Anemia- this is a discrepancy between the proportion of hemoglobin in human blood and the criteria adopted by the World Health Organization for a specific age and gender. The term "anemia" is not a diagnosis of a disease, but only indicates abnormal changes in the blood test.
Code for the international classification of diseases ICD-10: iron deficiency anemia - D50.
The most common are anemia due to blood loss and iron deficiency anemia:
- Anemia due to blood loss can be caused by prolonged menstruation, bleeding in the digestive tract and urinary tract, trauma, surgery, cancer.
- Iron-deficiency anemia formed as a result of a deficiency in the body's production of red blood cells
Causes and factors
Among the factors that increase the risk of developing anemia, doctors distinguish:
- insufficient intake of iron, vitamins and minerals;
- poor nutrition;
- loss of blood due to injury or surgery;
- kidney disease;
- diabetes;
- rheumatoid arthritis;
- HIV AIDS;
- inflammatory bowel disease (including Crohn's disease);
- liver disease;
- heart failure;
- diseases of the thyroid gland;
- anemia after an illness caused by an infection.
It is a misconception that anemia occurs only after an illness.
There are many more reasons:
Degrees and types of anemia
- lungs- the amount of hemoglobin is 90 g / l and above;
- middle severity - hemoglobin 70-90 g / l;
- heavy anemia - hemoglobin below 70 g / l, while the norm for women is 120-140 g / l, for men - 130-160 g / l.
- Iron deficiency anemia... Women during pregnancy, menstruation and lactation need several times more iron than usual. Therefore, iron deficiency anemia often occurs during this period.
Likewise the baby's body requires a lot of iron. This anemia can be treated with iron tablets or syrups. - Megaloblastic anemia occurs as a result of a deficiency of thyroid hormones, liver disease and tuberculosis. This type of anemia is caused by a lack of vitamin B12 and folate. Early diagnosis and treatment is very important for patients with megaloblastic anemia.
Weakness, tiredness, numbness of the hands, pain and burning of the tongue, shortness of breath are common complaints of this type of disease. - Chronic infectious anemia occurs due to a lack of bone marrow, with tuberculosis, leukemia and as a result of taking certain medications that contain toxic substances.
- Mediterranean anemia(a disease also known as thalassemia) is an inherited blood disorder. The high incidence of this type is observed in Italians and Greeks. Initially, the symptoms are the same as in iron deficiency anemia.
As the disease progresses jaundice is observed, anemia is added as a result of kidney disease and spleen growth. Thalassemia is treated with blood transfusions. - Sickle cell anemia this is also a hereditary disease in which the structure of hemoglobin in the blood differs from normal values. The erythrocyte takes the shape of a crescent, its life time is very short. This type is observed in representatives of the black race. The gene for this anemia is carried by women.
- Aplastic anemia it is a disruption in the production of red blood cells in the bone marrow. Vapors of harmful substances such as benzene, arsenic, and exposure to radiation can be the cause. The level of blood platelet cells also decreases.
The opposite of aplastic anemia is polycythemia., during which the usual number of red blood cells increases more than 2 times. The patient's skin turns red and an increase in blood pressure may be observed. The reason for this is lack of oxygen. This disease is treated by removing blood from the human body.
Who can get anemia?
Anemia is a disease that affects all age and ethnic groups, races.
- Some children in the first year of life are at risk of anemia due to iron deficiency. These are premature births and children who were fed breast milk with a lack of iron. These babies develop anemia within the first 6 months.
- Children from one to two years of age are prone to developing anemia... Especially if they drink a lot of cow's milk and don't eat food with enough iron. Cow's milk does not contain enough iron for a baby's growth. Instead of milk a baby under 3 years old should be fed foods rich in iron. Cow's milk can also prevent the absorption of iron in the body.
- Researchers continue to study how anemia affects adults. More than ten percent of adults are constantly mildly anemic. Most of these people have other medical diagnoses.
Signs and symptoms
The most common symptom of anemia is fatigue. People feel tired and exhausted.
Other signs and symptoms of anemia include:
- difficulty breathing;
- dizziness;
- headache;
- cold feet and palms;
- chest pain.
These symptoms may appear because it has become harder for the heart to pump oxygen-rich blood into the body.
In mild to moderate anemia (iron deficiency type), symptoms are:
- desire to eat a foreign object: earth, ice, limestone, starch;
- cracks in the corners of the mouth;
- irritated tongue.
