Anemia is considered one of the most common pathological conditions among the world’s population. Among the varieties of anemia, several basic conditions are distinguished, classifying them for the causes of anemia:
- Iron-deficiency anemia;
- hemolytic anemia;
- aplastic anemia;
- sideroblastic type of anemia;
- B12 deficiency resulting from vitamin B12 deficiency;
- posthemorrhagic anemia;
- sickle cell anemia and other forms.
Approximately one in four people on the planet, in accordance with the studies of specialists, suffers from an iron deficiency form of anemia due to a decrease in iron concentration. The danger of this condition is in the erased clinical picture of iron deficiency anemia. Symptoms become pronounced when the level of iron and, accordingly, hemoglobin, drops to a critical level.
The following population groups are at risk of developing anemia in adults:
- followers of vegetarian nutritional principles;
- people suffering from blood loss due to physiological causes (heavy menstruation in women), diseases (internal bleeding, severe 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 who are undernourished or have a limited diet.
The most common iron deficiency form of anemia is a consequence of a lack of iron, which, in turn, can be triggered by one of the following factors:
- insufficient intake of iron with food;
- increased need for iron in view of situational or individual characteristics (pathologies of development, 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 correcting the diet, prescribing vitamin-mineral complexes, and iron-containing preparations. Medium and severe form of anemia requires specialist intervention and appropriate treatment.
The diagnostic criterion for anemia in men is a decrease in the concentration of hemoglobin in the blood to a level below 130 g / l. Statistically, anemia in men is diagnosed less frequently than in women due to physiological characteristics: the absence of menstruation, which leads to monthly blood loss, gestation, lactation, often accompanied by deficiencies of necessary trace elements.
However, anemia in the male part of the population is also often diagnosed, and, as a rule, is a consequence of the presence of a chronic disease and disturbances in the functioning of various body systems. Thus, latent gastrointestinal bleeding in men with intestinal erosion and peptic ulcer most often leads to chronic iron deficiency anemia. hemorrhoids.
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Anemia in women
Anemia in women is diagnosed with hemoglobin levels below 120 g / l (or 110 g / l during gestation). Physiologically, women are more prone to anemia. With monthly menstrual bleeding, the female body loses red blood cells. The average monthly blood loss is 40-50 ml of blood, however, with heavy menstruation, the amount of secretions can reach 100 or more ml for a period of 5-7 days.
Several months of such regular blood loss can lead to the development of anemia. Another form of latent anemia, common among the female population with a high frequency (20% of women), is provoked by a decrease in the concentration of ferritin, a protein that performs the function of accumulating iron in the blood and releasing it when hemoglobin level declining.
Anemia is characterized by a decrease in the concentration of hemoglobin and red blood cells in a 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 red blood cells and red blood.
- acute or chronic blood loss;
- hemolysis, destruction of red blood cells;
- decreased production of red blood cells by bone marrow.
According to the variety of factors and causes, the following types of anemia are distinguished:
- food related to a lack of diet or a general lack of food;
- physical (injuries, surgical interventions, delivery, frostbite, burns, etc.);
- genetic etiology;
- infectious, secondary anemia in diseases such as viral hepatitis, cirrhosis, liver tuberculosis, glomerulonephritis, diseases of the gastrointestinal tract (gastrointestinal ulcer, colitis, gastritis, Crohn’s disease), rheumatoid arthritis, systemic lupus, benign and malignant neoplasms of various localization;
- infectious (with viral, bacterial, parasitic and protozoal diseases);
- poisoning with toxic substances and medicines, including during a long, especially uncontrolled course of therapy (antibiotic therapy, taking cytostatics, non-steroidal anti-inflammatory drugs, antithyroid, antiepileptic drugs);
- exposure to radioactive waves.
Iron deficiency accounts for up to 90% of all varieties of anemic conditions. According to studies by the World Health Organization, one in 6 men and one in three women in the world suffer from this form. Hemoglobin is a complex protein compound containing iron that is capable of reversible binding to oxygen molecules, which is the basis of the process of transporting oxygen from the lungs to tissues organism.
