity. Insufficient supply of brain cells with iron leads to memory impairment, absent-mindedness and weakening of intelligence in general.

Diagnosis of IDA

Iron deficiency anemia in children and adults can be diagnosed by any specialist, however, detailed diagnosis aimed at identifying the causes and treatment should be carried out by a hematologist. Patient examinations include:

• Visual examination of the patient is the first stage of diagnosing IDA. The specialist needs, from the patient’s words, to determine the general picture of the development of the pathology and conduct an examination that will help draw conclusions about the extent of the disease and identify complications, if any;
• from a finger or from a vein - a generalized picture of the patient’s health, with the help of which the doctor can unambiguously determine the presence or absence of IDA in the patient. This analysis is carried out in the laboratory using special equipment - a hematology analyzer. The diagnosis of iron deficiency anemia is established in a patient if:
  • a decrease in the number of red blood cells (in men - less than 4.0 x 1012/l, in women - less than 3.5 x 1012/l), when the number of platelets and leukocytes is normal or increased;
  • the predominance of red blood cells in the patient’s blood, the size of which is less than normal (a deviation is considered to be a size of less than 70 µm3);
  • color index (CI) is less than 0.8;
• a biochemical blood test allows a more detailed study of the patient’s condition, taking into account indicators related to the area under study. The following abnormalities indicate the presence of iron deficiency anemia:
  • serum iron (SI): in men – less than 17.9 µmol/l, in women – less than 14.3 µmol/l;
  • total serum iron binding capacity (TIBC): significantly exceeds the level of 77 µmol/l;
  • ferritin (a complex protein complex that acts as the main intracellular iron depot in humans) is below normal: in men - below 15 ng/ml, in women - less than 12 ng/ml;
  • (less than 120 g/l);

Iron deficiency anemia in children is characterized by the following blood test results:

• serum iron (SI) below 14 µmol/l;
• total iron binding capacity of serum (TIBC) more than 63 µmol/l;
• ferritin in the blood is below 12 ng/ml;
• hemoglobin level (less than 110 g/l).

• Bone marrow puncture is a diagnostic method based on the collection of bone marrow samples by taking it with a special instrument from the sternum. With IDA disease, an increase in the erythroid lineage of hematopoiesis is observed;
• X-rays are carried out to determine intestinal pathologies that can cause chronic bleeding, thereby causing the development of anemia;
• endoscopic examinations of human mucous membranes are also carried out to identify various pathologies of the abdominal organs. It can be:
  • fibroesophagogastroduodenoscopy (FEGDS);
  • sigmoidoscopy;
  • colonoscopy;
  • laparoscopy and others.

Treatment of iron deficiency anemia

According to doctors, when treating iron deficiency anemia in adults and children, one cannot limit oneself only to medications. It is best and easiest to compensate for the deficiency of an important microelement with the help of healthy food and a properly selected diet.

The daily requirement of iron that the diet should contain is at least 20 mg. It should be noted that treatment of this disease will be ineffective if measures are not taken to eliminate the primary pathology that caused iron deficiency.

To prevent the disease, each person should undergo a laboratory analysis of blood counts every year, eat a comprehensive diet and, if necessary, promptly eliminate possible causes of significant blood loss.

People with a predisposition to iron deficiency should consult a doctor for a course of medications with high iron content.

Nutrition and supplements

A balanced diet plays a major role in the prevention and treatment of IDA. When planning a diet, it should be taken into account that iron is better absorbed if it is taken in conjunction with vitamin C.

Moreover, this microelement is best absorbed by the intestines if it is contained in products of animal origin (up to 3 times more compared to plant products).

• white beans (72 mg);
• nuts of all types (51 mg);
• buckwheat (31 mg);
• pork liver (28 mg);
• molasses (20 mg);
• brewer's yeast (18 mg);
• seaweed and seaweed (16 mg);
• pumpkin seeds (15 mg);
• lentils (12 mg);
• blueberries (9 mg);
• beef liver (9 mg);
• heart (6 mg);
• beef tongue (5 mg);
• dried apricots (4 mg).

• ascorbic acid;
• succinic acid;
• fructose;
• nicotinamide

FOR REFERENCE! Seafood is also rich in iron, but it is not recommended to include it in the diet if you are deficient in this microelement. The fact is that, among other things, they contain a large amount of phosphates, which complicate the process of absorption of iron in the body.