Signs of folate deficiency:
- diarrhea;
- depression;
- swollen and red tongue;
Symptoms of anemia due to vitamin B12 deficiency:
- tingling and numbness in the upper and lower extremities;
- difficulty in distinguishing between yellow and blue;
- swelling and pain in the larynx;
- weight loss;
- blackening of the skin;
- diarrhea;
- depression;
- decreased intellectual function.
Complications
The doctor, when announcing the diagnosis, must warn of the danger of anemia:
- Patients may experience arrhythmias- a problem with the speed and rhythm of the heart. Arrhythmias can lead to heart damage and heart failure.
- Anemia can also lead to damage to other organs in the body: the blood cannot provide the organs with sufficient oxygen.
- With oncological diseases and HIV / AIDS, the disease can weaken the body, and reduce the result of treatment.
- Increased risk the occurrence of anemia in kidney disease, in patients with heart problems.
- Some types of anemia occur with insufficient fluid intake or excessive water loss in the body. Severe dehydration is the cause of blood disorders.
Diagnostics
The physician must take a family history of the disease to determine whether the disease is inherited or acquired. He may ask the patient about the general signs of anemia, whether he is on a diet.
The physical examination is:
- listening to the rhythm of the heart and the regularity of breathing;
- measuring the size of the spleen;
- the presence of pelvic or rectal bleeding.
- laboratory tests will help determine the type of anemia:
- general blood analysis;
- hemograms.
The hemogram test measures the value of hemoglobin and hematocrit in the blood. Low hemoglobin and low hematocrit are signs of anemia. Normal values vary by race and population.
Other tests and procedures:
- Hemoglobin electrophoresis determines the amount of different types of hemoglobin in the blood.
- Measurement of reticulocytes Is a count of young red blood cells in the blood. This test measures the rate of production of red blood cells by the bone marrow.
- Tests for measuring iron in blood- This is the determination of the level and total content of iron, transmission, binding capacity of blood.
- If the doctor suspects anemia due to blood loss, he can offer an analysis to determine the source of bleeding. He will offer to take a stool test to determine blood in the stool.
If there is blood, an endoscopy is necessary: examination of the inside of the digestive system with a small camera. - You may need also bone marrow analysis.
How is anemia treated?
Treatment for anemia depends on the cause, severity, and type of ailment. The goal of treatment is to increase oxygen in the blood by multiplying red cells and increasing hemoglobin levels.
Hemoglobin is a protein that transports oxygen to the body using iron.
Changes and additions to the diet
Iron
The body needs iron to form hemoglobin. The body absorbs iron more readily from meat than from vegetables and other foods. To treat anemia, eat more meat, especially red meat (beef or liver), as well as chicken, turkey, and seafood.
In addition to meat, iron is found in:
Vitamin B12
Low vitamin B12 levels can lead to pernicious anemia.
Sources of vitamin B12 are:
- cereals;
- red meat, liver, poultry, fish;
- eggs and dairy products (milk, yogurt and cheese);
- iron-based soy drinks and vegetarian foods fortified with vitamin B12.
Folic acid
The body needs folic acid to produce new cells and protect them. Folic acid is essential for pregnant women. It protects against anemia and helps the healthy development of the fetus.
Good food sources of folic acid are:
- bread, pasta, rice;
- spinach, dark green leafy vegetables;
- dry beans;
- liver;
- eggs;
- bananas, oranges, orange juice and some other fruits and juices.
Vitamin C
It helps the body absorb iron. Fruits and vegetables, especially citrus fruits, are a good source of vitamin C. Fresh and frozen fruits and vegetables contain more vitamin C than canned foods.
Vitamin C is rich in kiwi, strawberries, melons, broccoli, peppers, Brussels sprouts, tomatoes, potatoes, spinach, radishes.
Medicines
Your doctor may prescribe medications to treat the underlying cause of anemia and increase the number of red blood cells in your body.
It can be:
- antibiotics to treat infections;
- hormones to prevent excessive menstrual bleeding in young girls and women;
- artificial erythropoietin to stimulate the production of red blood cells.
Operations
If the anemia has developed into a severe stage, surgery may be required: transplantation of stem cells of blood and bone marrow, blood transfusion.
Stem cell transplantation is performed to replace damaged ones in a patient from another healthy donor. Stem cells are found in the bone marrow. Cells are transferred through a tube inserted into a vein in the breast. The process is similar to a blood transfusion.