The iron deficiency form is hypochromic anemia, with signs of microcytosis, the presence of erythrocytes in the blood formula with a diameter less than normal, which is associated with iron deficiency, the basic element for the formation of hemoglobin, which fills the erythrocyte cavity and gives it a red color. Iron is a vital trace element involved in many metabolic processes, nutrient metabolism, gas exchange of the body. During the day, an adult spends 20-25 mg of iron, while the total supply of this element in the body is about 4 g.
The reasons for the development of this form of the condition include factors of various etiologies. Violations of iron intake:
- unbalanced diet, strict vegetarianism without compensation for iron-containing products, starvation, diets, taking medications, narcotic and other substances that suppress the feeling of hunger, impaired appetite due to diseases of a physical or psychoemotional etiology;
- socio-economic causes of malnutrition, lack of food.
Violations of the process of absorption, assimilation of iron:
- diseases of the gastrointestinal tract (gastritis, colitis, peptic ulcer, resection of this organ).
An imbalance in the consumption and intake of iron due to the increased need of the body:
- pregnancy, lactation;
- age of puberty jumps of physical growth;
- chronic diseases that provoke hypoxia (bronchitis, obstructive pulmonary disease, heart defects and other diseases of the cardiovascular system and respiratory system);
- diseases accompanied by purulent-necrotic processes: sepsis, tissue abscesses, bronchiectasis, etc.
Loss of iron by the body, acute or chronic hemorrhagic:
- with pulmonary hemorrhages (tuberculosis, tumor formation in the lungs);
- with gastrointestinal bleeding accompanying peptic ulcer of the stomach, duodenum, cancers of the stomach and intestines, severe erosion of the gastrointestinal mucosa, varicose veins of the esophagus, rectum, hemorrhoids, helminthic invasion of the intestine, ulcerative colitis and others;
- with uterine bleeding (heavy menstruation, cancer of the uterus, cervix, myoma, placental abruption during the gestational period or during childbirth, ectopic pregnancy during the period of expulsion, birth injuries of the uterus and cervix);
- bleeding with localization in the kidneys (tumor formations in the kidneys, tuberculous changes in the kidneys);
- bleeding, including internal and latent, due to injuries, loss of blood during burns, frostbite, during planned and emergency surgical interventions, etc.
Symptoms of IDA
The clinical picture of the iron deficiency form is made up 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 endure prolonged physical and mental stress;
- attention deficit disorder, difficulty with concentration, rigidity;
- dizziness, sometimes fainting;
- drowsiness and sleep disturbances;
- shortness of breath, rapid heart rate, both during physical and / or psycho-emotional stress, and at rest;
- black 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 smell, desire to smell paint, household chemicals, substances with a pungent 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 – blueness of the sclera;
- the presence of cheilitis (cracks, “jam”) in the corners of the lips.
In severe stages of IDA, neurological symptoms are noted: sensations of “goosebumps”, numbness of the extremities, difficulty swallowing, weakening of bladder control, etc.
The diagnosis of iron deficiency anemia is based on data from an external examination, evaluation of the results of laboratory blood tests and instrumental examination of the patient. During an external medical examination and anamnesis, pay attention to the condition of the skin, mucous surfaces of the mouth, corners of the lips, and also assess the size of the spleen during palpation.
A general blood test in the classical clinical picture of IDA shows a decrease in the concentration of red blood cells and hemoglobin relative to age and gender, 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 , mild red blood cell color, low color index. The results of a biochemical blood test with IDA have the following indicators:
- reduced relative to normal limits the concentration of ferritin, a protein that performs the function of an iron depot in the body;
- low serum iron;
- increased iron binding capacity of blood serum.
Iron deficiency anemia is an extremely common condition. Of all cases of various anemia, it is 90%. And all in the world there are 2 billion suffering from this syndrome. It is estimated that latent iron deficiency (sideropenia) is present in every second person on Earth.
Iron deficiency anemia syndrome is more prone to women. Their condition is observed about 3 times more often than men. Adolescents (12-17 years old) are also at risk, since they should consume more iron due to the needs of a growing organism.