Despite the fact that iron deficiency anemia rarely develops in infants (except when the mother has this disease), it should be noted that in this case the disease is especially dangerous.

A lack of iron in children can result in serious impairments in physical development, and therefore requires prompt replenishment.

Treatment of iron deficiency anemia at this age is carried out through a strict diet and careful monitoring of the baby's daily intake, as well as a review of the baby's complementary feeding, if it is already available.

Drug treatment (medicines)

Proper nutrition is a necessary step in the treatment and prevention of IDA, but it cannot compensate for the lack of the necessary microelement in the body on its own, and therefore doctors recommend that patients take medications.

Most often, medications are prescribed in the form of tablets; less often, in cases of intestinal dysfunction, parenteral administration is prescribed.

Medicines for iron deficiency anemia should be taken over a long course (over several weeks or months).

All of them are designed to normalize the main indicators in a blood test and eliminate the symptoms of the disease. The most commonly used of them:

• Hemophere prolongatum;
• Sorbifer Durules;
• Ferroceron;
• Ferroplex;
• Tardiferon.

Before using medications, you should consult your doctor; improper use can lead to an excess of iron, which is also fraught with negative consequences and complications.

Red blood cell transfusion

In complex cases of anemia, it may be necessary to undergo a red blood cell transfusion. This procedure may be necessary if there is a serious threat to the patient’s life and should be carried out in the shortest possible period of time. Indications for prescribing red blood cell transfusion may be:

• significant blood loss;
• a sharp decrease in hemoglobin levels;
• preparation for surgery or early childbirth.

For the successful implementation of this procedure and the absence of complications, it is very important that the donor’s blood ideally matches the patient in all laboratory parameters.

Prognosis and complications

The degree of complexity of such a disease as iron deficiency anemia is quite low today.

With timely detection of symptoms and high-quality diagnosis, this disease can be completely eliminated without any consequences.

In some cases, complications may develop during the treatment of IDA. The reasons for this may be the following factors:

• illiterate implementation of diagnostic procedures and, as a result, establishment of a false diagnosis;
• failure to identify the first cause;
• untimely adoption of treatment measures;
• incorrect dosage of prescribed medications;
• non-compliance with regularity of treatment.

Possible complications of this disease are:

• in children – growth retardation and intellectual development. Children's iron deficiency is very dangerous, since in advanced cases of the disease, disruptions in the child's body can become irreversible;
• anemic coma, which develops against the background of poor-quality oxygen circulation in the body, in particular, due to insufficient oxygen supply to the brain. Characteristic signs of this complication are fainting, weakened and diminished reflexes. Failure to provide timely qualified medical assistance creates a strong threat to the patient’s life;
• appearance is a common occurrence with a long-term lack of iron in the body;
• infectious diseases for development.

These types of complications pose the greatest threat to pediatric and elderly patients.

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Interesting

Anemia is a disease in which the content of hemoglobin or red blood cells in the blood becomes lower than normal.

Blood consists of a liquid part - plasma and three types of cells:

• leukocytes - white blood cells - are part of the immune system
  systems and help fight infections;
• erythrocytes - red blood cells - carry oxygen
  throughout the body using hemoglobin protein;
• platelets help blood clot during injury.

As blood passes through the lungs, the hemoglobin in red blood cells binds oxygen molecules and releases carbon dioxide molecules. After leaving the lungs, hemoglobin delivers oxygen molecules to the body's tissues and absorbs excess carbon dioxide to deliver them back to the lungs.

Red blood cells are produced in bone marrow, which is found in large bones. Every day, millions of new ones are produced to replace old destroyed cells.

There are several types of anemia and each of them has its own causes, but the most common is anemia caused by iron deficiency - iron deficiency anemia.

Other forms of anemia can be caused by a lack of vitamin B12, folic acid, blood loss or, for example, a malfunction of the bone marrow.

The main symptoms of anemia are fatigue and lethargy (lack of energy). Contact your GP if you suspect you have anemia. For the initial diagnosis of the disease, you will need to take a blood test.

Treatment for anemia involves taking iron supplements to increase iron levels in the body. As a rule, such treatment is effective, and the disease rarely leads to complications. If anemia is not treated, the likelihood of infectious diseases increases, since a lack of iron affects the immune system (the body's defense system). Severe types of anemia can impair heart function and are especially dangerous during pregnancy.

Symptoms of anemia

Manifestations of anemia can be very scanty, sometimes almost invisible. Especially if the decrease in the amount of hemoglobin or red blood cells occurs over a long period of time and slowly.

