Iron deficiency anemia (IDA) used to be better known as anemia (now this term is outdated and out of habit, except by our grandmothers). The name of the disease is unique indicates a deficiency in the body of such a chemical element as iron, depletion of which in the organs depositing it leads to a decrease in the production of a complex protein (chromoprotein) important for the organism – hemoglobin (Hb), which is contained in red blood cells – erythrocytes. Such a property of hemoglobin, as its high affinity for oxygen, forms the basis of the transport function of red blood cells, which with the help of hemoglobin deliver oxygen to breathing tissues.
Although the erythrocytes themselves in the blood in case of iron deficiency anemia may be enough, while circulating through the bloodstream “empty”, they do not bring the main component to the tissues for breathing, which is why they begin to experience fasting (hypoxia).
Iron in the human body
Iron deficiency anemia (IDA) is the most common form of all currently known anemias, which is caused by a large number of causes and circumstances that can lead to iron deficiency, which will entail various disorders that are unsafe for the body.
Iron (ferrum, Fe) is a very important element to ensure the normal functioning of the human body.
In men (average height and weight) it contains approximately 4 – 4.5 grams:
- 2.5 – 3.0 g is in heme Hb;
- in tissues and parenchymatous organs it is stored in reserve from 1.0 to 1.5 g (about 30%), this is a reserve – ferritin;
- myoglobin and respiratory enzymes take over 0.3-0.5 g;
- a certain proportion is present in ferrum-transporting proteins (transferrin).
Of course, daily losses in males also occur: about 1.0-1.2 g of iron leaves through the intestines every day.
In women, the picture is somewhat different (and not only because of height and weight): their iron content is within 2.6 – 3.2 g, only 0.3 g is deposited, and the losses are not only daily through the intestines. Losing 2 ml of blood during menstruation, the female body breaks up with 1 g of this important element, so it is clear why a condition such as iron deficiency anemia often occurs in females.
In children, hemoglobin and iron content change with age, however, in general, they are much lower before the year of life, and in children and adolescents up to 14 years old they approach the female norm.
The most common form of anemia is IDA due to the fact that our body is not able to synthesize this chemical element at all and, except from animal products, we have nowhere else to take it. It is absorbed in the duodenum 12 and a little along the small intestine. The ferrum does not enter into any interaction with the colon and does not react to it, therefore, once there, it is transited and removed from the body. By the way, you can not worry that by consuming a lot of iron with food, we can “overeat” it – a person has special mechanisms that will promptly stop the absorption of excess iron.
iron metabolism in the body (scheme: myshared, Efremova
Causes, deficiencies, violations …
In order for the reader to understand the important role of iron and hemoglobin, let us try, using often the words “cause”, “deficiency” and “disturbance”, to describe the interrelation of various processes, which constitute the essence of IDA:
- The main reason for the development of iron deficiency states, of course, is iron deficiency;
- The lack of this chemical element leads to the fact that it is not enough to complete the final stage of heme synthesis, which selects iron from the backup hemoprotein – ferritin, in which Fe should also be enough to be able to give. If ferritin ferrous protein contains iron less than 25%, it means that for some reason the element has not reached it;
- The lack of heme synthesis leads to impaired hemoglobin production (there are not enough hemes to form a hemoglobin molecule, which consists of 4 hemes and globin protein);
- Disruption of Hb synthesis results in the fact that part of the red blood cells leaves the bone marrow without it (hypochromic type of anemia), and, therefore, is not able to fully perform its tasks (deliver oxygen to the tissues, which has nothing to communicate);
- As a result of a lack of hemoprotein Hb, tissue hypoxia occurs in the blood and a circulatory hypoxic syndrome develops. In addition, the lack of Fe in the body violates the synthesis of tissue enzymes, which is not the best effect on metabolic processes in tissues (trophic disorders of the skin, atrophy of the gastrointestinal mucosa) – symptoms of iron deficiency anemia appear.
erythrocyte and hemoglobin molecules
In this way, The reason for these disorders is iron deficiency and its lack of reserve (ferritin), which complicates the synthesis of heme and, accordingly, hemoglobin production. If the hemoglobin formed in the bone marrow is not enough to fill young red blood cells, there will be nothing left for blood cells to leave the “place of birth” without it. However, circulating in the blood in such an incomplete state, the red blood cells will not be able to provide the tissues with oxygen, and they will experience starvation (hypoxia). And it all started with iron deficiency …
Reasons for the development of IDA
The main prerequisites for the development of iron deficiency anemia are diseases, as a result of which iron does not reach a level capable of ensuring normal synthesis of heme and hemoglobin, or due to some circumstances this chemical element is removed along with erythrocytes and hemoglobin already formed, which occurs during bleeding.