Degrees of anemia
It is customary to distinguish the degree of anemia depending on the concentration of hemoglobin in the blood.
|Stage of anemia||hemoglobin concentration, g / l|
|easy stage||less than normal but over 90|
|middle stage||70 – 90|
|severe stage||less 70|
Another classification is also used in which the degree of IDA depends on the clinical manifestations.
|2||moderate weakness and dizziness|
|3||strongly expressed, the patient is incapable of work|
The first stage of IDA may not be accompanied by any signs of malaise. As soon as a state of iron deficiency occurs in the body, reserves from the liver begin to be used. And only after they are completely exhausted, does the IDA actually arise. In this case, only a state of a slight deficiency of an element in the body is observed, however, anemia itself is still far away. This condition is called sideropenia.
Aplastic anemia: symptoms, causes, diagnosis, treatment
IDA is a symptom showing that something is wrong with the body. This may be an internal cause (occult bleeding, helminth disease) or an external cause (for example, a dietary disorder). And the doctor must determine the root cause of hemoglobin deficiency in order to prescribe the correct treatment. To this end, he collects all the information about the patient – his complaints, lifestyle, diseases he has suffered.
The presence of anemia is determined by the amount of hemoglobin contained in red blood cells. The hemoglobin content in the range of 120-140 g / l is considered the norm. However, this indicator can vary greatly depending on the gender and age of the patient.
In any case, if anemia is suspected, a general blood test (from the finger) should be performed to determine the level of red blood cells and hemoglobin.
In addition, the doctor may prescribe additional blood tests that determine the content of hemoglobin in the blood cell, the number of reticulocytes. A biochemical blood test allows you to find out the level of iron and bilirubin.
To determine the cause of the disease and determine how to treat this type of anemia, various diagnostic methods can be used to study the condition of the gastrointestinal tract (fibrogastroscopy, fibrocolonoscopy, etc.).
Since the symptoms and treatment in adult women may resemble those of gynecological pathologies, it is important to carry out the necessary “female” tests.
In general, there are a lot of reasons that cause anemia, so the choice of a diagnostic method is determined by the doctor depending on the history.
Iron deficiency anemia in children and adults can be established by any specialist, however, a detailed diagnosis aimed at identifying the causes and treatment of this disease should be carried out by a hematologist. Examinations of the patient include:
- visual examination of the patient is the first stage of the diagnosis of IDA. According to the patient, the specialist needs to determine the general picture of the development of pathology and conduct an examination that will help draw conclusions about the degree of the disease and identify complications if they are present;
- a general blood test from a finger or from a vein is a generalized picture of the patient’s health, with the help of which the doctor can unambiguously establish 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 the patient, in the case of:
- 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 prevalence of red blood cells in the patient’s blood, in which the size is less than normal (a deviation is considered to be less than 70 μm3);
- color indicator (CPU) is less than 0,8;
- a biochemical blood test allows you to more closely examine the patient’s condition, taking into account indicators related to the study area. The following deviations indicate the presence of iron deficiency anemia:
- serum iron (SG): in men – less than 17,9 micromol / l, in women – less than 14,3 micromol / l;
- total iron binding capacity of serum (OZHSS): significantly exceeds the level of 77 micromol / l;
- ferritin (a complex protein complex that plays the role of the main intracellular iron depot in humans) is below normal: in men – below 15 ng / ml, in women – less than 12 ng / ml;
- low hemoglobin level (less than 120 g / l);
- bone marrow puncture – a diagnostic method based on the collection of bone marrow samples by taking it with a special tool from the sternum. With IDA disease, an increase in the erythroid germ of hematopoiesis is observed;
- Radiography is performed to determine intestinal pathologies that can cause chronic bleeding, thereby causing anemia;
- endoscopic examinations of the human mucous membranes are also carried out to identify various pathologies of the abdominal organs. It can be:
- fibroesophagogastroduodenoscopy (FEGDS);
- laparoscopy and others.
Diagnosis of anemia includes the following examination methods:
- General blood analysis;
- Blood chemistry;
- General clinical analysis of urine;
- Computed tomography (CT);
With aplastic, hypoplastic forms of anemia, the causes of this condition can be as follows:
- stem cell defect;
- suppression of the process of hematopoiesis (hematopoiesis);
- insufficiency of factors stimulating hematopoiesis;
- immune, autoimmune reactions;
- deficiency of iron, vitamin B12 or their exclusion from the process of hematopoiesis due to impaired functions of the blood-forming tissues and organs.