The most common symptoms of iron deficiency anemia are:

• fatigue;
• loss of strength (lack of energy);
• feeling of lack of air (shortness of breath).

Less common symptoms include:

• headache;
• tinnitus is the perception of sound in one or both ears that comes from within, such as ringing in the ears;
• change in taste sensations;
• pica - the desire to eat inedible objects, such as ice, paper or clay;
• irritation on the tongue;
• baldness;
• swallowing disorder (dysphagia).

You may also notice changes in your appearance. For example, signs of possible anemia may include:

• pallor;
• uncharacteristically smooth tongue;
• painful ulcers (open sores) in the corners of the lips;
• dry, flaky nails;
• spoon-shaped nails.

The severity of symptoms may depend on how quickly the anemia develops. For example, you may notice only a few symptoms, or their severity may increase gradually if the anemia is caused by chronic, slow blood loss, such as due to stomach ulcers.

Causes of iron deficiency anemia

Iron deficiency anemia occurs when there is not enough iron in the body. Iron deficiency can be caused by a number of factors. Some of them are described below.

Period. In women of reproductive age, the most common cause of iron deficiency is menstruation. Typically, anemia develops only in women with particularly heavy periods. If you experience heavy bleeding during your period for several months in a row, it is called menorrhagia (hypermenorrhea).

Pregnancy. Very often, women develop iron deficiency during pregnancy. This happens because the expectant mother's body requires more iron to provide the baby with enough blood, as well as the oxygen and nutrients it needs. Many pregnant women need to take iron supplements, especially starting around the 20th week of pregnancy.

Gastrointestinal bleeding is the most common cause of anemia in men and women after menopause (when a woman stops having periods). Causes of gastrointestinal bleeding can be:

• Ibuprofen and aspirin are two of the most commonly prescribed anti-inflammatory drugs. Stomach and duodenal ulcers can cause bleeding, which can lead to anemia. Heavy bleeding leads to vomiting blood or blood in the stool. However, if the ulcers do not bleed heavily, there may be no symptoms.
• Stomach or intestinal cancer is a rare cause of bleeding in the gastrointestinal tract. The incidence of stomach cancer in our country is one of the highest in the world. Among malignant tumors, stomach cancer ranks second in Russia. If your GP suspects cancer, you will be immediately referred to an oncologist.
• Angiodysplasia is a pathology of blood vessels in the gastrointestinal tract that can cause bleeding.

Kidney failure can also cause anemia. Iron supplements are most often given intravenously for kidney failure, but ferrous sulfate tablets may be tried first.

Malabsorption disorder(when your body can't absorb iron from food) can also cause anemia. This may happen in the following cases:

• celiac enteropathy, a disease that affects the intestinal wall;
• gastrectomy, an operation to surgically remove the stomach, for example, in the treatment of stomach cancer.

Nutrition. Anemia is rarely caused by a lack of iron in the diet, except during pregnancy. Some studies suggest that vegetarians are more prone to anemia due to the lack of meat in their diet. However, if you follow a vegetarian diet, you can get enough iron from other types of foods, such as the following:

• beans;
• nuts;
• dried fruits, such as dried apricots;
• fortified breakfast cereals;
• soy flour;
• most dark green leafy vegetables, such as watercress and collard greens.

Pregnant women may need to increase the amount of iron-rich foods in their diet to prevent anemia.

Diagnosis of anemia

If you have symptoms of anemia, contact your GP. To confirm the diagnosis, it is necessary to do a general blood test. This means that the number of all types of blood cells in a blood sample is counted.

If you have anemia, the test results will show the following:

• you will have low hemoglobin levels;
• you will have low red blood cells (RBCs);
• red blood cells may be smaller or paler than usual.

Your doctor may also order a test for ferritin, a protein that stores iron. If you have low ferritin levels, your body does not have enough iron.

To exclude other causes of anemia, a blood test for vitamin B12 and folic acid is performed. Folic acid, along with vitamin B12, helps the body produce red blood cells. Anemia caused by a lack of vitamin B12 and folic acid is more common in people over 75 years of age.