Surgical interventions
For life-threatening bleeding in the body that causes anemia, surgery is necessary.
For example, anemia in stomach ulcers or colon cancer requires surgery to prevent bleeding.
Prophylaxis
Some types of anemia can be prevented by eating foods rich in iron and vitamins. It is helpful to take nutritional supplements while dieting.
Important! For women who are fond of losing weight and various diets, taking additional iron supplements and vitamin complexes is a must!
After the main treatment for anemia, you should keep in touch with your doctor and regularly check your blood count.
If the patient has inherited a malignant type of anemia, treatment and prevention should last for years. You need to be prepared for this.
Anemia in children and young people
Chronic illness, iron deficiency, and poor nutrition can lead to anemia. The disease is often accompanied by other health problems. Thus, the signs and symptoms of anemia are often less obvious.
You should definitely see a doctor if you have symptoms of anemia or if the person is on a diet. You may need a blood transfusion or hormone therapy. If anemia is diagnosed in time, it can be completely cured.
Chapter 2. ANEMIA
Chapter 2. ANEMIA
Anemia(from the Greek haima - anemia) - This is a clinical hematological syndrome characterized by a decrease in the hemoglobin content per unit volume of blood, often with a simultaneous decrease in the number of erythrocytes and a change in their qualitative composition, which leads to a decrease in the respiratory function of the blood and the development of oxygen starvation of tissues, most often expressed by symptoms such as pallor of the skin, increased fatigue, weakness, headaches, dizziness, palpitations, shortness of breath, etc.
In itself, anemia is not a disease, but is often included in the structure of a large number of independent diseases.
According to the mechanism of development, anemias are divided into three different groups.
Anemia can occur as a result of blood loss due to bleeding or hemorrhage - posthemorrhagic anemia.
Anemia can be the result of an excess of the rate of destruction of red blood cells over their production - hemolytic anemia.
Anemia can be due to insufficient or impaired production of red blood cells in the bone marrow - hypoplastic anemia.
Anemia is a decrease in the hemoglobin content per unit of blood volume (<100 г/л), чаще при одновременном уменьшении количества (<4,0х10 12 /л) или общего объема эритроцитов. Заболеваемость анемией в 2001 г. составила 157 на 100 000 населения.
Classifying criteria
Depending on the average erythrocyte volume, there are:
Microcytic [average erythrocyte volume (SEV) less than 80 fl (μm)];
Normocytic (SEO - 81-94 fl);
Macrocytic anemia (SEA> 95 vl).
According to the content of hemoglobin in erythrocytes, the following are distinguished:
Hypochromic [the average content of hemoglobin in the erythrocyte (AED) is less than 27 pg];
Normochromic (SSGE - 27-33 pg);
Hyperchromic (SSGE - more than 33 pg) anemias.
Pathogenetic classification
1.Anemia due to blood loss.
Acute post-hemorrhagic anemia.
Chronic post-hemorrhagic anemia.
2.Anemia due to violations of hemoglobin synthesis and iron metabolism.
Microcytic anemias:
Iron-deficiency anemia;
Anemia with impaired iron transport (atransferritinemia);
Anemia due to impaired iron utilization (sideroblastic anemia);
Anemia due to impaired iron reutilization (anemia in chronic diseases).
Normochromic-normocytic anemias:
Hyperproliferative anemia (with kidney disease, hypothyroidism, protein deficiency);
Anemias caused by bone marrow failure (aplastic anemia, refractory anemia in myelodysplastic syndrome);
Metaplastic anemia (with hemoblastosis, metastases in the red bone marrow);
Diserythropoietic anemia.
Macrocytic anemias:
Vitamin B 12 deficiency;
Folic acid deficiency;
Copper deficiency;
Vitamin C deficiency.
3. Hemolytic anemias.
Acquired:
Hemolytic anemias caused by immune disorders [isoimmune hemolytic anemia, autoimmune hemolytic anemia (with warm or cold antibodies), paroxysmal nocturnal hemoglobinuria];
Hemolytic microangiopathic anemias;
Hereditary:
Hemolytic anemias associated with a violation of the structure of the erythrocyte membrane (hereditary spherocytosis, hereditary elliptocytosis);
Hemolytic anemias associated with a deficiency of enzymes in erythrocytes (deficiency of glucose-6-phosphate dehydrogenase, pyruvate kinase);
Hemolytic anemias associated with impaired synthesis of Hb (sickle cell anemia, thalassemia).