Meanwhile, acute post-hemorrhagic anemia that occurs during massive blood loss should not be attributed to IDA (severe injuries, childbirth, criminal abortions and other conditions caused mainly by damage to large vessels). With a favorable set of circumstances, the BCC (circulating blood volume) will be restored, the red blood cells and hemoglobin will rise and everything will fall into place.
The following pathological conditions can be the cause of iron deficiency anemia:
Chronic blood loss, which is characterized by permanent erythrocyte withdrawal along with hemoglobin and the ferrous iron contained in this chromoprotein, low bleeding rate and small amounts of loss: uterine (prolonged menses due to ovarian dysfunction, uterine fibroids, endometriosis), gastrointestinal, pulmonary, nasal gingival bleeding;
Obviously, iron deficiency anemia is most of all a “female” disease, as it often develops due to uterine bleeding or frequent delivery, as well as a “teenage” problem, which is created by intensive growth and rapid sexual development (in girls during puberty). A separate group consists of children, iron deficiency of which was noticed before the year of life.
At first, the body still manages
During the formation of iron deficiency states of great importance is the speed of development of the process, the stage of the disease and the degree of compensation, After all, IDA has different causes and may come from another disease (for example, recurrent bleeding with a stomach or duodenal ulcer, gynecological pathology, or chronic infections). Stages of the pathological process:
- Hidden (latent) deficit in a flash does not go into IDA. But in the blood test it is already possible to detect the deficiency of the element, if we examine the serum iron, although the hemoglobin will still be within normal limits.
- Clinical manifestations are characteristic of tissue sideropenic syndrome: gastrointestinal disorders, trophic changes of the skin and derivatives (hair, nails, sebaceous and sweat glands);
- With the depletion of own reserves of the IDA element can be determined by the level of hemoglobin – it begins to fall.
Depending on the depth of iron deficiency are distinguished 3 degrees of severity:
- Easy – hemoglobin values are in the range of 110 – 90 g / l;
- Medium – Hb content ranges from 90 to 70 g / l;
- Heavy – hemoglobin level drops below 70 g / l.
A person begins to feel ill already at the stage of latent deficiency, but the symptoms will become clearly visible only with sideropenic syndrome. Before the appearance of the clinical picture of iron deficiency anemia, it will take another 8 to 10 years to complete, and only then a person who has little interest in his health learns that he has anemia, that is, when hemoglobin decreases markedly.
How does iron deficiency manifest?
The clinical picture at the first stage usually does not manifest itself, the latent (latent) period of the disease gives insignificant changes (mainly due to oxygen starvation of the tissues), which have not yet identified any clear symptoms. Circulatory-hypoxic syndrome: weakness, tachycardia during physical exertion, sometimes ringing in the ears, cardialgia – many people present similar complaints. But very few people would think of taking a biochemical blood test, where among the other indicators will be serum iron. And yet at this stage one can suspect the development of IDA if there are problems with the stomach:
- The desire to eat food disappears, the person does it rather out of habit;
- Taste and appetite become perverted: I want to try tooth powder, clay, chalk, flour instead of normal food;
- There are difficulties with swallowing food and some vague and incomprehensible sensations of discomfort in the epigastrium.
- Body temperature may rise to subfebrile values.
Due to the fact that in the initial stage of the disease, the symptoms may be absent or weakly manifest, in most cases, people do not pay attention to them until the development of sideropenic syndrome. Is it possible that on any medical examination a decrease in hemoglobin is found and the doctor will begin to clarify the history?