To determine the cause of your anemia, your doctor may ask you about your lifestyle and previous medical conditions. For example, you may be asked the following:

• your diet - to find out how you usually eat and whether you have iron-rich foods in your diet;
• medications you are taking - whether you regularly take medications that can cause bleeding in the gastrointestinal tract, such as ibuprofen or aspirin;
• menstrual cycle - how heavy the periods are, whether they come regularly;
• family history - you will be asked if your immediate family has had anemia or bleeding in the gastrointestinal tract or blood disorders;
• blood donation - do you donate blood regularly and have you had any severe bleeding;
• other illnesses - whether you have recently had another illness or symptoms, such as weight loss.

Medical examination for anemia

For additional diagnostics, the doctor will examine your abdomen and also check for signs of heart failure, such as listening to your heart, measuring your blood pressure, and examining your legs for swelling. If necessary, you will be referred for consultation to specialists who will conduct special types of examination.

Rectal examination. Typically, a rectal examination is only necessary if there is rectal bleeding. The doctor will put on a glove, lubricate one finger, and insert it into the rectum to check for any abnormalities. There is no need to be embarrassed about a rectal examination, as the doctor often performs a similar procedure. You should not feel much pain or discomfort, just a slight sensation of movement in your intestines.

Gynecological examination. Women may be referred for a gynecological examination. During the examination, the gynecologist examines the perineum for bleeding or infection. An internal inspection may also be performed. To do this, your doctor will insert lubricated, gloved fingers into your vagina to check for any enlarged or painful tenderness in the ovarian or uterine area.

In difficult cases of diagnosing anemia, your doctor will refer you for a consultation with a hematologist, a specialist in blood diseases.

Treatment of anemia

Typically, treatment for anemia involves taking iron supplements to replenish the body's iron stores, as well as treating the cause of the anemia.

Your doctor will prescribe an iron supplement to help replenish your body's iron stores. They are usually taken orally (by mouth) two or three times a day. Some people may experience side effects when taking iron supplements, including the following:

• nausea;
• vomit;
• abdominal pain;
• heartburn;
• constipation;
• diarrhea;
• black stool (feces).

These side effects should go away over time. To improve tolerability of the drug, try taking it with or after meals. Your doctor may also recommend taking just one tablet a day instead of two or three if you are having trouble coping with side effects. In some cases, the drug is replaced with another one with less pronounced side effects.

If you have small children, keep iron supplements away from them, as an overdose of these drugs can be fatal to a young child.

To treat anemia, it is important to eliminate its cause. For example, if non-steroidal anti-inflammatory drugs (NSAIDs) cause bleeding in the stomach, it is necessary to stop the drug or replace it with a similar one under the supervision of a doctor. Heavy periods (hypermenorrhea) also require treatment by a gynecologist.

There are several ways to increase iron in your diet. Iron-rich foods include the following:

• dark green leafy vegetables, such as watercress
  and kale;
• iron-fortified cereal;
• whole grains, such as brown rice;
• beans;
• nuts;
• meat;
• apricots;
• plums;
• raisin.

To maintain a healthy, balanced diet, eat foods from all four major food groups. However, some foods and medications can interfere with the absorption of iron. These include the following:

• tea and coffee;
• calcium, found in dairy products such as milk;
• antacids (indigestion medications);
• proton pump blockers that affect the production of gastric juice;
• Whole grain cereals - although they are rich in iron themselves, they also contain phytic acid, which can interfere with the absorption of iron from other foods and medications.

If you are having trouble incorporating iron-containing foods into your diet, you may be referred to a dietitian (nutrition specialist) who can create a detailed plan for you to change your diet.

Health monitoring for anemia

Your doctor will schedule a follow-up visit 2 to 4 weeks after you start taking iron supplements to evaluate how your body is responding to treatment. You will need to have a blood test to check your hemoglobin levels. If the blood test results show improvement, you will be asked to return in 2-4 months for another test.

Once your hemoglobin levels and red blood cell counts return to normal, your doctor will likely recommend continuing to take the drug for three months to replenish your body's iron stores. After this, depending on the cause of the anemia, you can stop taking the drug. Then every three months for a year you will need to come for an examination.

Continuous treatment of iron deficiency anemia

For some people, after the body's iron stores are replenished, they begin to decrease again. This may happen in the following cases:

• you eat few foods rich in iron;
• You are pregnant;
• you have heavy periods (hypermenorrhea).

In this case, you may be prescribed to take iron supplements on an ongoing basis. As a rule, you need to take one tablet per day. This will prevent the anemia from returning.

Complications of iron deficiency anemia

Anemia rarely causes severe or chronic complications. However, some people with anemia notice that the disease affects their daily life.