Classification of anemias according to ICD-10
D50 - D53 Nutritional anemias.
D55 - D59 Hemolytic anemias.
D60 - D64 Aplastic and other anemias.
When taking anamnesis in patients with anemia, it is necessary to ask:
About recent bleeding;
Recent pallor;
The severity of menstrual bleeding;
Diet and alcohol consumption;
Decrease in body weight (> 7 kg for 6 months);
Family history of anemia;
A history of gastrectomy (if vitamin B 12 deficiency is suspected) or bowel resection;
Pathological symptoms from the upper gastrointestinal tract (dysphagia, heartburn, nausea, vomiting);
Pathological symptoms from the lower gastrointestinal tract (change in the usual functioning of the intestine, bleeding from the rectum, pain that decreases with bowel movements).
When examining the patient, they are looking for:
Pallor of the conjunctiva;
Pallor of the skin of the face;
Pallor of the skin of the palms;
Signs of acute bleeding:
Tachycardia in the supine position (pulse rate> 100 per minute);
Hypotension in the supine position (systolic blood pressure<95 мм рт.ст);
Increased heart rate> 30 per minute or severe dizziness when moving from a lying position to a sitting or standing position;
Signs of heart failure;
Jaundice (suggesting hemolytic or sideroblastic anemia);
Signs of infection or spontaneous bruising (suggesting a lack of bone marrow function)
Tumor-like formations in the abdominal cavity or rectum:
An examination of the patient's rectum and a fecal occult blood test are performed.
Research to be done
Counting of blood cells and blood smear.
Determination of the blood group and creation of the patient's own blood bank.
Determination of urea concentration and electrolyte content.
Functional liver function tests.
Determination of SEA and ESSE can help in identifying potential causes of anemia (Table 192).
Table 192. The reasons for the development of anemia
Average erythrocyte volume
SEA (MCV - mean corpuscular volume)- average corpuscular volume - the average value of the volume of erythrocytes, measured in femtoliters (fl) or cubic micrometers. In hematology analyzers, SEA is calculated by dividing the sum of cell volumes by the number of erythrocytes, but this parameter can be calculated using the formula:
Ht (%) 10
RBC (10 12 / l)
The values of the average volume of erythrocyte, characterizing the erythrocyte:
80-100 fl - normocyte;
-<80 fl - микроцит;
-> 100 fl - macrocyte.
SEA (Table 193) cannot be reliably determined if the test blood contains a large number of abnormal red blood cells (for example, sickle cells) or a dimorphic population of red blood cells.
Table 193. Average erythrocyte volume (Titz N., 1997)
The average erythrocyte volume is 80-97.6 microns.
The clinical significance of SEA is similar to the value of unidirectional changes in the color index and the hemoglobin content in the erythrocyte (MCH), since usually macrocytic anemias are
simultaneously hyperchromic (or normochromic), and microcytic - hypochromic. SEA is used mainly to characterize the type of anemia (Table 194).
Table 194. Diseases and conditions accompanied by changes in the average volume of erythrocytes
Changes in SEA give information about violations of the water-electrolyte balance: an increased value of SEA is a hypotonic nature of violations of the water-electrolyte balance, a decrease is hypertensive.
The average content of hemoglobin in the erythrocyte (table. 195)
Table 195. Average hemoglobin content in erythrocyte (Titz N., 1997)
The end of the table. 195
The average hemoglobin content in the erythrocyte is 26-33.7 pg.
The MCH does not have an independent meaning and always correlates with the SEA, the color indicator and the average concentration of hemoglobin in the erythrocyte (MCHS). On the basis of these indicators, normo-, hypo- and hyperchromic anemias are distinguished.
A decrease in MCH (i.e., hypochromia) is characteristic of hypochromic and microcytic anemias, including iron deficiency, anemia in chronic diseases, thalassemia; with some hemoglobinopathies, lead poisoning, impaired synthesis of porphyrins.
An increase in MCH (i.e., hyperchromia) is observed in megaloblastic, many chronic hemolytic anemias, hypoplastic anemia after acute blood loss, hypothyroidism, liver disease, metastases of malignant neoplasms; when taking cytostatics, contraceptives, anticonvulsants.