The signs of sideropenic syndrome already suggest that there is an iron deficiency, as the clinical picture begins to acquire characteristic for IDA color. The skin and its derivatives are the first to suffer, a little later, due to constant hypoxia, the internal organs are involved in the pathological process:
- The skin is dry, peel off on the hands and feet;
- Layered nails – flat and dull;
- Bits in the corners of the mouth, cracks in the lips;
- Drooling at night;
- Hair split, grow poorly, lose their natural shine;
- The tongue hurts, wrinkles appear on it;
- The slightest scratches heal with difficulty;
- Low body resistance to infectious and other adverse factors;
- Muscle weakness;
- Weakness of the physiological sphincters (urinary incontinence during laughter, coughing, straining);
- Nest atrophy along the esophagus and stomach (esophagoscopy, fibrogastroduodenoscopy – FGDS);
- Imperative (sudden desire, which is difficult to contain) urge to urinate;
- Bad mood;
- Intolerance of stuffy rooms;
- Drowsiness, lethargy, swelling of the face.
Such a course can last up to 10 years, the treatment of iron deficiency anemia from time to time can slightly raise hemoglobin, from which the patient calms down for a while. Meanwhile, the deficit continues to deepen, if you do not affect the root cause and gives a more pronounced clinic: all of the above symptoms + severe shortness of breath, muscle weakness, constant tachycardia, reduced working capacity.
Iron deficiency anemia in children and pregnant women
IDA in children up to 2–3 years of age occurs 4–5 times more often than other deficient states. As a rule, it is caused by nutritional deficiency, where improper feeding, unbalanced nutrition for the baby leads not only to the lack of this chemical element, but also to a decrease in the components of the protein-vitamin complex.
In children, iron deficiency anemia often has a latent (latent) course, reducing the number of cases by the third year of life by a factor of 2-3.
Iron deficiency is most susceptible to premature babies, babies from twins or triplets, babies with greater weight and height at birth, and rapidly gaining weight in the first months of life. Artificial feeding, frequent colds, a tendency to diarrhea – also belong to the factors that contribute to the reduction of this element in the body.
How will IDA in children – depends on the degree of anemia and compensatory opportunities child’s body. The severity of the condition is determined, basically, not by the Hb level – to a greater extent it depends on the speed of the fall of hemoglobin. Without treatment, iron deficiency anemia with good adaptation can last for years without manifesting significant impairment.
Reference signs in the diagnosis of iron deficiency in children can be considered: pallor of mucous membranes, waxy color of auricles, dystrophic changes of false covers and skin derivatives, indifference to food. Symptoms such as weight loss, growth retardation, subfebrile, frequent colds, enlargement of the liver and spleen, stomatitis, syncope can also be present during IDA, but are not obligatory for it.
In women, iron deficiency anemia poses the greatest danger during pregnancy: mainly for the fetus. If the poor state of health of a pregnant woman is caused by oxygen starvation of tissues, then one can imagine what kind of suffering the organs have and, above all, the child’s central nervous system (fetal hypoxia). In addition, during IDA in women waiting for the birth of the baby, there is a high probability of the onset of preterm birth and a high risk of developing infectious complications in the postpartum period.
Diagnostic cause search
Bearing in mind the patient’s complaints and information about a decrease in hemoglobin in history, IDA can only be assumed, therefore:
- The first stage of the diagnostic search will be the proof that the body actually has a lack of this chemical element, which is the cause of anemia;
- The next stage of diagnosis is the search for diseases that have become prerequisites for the development of an iron deficiency state (causes of deficiency).
The first stage of diagnosis, as a rule, is based on carrying out various additional laboratory tests (except for the hemoglobin level) proving that the body lacks iron:
- Complete blood count (UAC): low Hb level – anemia, an increase in the number of red blood cells that have an unnaturally small size, with a normal number of erythrocytes – microcytosis, a decrease in color index – hypochromia, the content of reticulocytes is likely to be elevated, although it may not move away from normal values;
- Serum iron, the rate of which in men is in the range of 13–30 µmol / l, in women from 11 to 30 µmol / l (during IDA, these figures will decrease);
- Total iron binding capacity (OZHSS) or total transferrin (the norm is 27 – 40 µmol / l, with IDA – the level increases);
- Transferrin saturation with iron with a deficiency of the element decreases below 25%;
- Serum ferritin (reserve protein) in iron-deficient conditions in men becomes lower than 30 ng / ml, in women – lower than 10 ng / ml, which indicates the depletion of iron stores.