The following factors are referred to the development of disorders provoking an aplastic or hypoplastic form:
- hereditary diseases and genetic pathologies;
- taking certain medications from antibiotic groups, cytostatics, non-steroidal anti-inflammatory drugs;
- poisoning with chemicals (benzene, 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 undetected.
The severity of pancytopenia, a decrease in the number of basic types of blood cells, determines the severity of symptoms. The following signs are referred to the clinical picture of the aplastic form:
- tachycardia, heart palpitations;
- pallor of the skin, mucous membranes;
- 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 slight bruising;
- frequent acute infections, chronic diseases as a result of a decrease in general immunity and leukocyte insufficiency;
- erosion, ulcers on the inner surface of the oral cavity;
- yellowness of the skin, sclera of the eyes as a sign of the onset of liver damage.
To establish the diagnosis, laboratory methods for studying various biological fluids and tissues and instrumental examination are used. A general blood test shows a reduced number of red blood cells, hemoglobin, reticulocytes, white blood cells, and platelets, in accordance with the norm, the color index and the content of hemoglobin in red blood cells.
The results of a biochemical study showed an increase in serum iron, bilirubin, lactate dehydrogenase, transferrin saturation with iron by 100% of the possible. To clarify the diagnosis, histological examination of the material removed from the bone marrow during puncture is performed. As a rule, according to the results of the study, underdevelopment of all sprouts and bone marrow replacement with fat are noted.
Anemia of this variety cannot be treated with dietary correction. First of all, a patient with aplastic anemia is prescribed selective or combined administration of drugs of the following groups:
- immunoglobulins of antilymphocytic and antiplatelet action;
- antimetabolic drugs;
- stem cell stimulators of red blood cell production.
With the ineffectiveness of drug therapy, non-drug treatment methods are prescribed:
- bone marrow transplantation;
- erythrocyte, platelet transfusion;
Aplastic anemia is accompanied by a decrease in general immunity due to leukocyte insufficiency, therefore, in addition to general therapy, an aseptic environment, antiseptic surface treatment, lack of contact with carriers of infectious diseases are recommended. If these treatment methods are insufficient, the patient is prescribed splenectomy surgery, spleen removal. Since it is in this body that the red blood cells decay, its removal can improve the general condition of the patient and slow down the development of the disease.
- Myocardial dystrophy with an increase in heart size;
- Functional systolic murmur;
- Heart failure;
- Exacerbation of coronary insufficiency;
- The development of paranoia.
The prognosis for the recovery of anemia in most cases is favorable.
The prognosis is serious with an aplastic form of anemia.
Supplementation with iron, B12, and folic acid is also an excellent prophylactic against acute respiratory infections in children.
The degree of complexity of a disease such as iron deficiency anemia today is quite low.
With the timely detection of symptoms and conducting a qualitative diagnosis, this ailment can be completely eliminated without any consequences.
In some cases, the development of complications in the treatment of IDA may occur. The reasons for this may be the following factors:
- illiterate diagnostic procedures and, as a consequence, the establishment of a false diagnosis;
- failure to identify the first cause;
- untimely adoption of treatment measures;
- incorrect dosage of prescribed drugs;
- non-compliance with the 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, malfunctions 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 supply of oxygen to the brain. The characteristic signs of this complication are fainting conditions, weakened and suppressed reflexes. Failure to provide timely qualified medical assistance to doctors creates a strong threat to the patient’s life;
- the appearance of heart failure is a common occurrence with a long lack of iron in the body;
- infectious diseases with anemia can cause sepsis.
These types of complications pose the greatest threat to pediatric and elderly patients.
In the case of timely treatment of iron deficiency anemia, the prognosis is favorable, it is enough only to eliminate its main causes.
In cases where anemia is due to bleeding, (posthemorrhagic anemia), the prognosis is also favorable, but only with timely detection of the problem and adequate treatment.
The prognosis for other forms of anemia is poor, since in most cases it is impossible to defeat the disease caused by genetic disorders, and treatment consists only in providing palliative care to the patient.
IDA in infants
If IDA is diagnosed in an infant, then the root cause is most likely iron deficiency in the mother’s body. In this case, the mother needs to take iron-containing drugs to treat the condition. Breast milk contains iron compounds, from which this element passes into the body of the child without loss. Therefore, for the prevention of IDA in infants, their mothers should adhere to breastfeeding for as long as possible.
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