The four main functions of iron
enzymes
Transport of electrons (cytochromes, iron seroproteins).
Transport and storage of oxygen (hemoglobin, myoglobin).
Participation in the formation of active centers of redox enzymes (oxidase, hydroxylase, superoxide dismutase, etc.).
Transport and storage of iron (transferrin, hemosiderin, ferritin).
The level of iron in the blood determines the state of the body (Table 196,
197).
Table 196. Serum iron content is normal (Titz N., 2005)
Table 197. The most important diseases, syndromes, signs of iron deficiency and excess in the human body (Avtsyn A.P., 1990)
Research Needed
Microcytic anemia: - ± serum ferritin.
Macrocytic anemia:
Serum folic acid;
Vitamin B 12 (cobalamin) in serum;
- ± methylmalonic acid in urine or blood serum (if vitamin B 12 deficiency is suspected).
Subsequent research
Iron-deficiency anemia:
Gastroscopy and colonoscopy.
Vitamin B 12 deficiency
Antibodies to the Castle factor.
Schilling test.
Iron-deficiency anemia
In 2/3 of cases, anemia occurs due to a disease of the upper sections
Gastrointestinal tract.
Common causes of iron deficiency anemia in the elderly include:
Peptic ulcer or erosion;
Neoplasm in the rectum or colon;
Stomach surgery;
The presence of a hernial opening (> 10 cm);
Malignant disease of the upper gastrointestinal tract;
Angiodysplasia;
Varicose veins of the esophagus.
Vitamin B 12 deficiency
Common reasons:
Pernicious anemia;
Tropical sprue;
Bowel resection;
Jejunum diverticulum;
Impaired absorption of vitamin B 12;
Vegetarianism.
Folic acid deficiency
Common reasons:
Alcoholism;
Malnutrition.
Approved by order of the Ministry of Health and Social Development of the Russian Federation dated _____________ No.
Standard of care for patients with gastrointestinal bleeding, unspecified
1. Patient model.
. Nosological form: gastrointestinal bleeding, unspecified.
. Code for MKB-10: K92.2.
. Phase: acute condition.
. Stage: first appeal.
. Complications: regardless of complications.
. Terms of provision: emergency.
Diagnostics
Treatment at the rate of 20 minutes
Chronic post-hemorrhagic anemia
The end of the table.
* ATC - anatomical-therapeutic-chemical classification. ** ODD is an approximate daily dose. *** EKD - equivalent course dose.
CLINICAL ANALYSIS
Patient V., 58 years old, complained of general weakness, rapid fatigue, recurrent dizziness, tinnitus, flashing "flies" before the eyes, drowsiness in the daytime. Notes that she has been tempted to eat chalk lately.
Anamnesis
Over the past two years, the patient has switched to a vegetarian diet.
Objectively: the skin and visible mucous membranes are pale, the nails are thinned. Peripheral lymph nodes are not enlarged. In the lungs, vesicular breathing, no wheezing. Muffled heart sounds, rhythmic, systolic murmur at the apex. Heart rate 80 per minute. BP 130/75 mm Hg. Art. Tongue moist, covered with a white coating. The abdomen is soft and painless on palpation.
The patient was examined
General blood analysis
Hemoglobin - 85 g / l, erythrocytes - 3.4x10 12 / l, color index - 0.8, hematocrit - 27%, leukocytes - 5.7x10 9 / l, stab - 1, segmented - 72, lymphocytes - 19, monocytes - 8, platelets - 210x10 9 / l, anisochromia and poikilocytosis are noted.
MCH (average hemoglobin content in erythrocyte) - 24.9 pg (norm 27-35 pg).
ICSU - 31.4% (norm 32-36%). SEA - 79.4 microns (norm 80-100 microns).
Blood chemistry
Serum iron - 10 μmol / L (norm 12-25 μmol / L).
The total iron-binding capacity of serum is 95 μmol / l (the norm is 30-86 μmol / l).
The percentage of transferrin saturation with iron - 10.5% (normal
16-50%).
Fibrogastroduodenoscopy
Conclusion: superficial gastroduodenitis.
Colonoscopy. Conclusion: no pathology was revealed.
Obstetrician-gynecologist consultation. Conclusion: Menopause 5 years. Atrophic colpitis.