Fatigue. Anemia may make you feel tired and lacking energy, and you may be less productive and active at work. It may become more difficult for you to stay awake and concentrate, and you may not have enough energy to exercise regularly.

The immune system. Research has shown that anemia can affect your immune system, making you more vulnerable to disease and infection.

Complications on the heart and lungs. Severe anemia in adults may increase the risk of complications affecting the heart or lungs. For example, the following diseases may develop:

• tachycardia (rapid heartbeat);
• heart failure, in which the heart does not pump blood around the body effectively.

Pregnancy. Severe anemia in pregnant women increases the risk of complications, especially during and after childbirth. They may also develop postpartum depression (a type of depression that some women experience after having a baby). Research has shown that children born to women with anemia are more likely to have:

• born prematurely (before the 37th week of pregnancy);
• have low birth weight;
• have problems with iron levels in the body;
• have lower mental abilities.

Restless legs syndrome (RLS). Some cases of restless legs syndrome are thought to be caused by anemia. Doctors call this secondary restless legs syndrome. Restless legs syndrome is a common disorder that affects the nervous system, causing an irresistible urge to move the legs. It also causes discomfort in the feet, calves and thighs. RLS caused by anemia is usually treated with iron supplements.

Which doctor should I contact if I have anemia?

For diagnosis and treatment of anemia, consult or (for a child). In difficult diagnostic cases, or if anemia is difficult to treat, who specializes in blood diseases.

If, in addition to the symptoms of anemia, you notice manifestations of another disease, use the section “Who treats it” to find the right specialist.

Localization and translation prepared by site. NHS Choices provided the original content for free. It is available from www.nhs.uk. NHS Choices has not reviewed, and takes no responsibility for, the localization or translation of its original content

Copyright notice: “Department of Health original content 2019”

All site materials have been checked by doctors. However, even the most reliable article does not allow us to take into account all the features of the disease in a particular person. Therefore, the information posted on our website cannot replace a visit to the doctor, but only complements it. The articles have been prepared for informational purposes and are advisory in nature.

This is anemia that occurs when there is insufficient supply of iron to the bone marrow, which leads to disruption of the normal production of red blood cells. IDA was first described by Lange in 1554, and iron preparations for its treatment were first used by Sydenham in 1600.
Iron deficiency is the most common cause of anemia worldwide. In European countries, iron deficiency is detected in approximately 15-25% of women and 2% of men. This prevalence of IDA is explained by the high frequency of blood loss and the limited ability of the gastrointestinal tract to absorb iron.
The adult human body contains approximately 4 g of iron. Daily iron loss through feces, urine, sweat, skin cells and gastrointestinal mucosa is about 1 mg. Iron absorption occurs primarily in the duodenum and, to a lesser extent, in the jejunum. The amount of iron and the possibility of its absorption in the gastrointestinal tract varies widely depending on the type of product. Meat and liver are better sources of iron than vegetables, fruits or eggs. The most actively absorbed iron is heme and inorganic iron. The average daily diet contains 10-15 mg of iron, of which only 5-10% is absorbed. Typically, no more than 3.5 mg of iron is absorbed into the gastrointestinal tract per day. In some conditions, such as iron deficiency or pregnancy, the proportion of iron absorbed may increase to 20-30%. but still the main part of dietary iron is not utilized. The daily requirement for iron depends mainly on gender and age, it is especially high during pregnancy, in adolescents and women of reproductive age. It is these categories that are most likely to develop iron deficiency due to additional loss or insufficient intake.

Causes:

The main cause of iron deficiency is chronic blood loss as a result of uterine and gastrointestinal bleeding. 1 ml of whole blood contains approximately 0.5 mg of iron. Therefore, despite increased iron absorption in such individuals, chronic loss of even small volumes of blood leads to iron deficiency. In women, iron deficiency often occurs due to menorrhagia or other gynecological pathologies. Normal iron loss through menstrual blood is about 20 mg per month. The increased need for iron in pregnant women consists of a 35% increase in the total number of red blood cells, transfer of iron to the fetus and blood loss during childbirth. In general, during pregnancy and childbirth, a woman’s body loses approximately 500-1000 mg of iron.
Impaired iron absorption is rarely the only cause of IDA. However (after which accelerated passage of food occurs), as well as severe gastrointestinal diseases (chronic, chronic atrophic gastritis) can participate in the formation of iron deficiency. It should be remembered that iron deficiency itself contributes to the development of chronic atrophic gastritis and duodenitis.
Often one patient simultaneously has several causes of iron deficiency.
The main causes of iron deficiency:
1. Chronic blood loss: menorrhagia, metrorrhagia:
- gastrointestinal bleeding (varicose veins of the esophagus, gastric and duodenal ulcers, gastritis, duodenitis, long-term use of anti-inflammatory drugs, tumors, hemangioma, helminthic infestations, etc.);
- rare causes of blood loss (massive, hemoglobinuria, pulmonary hemosiderosis, etc.).
2. Increased need for iron: rapid growth; pregnancy, lactation.
3. Impaired absorption of iron:
- total gastrectomy;
- chronic and trophic gastritis, duodenitis, enteritis.
4. Inadequate intake of iron from food.
A rare cause of IDA may be impaired incorporation of transferrin-bound iron into erythroid cells due to a defect or absence of transferrin receptors. This pathology can be either congenital or acquired as a result of the appearance of antibodies to these receptors.
As deficiency develops, iron reserves in the body (ferritin, hemosiderin of RES macrophages) are completely depleted even before anemia develops, and so-called latent iron deficiency occurs. As the deficiency progresses, iron deficiency erythropoiesis occurs, and then anemia.

Symptoms:

Since iron deficiency usually develops gradually, its symptoms, especially in the initial period, may be scanty. As the disease progresses, signs of the so-called sideropenic syndrome appear: muscle weakness, decreased performance and tolerance to physical activity, perversion of taste and smell (pica chlorotica ~ patients like the taste of chalk, lime, the smell of paint, gasoline, etc.), peculiar skin changes, nails, hair, mucous membranes (glossitis, angular, easily broken nails, etc.). These symptoms can also appear with normal hemoglobin levels, i.e. with latent iron deficiency.
A decrease in hemoglobin concentration is accompanied by the appearance of signs of anemic syndrome. Many patients with IDA often have complaints related to the pathology of the gastrointestinal tract (usually atrophic with achlorhydria): pain, a feeling of heaviness in the epigastric region after eating, decreased appetite, etc.
Iron deficiency leads not only to the development of anemia, but also to non-hematological consequences (slower development of the fetus with severe iron deficiency in the mother, changes in the skin, nails and mucous membranes, impaired muscle function, decreased tolerance for heavy metal poisoning, changes in behavior, decreased motivation, intellectual abilities, etc.). Non-hematological manifestations of iron deficiency are more pronounced in children than in adults; restoration of iron stores usually leads to the disappearance of these phenomena.

Diagnostics:

Laboratory tests can identify all stages of the development of iron deficiency. Latent iron deficiency is characterized by a sharp decrease or absence of iron deposits in bone marrow macrophages, which are detected using special staining. The second sign of depletion of iron reserves in the body is a decrease in ferritin levels in the blood serum.
Iron deficiency erythropoiesis is accompanied by the appearance of moderate hypochromic microcytosis with normal hemoglobin concentration. The concentration of unsaturated transferrins increases, the content of saturated transferrins and iron in the blood serum decreases. The amount of free protoporphyrin in erythrocytes increases due to a lack of iron necessary for its conversion into heme.
IDA is characterized by a decrease in hemoglobin concentration, more pronounced hypochromia and microcytosis of erythrocytes, and the appearance of poikilocytosis. The reticulocyte count is normal or moderately decreased, but may increase after acute blood loss. The leukocyte formula usually does not change, the platelet count is normal or slightly increased. The concentration of iron and saturated transferrins is reduced, and the concentration of unsaturated transferrins is increased. Bone marrow cellularity is normal; moderate hyperplasia of the erythroid lineage may be observed. The number of sideroblasts is sharply reduced.
If the patient has already been treated with iron supplements or has undergone red blood cell transfusion, then microscopy of peripheral blood may reveal so-called dimorphic red blood cells, i.e., a combination of hypochromic microcytes and normal red blood cells. When iron deficiency and vitamin B2D are combined, hypochromic microcytes and hyperchromic macrocytes can be detected simultaneously.
Differential diagnosis is carried out with other hypochromic microcytic anemias: thalassemia, sideroblastic anemia and anemia in chronic inflammatory and malignant diseases.
If diagnosing IDA usually does not present significant difficulties, then determining its cause is not always simple, and often requires the persistence of a doctor and a comprehensive examination of the patient. Particular attention should be paid to elderly patients, in whom iron deficiency may be the first sign of malignancy. In adolescent girls and women of childbearing age, the main causes of iron deficiency are usually menorrhagia and recurrent pregnancies, although other possible causes should be excluded. In postmenopausal men and women, the main cause of iron deficiency is bleeding from the gastrointestinal tract.
In all patients with IDA, a thorough examination of the gastrointestinal tract is required, with repeated examination of stool for hidden stool using fibrogastroduodenoscopy and sigmoidoscopy. Fluoroscopy of the esophagus and stomach, irrigoscopy, fibrocolonoscopy, ultrasound and computed tomography of the abdominal organs are indicated. If a stool occult blood test indicates bleeding from the gastrointestinal tract, and these methods did not lead to identification of the source, angiography of the abdominal vessels may be performed to exclude. An accurate method of identification from the gastrointestinal tract is a test with radioactive chromium, in which the patient's red blood cells, after incubation with chromium, are reinfused into the patient, and then a radioactive assessment of the stool is performed within 5 days. Examination of the gastrointestinal tract allows you to simultaneously identify the causes of possible impaired iron absorption.
If uterine or gastrointestinal blood loss is not detected, then more rare sources of bleeding should be excluded. organs of the chest cavity allow one to suspect isolated pulmonary hemosiderosis. Repeated urine testing is carried out to detect hematururia, as well as hemosiderinuria caused by chronic intravascular hemolysis.
It should be emphasized once again that lack of iron in food and impaired absorption are rarely the only cause of iron deficiency.