Based on the patient's complaints (general weakness, fatigue, recurrent dizziness, tinnitus, flashing "flies" before the eyes, drowsiness in the daytime, desire to eat chalk) and laboratory data [in the general blood test, the content of hemoglobin, erythrocytes is reduced; the size of erythrocytes is reduced, of different shapes, of different color intensity (signs of irritation of the erythrocyte germ); a biochemical blood test shows a decrease in serum iron, an increase in the total iron-binding capacity of serum, a decrease in the percentage of transferrin saturation with iron and a decrease in serum ferritin], the patient was diagnosed with moderate iron deficiency anemia (of alimentary origin).
Anemia is one of the most common blood diseases, both among adults and among children.
To draw up medical documentation for a patient with anemia of any etiology, the doctor uses the ICD 10 anemia code. There are different forms of the disease depending on the cause, which led to a decrease in hemoglobin and erythrocytes in the blood. Anemia can be iron deficiency, folate deficiency, B-12 deficiency, hemolytic, aplastic, and unspecified.
Causes of occurrence, clinic and treatment of a pathological condition
The general mechanism of development for any type of disease is a disruption in the functioning of the hematopoietic organs due to a chronic lack of certain nutrients or, in some cases, due to the rapid destruction of blood cells in the bloodstream. Also, an important role is played by immune disorders, exposure to toxic substances.
In ICD 10, anemia belongs to the class of blood diseases and has the code D50-D64.
The main clinical symptoms are:
- weakness;
- pallor;
- dizziness;
- pathological changes in taste;
- pathological changes in the skin;
- headache;
- digestive problems;
- intoxication (with hemolytic forms).
Treatment is carried out depending on the cause of the pathological decrease in hemoglobin and erythrocytes. It is imperative to choose the right diet and regimen for the patient. Unspecified anemia requires an extended comprehensive examination of the patient's body and symptomatic treatment at the initial stages.
Hypochromic anemia is a whole group of blood diseases, which are united by a common symptom: a decrease in the value of the color index is less than 0.8. This indicates an insufficient concentration of hemoglobin in the erythrocyte. It plays a key role in the transport of oxygen to all cells, and its lack causes the development of hypoxia and its accompanying symptoms.
Classification
Depending on the reason for the decrease in the color index, several types of hypotchromic anemias are distinguished, these are:
- Iron deficiency or hypochromic microcytic anemia is the most common cause of hemoglobin deficiency.
- Iron-saturated anemia, it is also called sideroachrestic. With this type of disease, iron enters the body in sufficient quantities, but due to a violation of its absorption, the concentration of hemoglobin decreases.
- Iron redistribution anemia occurs due to increased breakdown of red blood cells and the accumulation of iron in the form of ferrites. In this form, it is not included in the process of erythropoiesis.
- Anemia of mixed genesis.
According to the generally accepted international classification, hypochromic anemias are referred to as iron deficiency. They have been assigned a code according to ICD 10 D.50
Causes
The causes of hypochromic anemia differ depending on the type. So, the factors that contribute to the development of anemia with a lack of iron are:
- Chronic blood loss associated with menstrual bleeding in women, gastric ulcer, rectal lesions with hemorrhoids, etc.
- Increased iron intake, for example due to pregnancy, lactation, or growth during adolescence.
- Insufficient intake of iron from food.
- Impaired absorption of iron in the gastrointestinal tract due to diseases of the digestive system, surgery for resection of the stomach or intestines.
Iron-rich anemias are uncommon. They can develop under the influence of hereditary congenital pathologies, such as porphyria, and also be acquired. The reasons for this type of hypochromic anemia can be the intake of certain medications, poisoning with poisons, heavy metals, and alcohol. It should be noted that very often these diseases are referred to as hemolytic blood diseases.
Iron-redistribution anemia is a companion of acute and chronic inflammatory processes, suppuration, abscesses, non-infectious diseases, such as tumors.
Diagnosis and determination of the type of anemia
When examining the blood, signs are revealed that are characteristic of most of these diseases - a decrease in the level of hemoglobin, the number of red blood cells. As mentioned above, a decrease in the value of the color index is characteristic of hypochromic anemia.
To determine the treatment regimen, it is necessary to diagnose the type of hypochromic anemia. Additional diagnostic criteria are the following parameters:
- Determination of the level of iron in the blood serum.
- Determination of the iron-binding capacity of serum.
- Measurement of the level of the iron-containing protein ferritin.
- It is possible to determine the total level of iron in the body by counting sideroblasts and siderocytes. What it is? These are erythoid cells in the bone marrow that contain iron.