Treatment:

Treatment of IDA includes treatment of the pathology that led to iron deficiency and the use of iron-containing drugs to restore iron reserves in the body. Identification and correction of pathological conditions that cause iron deficiency are the most important elements of complex treatment. Routine administration of iron-containing drugs to all patients with IDA is unacceptable, since it is not effective enough, is expensive and, more importantly, is often accompanied by diagnostic errors (failure to detect neoplasms, etc.).
The diet of patients with IDA should include meat products containing heme iron, which is absorbed better than from other products. It must be remembered that severe iron deficiency cannot be compensated for by diet alone.
Treatment of iron deficiency is carried out mainly with oral iron-containing drugs; parenteral drugs are used if there are special indications. It should be noted that the use of iron-containing oral medications is effective in most patients, whose body is able to absorb a sufficient amount of pharmacological iron to correct the deficiency. Currently, a large number of drugs containing iron salts are produced (ferroplex, orferon, tardiferon, etc.). The most convenient and cheapest are preparations containing 200 mg of ferrous sulfate, i.e. 50 mg of elemental iron in one tablet (ferrocal, ferroplex). The usual dose for adults is 1-2 tablets. 3 times a day. An adult patient should receive at least 3 mg of elemental iron per kg of body weight per day, i.e. 200 mg per day. The usual dosage for children is 2-3 mg of elemental iron per kg of body weight per day.
The effectiveness of preparations containing ferrous lactate, succinate or fumarate does not exceed the effectiveness of tablets containing ferrous sulfate or gluconate. The combination of iron salts and vitamins in one preparation, with the exception of the combination of iron and folic acid during pregnancy, as a rule, does not increase iron absorption. Although this effect can be achieved with large doses of ascorbic acid, the resulting adverse effects make therapeutic use of such a combination inappropriate. The effectiveness of slow-acting (retard) drugs is usually lower than that of conventional drugs because they enter the lower intestine, where iron is not absorbed, but it may be higher than that of fast-acting drugs taken with food.
It is not recommended to take a break of less than 6 hours between taking tablets, since for several hours after using the drug, duodenal enterocytes are refractory to iron absorption. Maximum absorption of iron occurs when taking the tablets on an empty stomach; taking it during or after meals reduces it by 50-60%. Do not take iron-containing medications with tea or coffee, which inhibit iron absorption.
Most adverse events when using iron-containing drugs are associated with gastrointestinal irritation. In this case, adverse events associated with irritation of the lower gastrointestinal tract (moderate constipation, diarrhea) usually do not depend on the dose of the drug, while the severity of irritation of the upper gastrointestinal tract (nausea, discomfort, pain in the epigastric region) is determined by the dose. Adverse effects are less common in children, although in them the use of iron-containing liquid mixtures may lead to temporary darkening of the teeth. To avoid this, you should give the drug to the root of the tongue, take the medicine with liquid and brush your teeth more often.
If there are severe side effects associated with irritation of the upper gastrointestinal tract, you can take the drug after meals or reduce the single dose. If adverse effects persist, you can prescribe drugs containing smaller amounts of iron, for example, in the composition of ferrous gluconate (37 mg of elemental iron per tablet). If in this case the adverse effects do not stop, then you should switch to slow-acting drugs.
Improvement in the well-being of patients usually begins on the 4-6th day of adequate therapy, on the 10-11th day the number of reticulocytes increases, on the 16th-18th day the hemoglobin concentration begins to increase, microcytosis and hypochromia gradually disappear. The average rate of increase in hemoglobin concentration with adequate therapy is 20 g/l over 3 weeks. After 1-1.5 months of successful treatment with iron supplements, the dose can be reduced.