A summary table of these indicators for various types of hypochromic anemia is presented below.
Symptoms
Doctors note that the clinical picture of the disease depends on the severity of its course. Depending on the concentration of hemoglobin, a mild degree is distinguished (the Hb content is in the range of 90 - 110 g / l), hypochromic anemia of moderate severity (the concentration of hemoglobin is 70 - 90 g / l) and a severe degree. As the amount of hemoglobin decreases, the severity of the symptoms increases.
Hypochromic anemia is accompanied by:
- Dizziness, flashing "flies" before the eyes.
- Digestive disorders, which are manifested by constipation, diarrhea or nausea.
- Changes in taste and perception of odors, lack of appetite.
- Dry and flaky skin, painful cracks in the corners of the mouth, on the feet and between the toes.
- Inflammation of the oral mucosa.
- Rapidly developing carious processes.
- Deterioration of the condition of hair and nails.
- The onset of shortness of breath, even with minimal physical exertion.
Hypochromic anemia in children is manifested by tearfulness, increased fatigue, and moodiness. Pediatricians say that a severe degree is characterized by a delay in psycho-emotional and physical development. Congenital forms of the disease are detected very quickly and require immediate treatment.
With a small but chronic loss of iron, chronic mild hypochromic anemia develops, which is characterized by constant fatigue, lethargy, shortness of breath, and decreased performance.
Treatment for iron deficiency anemia
Treatment of any type of hypochromic anemia begins with determining its type and etiology. Timely elimination of the cause of a decrease in hemoglobin concentration plays a key role in successful therapy. Then drugs are prescribed that help restore normal blood counts and alleviate the patient's condition.
For the treatment of iron deficiency anemia, iron preparations are used in the form of syrups, tablets or injections (in case of impaired absorption of iron in the digestive tract). These are ferrum lek, sorbifer durules, maltofer, sorbifer, etc. For adults, the dosage is 200 mg of iron per day, for children it is calculated depending on weight and is 1.5 - 2 mg / kg. To increase the absorption of iron, ascorbic acid is prescribed at a dose of 200 mg for every 30 mg of iron. In severe cases, red blood cell transfusion is indicated, taking into account the blood group and Rh factor. However, this is resorted to only as a last resort.
So, with thalassemia, children are given periodic blood transfusions from an early age, and in severe cases, bone marrow transplants are performed. Often, such forms of the disease are accompanied by an increase in the concentration of iron in the blood, therefore, the appointment of drugs containing this trace element leads to a deterioration in the patient's condition.
Such patients are shown the use of the drug desferal, which helps to remove excess iron from the body. The dosage is calculated based on age and blood counts. Desferal is usually given in conjunction with ascorbic acid, which increases its effectiveness.
In general, with the development of modern methods of treatment and diagnostics, therapy of any form of hypochromic anemia, even hereditary, is quite possible. A person can undergo supportive treatments with certain drugs and lead a completely normal life.
Treatment of IDA includes treatment of the pathology that led to iron deficiency, and the use of iron-containing drugs to restore iron stores in the body. The identification and correction of pathological conditions that cause iron deficiency are the most important elements of a comprehensive treatment. Routine administration of iron-containing drugs to all patients with IDA is unacceptable, since it is insufficiently effective, expensive and, more importantly, is often accompanied by diagnostic errors (non-detection of neoplasms).
The diet of patients with IDA should include meat products containing iron in the composition of the heme, which is absorbed better than from other foods. It must be remembered that it is impossible to compensate for a pronounced iron deficiency only by prescribing a diet.
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 oral iron-containing drugs is effective in most patients, whose body is able to adsorb a sufficient amount of pharmacological iron to correct the deficiency. Currently, a large number of preparations containing iron salts are produced (ferroplex, orferon. Tardiferon). 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 lactate, succinate or ferrous 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 the absorption of iron. Although this effect can be achieved with high doses of ascorbic acid, the undesirable effects occurring make the therapeutic use of such a combination impractical. The effectiveness of slow-acting (retard) drugs is usually lower than that of conventional drugs, since they enter the lower intestines, where iron is not absorbed, but it can be higher than that of fast-acting drugs taken with food.