The main reasons for the lack of the expected effect when using iron-containing drugs are presented below. It should be emphasized that the main reason for the ineffectiveness of such treatment is ongoing bleeding, therefore identifying the source and stopping the bleeding is the key to successful therapy.
The main reasons for the ineffectiveness of treatment for iron deficiency anemia: ongoing blood loss; inappropriate use of medications:
- incorrect diagnosis (anemia in chronic diseases, sideroblastic anemia);
- combined deficiency (iron and vitamin B12 or folic acid);
- taking slow-acting medications containing iron: impaired absorption of iron supplements (rare).
It is important to remember that in order to restore iron reserves in the body in case of severe deficiency, the duration of taking iron-containing drugs should be at least 4-6 months or at least 3 months after normalization of hemoglobin levels in peripheral blood. The use of oral iron supplements does not lead to iron overload, since absorption is sharply reduced when iron stores are restored.
Prophylactic use of oral iron-containing drugs is indicated during pregnancy, patients receiving regular iron, and blood donors. For premature babies, the use of nutritional mixtures containing iron salts is recommended.
Patients with IDA rarely need the use of parenteral drugs containing iron (ferrum-lek, imferon, ferkoven, etc.), since they usually respond quickly to treatment with oral drugs. Moreover, adequate therapy with oral medications, as a rule, is well tolerated even by patients with gastrointestinal pathology (peptic ulcer, peptic ulcer, etc.). The main indications for their use are the need to quickly compensate for iron deficiency (significant blood loss, upcoming surgery, etc.), severe side effects of oral medications, or impaired iron absorption due to damage to the small intestine. Parenteral administration of iron supplements may be accompanied by severe side effects and may also lead to excessive accumulation of iron in the body. Parenteral iron preparations do not differ from oral preparations in the rate of normalization of hematological parameters, although the rate of restoration of iron reserves in the body when using parenteral preparations is much higher. In any case, the use of parenteral iron supplements can be recommended only if the doctor is convinced that treatment with oral medications is ineffective or intolerable.
Iron preparations for parenteral use are usually administered intravenously or intramuscularly, with the intravenous route of administration being preferred. They contain from 20 to 50 mg of elemental iron per ml. The total dose of the drug is calculated using the formula:
Iron dose (mg) = (Hemoglobin deficiency (g/l)) / 1000 (Circulating blood volume) x 3.4.
The volume of circulating blood in adults is approximately 7% of body weight. To restore iron stores, 500 mg is usually added to the calculated dose. Before starting therapy, 0.5 ml of the drug is administered to exclude an anaphylactic reaction. If there are no signs of anaphylaxis within 1 hour, then the drug is administered so that the total dose is 100 mg. After this, 100 mg is administered daily until the total dose of the drug is reached. All injections are given slowly (1 ml per minute).
An alternative method involves simultaneous intravenous administration of the entire total dose of iron. The drug is dissolved in 0.9% sodium chloride solution so that its concentration is less than 5%. The infusion is started at a rate of 10 drops per minute; if there are no adverse events within 10 minutes, the rate of administration is increased so that the total duration of the infusion is 4-6 hours.
The most severe side effect of parenteral iron supplements is an anaphylactic reaction, which can occur with both intravenous and intramuscular administration. Although such reactions occur relatively rarely, the use of parenteral iron supplements should only be carried out in medical institutions that are fully equipped to provide emergency care. Other undesirable effects include facial flushing, increased body temperature, urticarial rash, and phlebitis (if the drug is administered too quickly). Drugs should not get under the skin. The use of parenteral iron preparations can lead to activation of rheumatoid.
Red blood cell transfusions are performed only in cases of severe IDA, accompanied by severe signs of circulatory failure, or upcoming surgical treatment.