It is not recommended to take a break between taking pills for less than 6 hours, since within a few hours after using the drug, the enterocytes of the duodenum are refractory to iron absorption. The maximum absorption of iron occurs when taking tablets on an empty stomach, taking it during or after meals reduces it by 50-60%. You should not drink iron preparations with tea or coffee, which inhibit the absorption of iron.
Most of the undesirable effects when using iron-containing drugs are associated with irritation of the gastrointestinal tract. In this case, undesirable phenomena 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 sections (nausea, discomfort, pain in the epigastric region) is determined by the dose. Adverse events are less common in children, although the use of iron-containing liquid mixtures for them can lead to temporary darkening of the teeth. To avoid this, you should give the drug to the root of the tongue, drink the medicine with liquid and brush your teeth more often.
In the presence of pronounced adverse events associated with irritation of the upper gastrointestinal tract, you can take the drug after meals or reduce a single dose. If adverse events persist, preparations containing less iron can be prescribed, for example, in the composition of ferrous gluconate (37 mg of elemental iron per tablet). If, in this case, the undesirable effects do not stop, then you should switch to slow-acting drugs.
Improvement of patients' well-being usually begins on the 4-6th day of adequate therapy, on the 10-11th day the number of reticulocytes increases, on the 16-18th day the concentration of hemoglobin begins to increase, microcytosis and hypochromia gradually disappear. The average rate of increase in hemoglobin concentration with adequate therapy is 20 g / l in 3 weeks. After 1-1.5 months of successful treatment with iron preparations, their 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 bleeding is the key to successful therapy.
The main reasons for the ineffectiveness of treatment of iron deficiency anemia: continued blood loss; improper drug intake:
- wrong diagnosis (anemia in chronic diseases, thalassemia, sideroblastic anemia);
- combined deficiency (iron and vitamin B12 or folic acid);
- taking slow-acting preparations containing iron: impaired absorption of iron preparations (rare).
It is important to remember that in order to restore iron stores in the body with a pronounced deficiency, the duration of taking iron-containing preparations should be at least 4-6 months or at least 3 months after the normalization of hemoglobin levels in the peripheral blood. The use of oral iron preparations does not lead to iron overload, since absorption decreases sharply when its reserves are restored.
The prophylactic use of oral iron-containing preparations is indicated during pregnancy, patients receiving continuous hemodialysis, and blood donors. Premature infants are shown the use of nutritional mixtures containing iron salts.
Patients with IDA rarely need the use of parenteral preparations containing iron (ferrum-lek, imferon, fercoven and), since they usually respond quickly to treatment with oral drugs. Moreover, even patients with gastrointestinal tract pathology (peptic ulcer disease, enterocolitis, ulcerative colitis) are generally well tolerated by adequate oral therapy. The main indications for their use are the need to quickly compensate for iron deficiency (significant blood loss, upcoming surgery, etc.), pronounced side effects of oral drugs or impaired iron absorption due to damage to the small intestine. Parenteral administration of iron preparations can be accompanied by severe adverse events, as well as lead to excessive accumulation of iron in the body. Parenteral iron preparations do not differ from oral preparations in terms of the rate of normalization of hematological parameters, although the rate of recovery of iron stores in the body with the use of parenteral preparations is much higher. In any case, the use of parenteral iron preparations can be recommended only if the physician is convinced that treatment with oral preparations is ineffective or intolerant.
Iron preparations for parenteral administration are usually administered intravenously or intramuscularly, with the intravenous route of administration being preferred. They contain 20 to 50 mg of elemental iron per ml. The total dose of the drug is calculated by the formula:
Iron dose (mg) = (Hemoglobin deficiency (g / L)) / 1000 (Circulating blood volume) x 3.4.
The circulating blood volume 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 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 that, 100 mg is injected daily until the total dose of the drug is reached. All injections are done slowly (1 ml per minute).
An alternative method is the 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%. Infusion begins at a rate of 10 drops per minute, in the absence of 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 supplementation is anaphylactic reaction, which can occur with both intravenous and intramuscular administration. Although these reactions are relatively rare, parenteral iron supplementation should only be used in hospitals equipped to provide full emergency care. Other undesirable effects include facial flushing, fever, urticaria, arthralgia and myalgia, phlebitis (if the drug is administered too quickly). Drugs should not come into contact with the skin. The use of parenteral iron preparations can lead to the activation of rheumatoid arthritis.
Erythrocyte transfusions are carried out only with severe IDA, accompanied by pronounced signs of circulatory failure, or the forthcoming surgical treatment.
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