If in the patient’s body, with the help of tests, iron deficiency was identified, then the next step will be to find the reasons for this deficiency:
- History taking (perhaps a person is a staunch vegetarian or too long and unwisely diets for weight loss);
- It can be assumed that there is bleeding in the body, which the patient does not guess or knows, but does not attach much importance to it. In order to detect the problem and fix the status of the cause for it, the patient will be asked to undergo a mass of various examinations: FGDs, rector and colonoscopy, bronchoscopy, a woman will be sent to a gynecologist. There is no certainty that even these, by the way, rather unpleasant procedures will clarify the situation, but it will be necessary to search until a source of heavy disappointments is found.
These stages of diagnosis, the patient must go to the appointment of ferrotherapy. Treatment of iron deficiency anemia is not performed at random.
Make iron stay in the body
In order to make the impact on the disease rational and effective, one should adhere to the basic principles of treatment of iron deficiency anemia:
- It is impossible to stop iron deficiency anemia only by nutrition without the use of iron preparations (limited absorption of Fe in the stomach);
- It is necessary to observe the sequence of treatment consisting of 2 stages: the first is the relief of anemia, which takes 1–1.5 months (the hemoglobin level rises from the 3rd week), and the 2nd, designed to replenish the Fe depot (it will continue) 2 months);
- Normalization of hemoglobin does not mean the end of treatment – the whole course should last 3 to 4 months.
At the first stage (5–8 day) of treating iron deficiency anemia, to find out that the drug and its doses are chosen correctly, the so-called reticulocyte crisis will help – a significant increase (20–50 times) in the number of young forms of erythrocytes (reticulocytes – normal: about 1% ).
When prescribing iron preparations for per os intake (through the mouth), it is important to remember that only 20–30% of the accepted dose will be absorbed, the rest will be excreted through the intestine, therefore, the dose must be calculated correctly.
Ferrotherapy must be combined with a diet rich in vitamins and protein. Nutrition of the patient should include lean meats (veal, beef, hot lamb), fish, buckwheat, citrus fruits, apples. Ascorbic acid in a dose of 0.3 – 0.5 g per reception, antioxidant complex, vitamins A, B, E, the doctor usually prescribes separately in addition to ferrotherapy.
Iron preparations differ from other medicines by special rules of administration:
- Ferrum-containing short-acting drugs are not consumed immediately before and during meals. The medicine is taken 15 to 20 minutes after a meal or in a pause between doses, prolonged medications (ferrogradmet, ferograd, tardiferron-retard, sorbifer-durules) can be taken before meals and overnight (1 time per day);
- Iron preparations are not washed down with milk and milk-based drinks (kefir, ryazhenka, yogurt) – they contain calcium, which will inhibit iron absorption;
- Tablets (with the exception of chewing), pills and capsules are not chewed, swallowed whole and washed down with plenty of water, broth hips or clarified juice without pulp.
Small children (under 3 years old) should preferably be given iron supplements in drops, slightly older (3–6 years) in syrups, and children over 6 years old and adolescents are well “taken” to chewable tablets.
The most common iron supplements
Currently, the attention of doctors and patients presents a wide selection of drugs that increase the iron content in the body. They are available in various pharmaceutical forms, so their ingestion does not cause any special problems even with the treatment of iron deficiency anemia in young children. The most effective drugs to increase the concentration of iron include:
- Ferrum Lek;
- Ferroceron; (paints urine pink);
The list of ferrum-containing drugs is not a guide to action; prescribing and calculating the dose is the business of the attending physician. Therapeutic doses are prescribed until the hemoglobin level is normalized, then the patient is transferred to prophylactic doses.
Preparations for parenteral administration are prescribed in violation of iron absorption in the gastrointestinal tract (gastrectomy, gastric ulcer and duodenal ulcer in the acute phase, resection of large areas of the small intestine).
When prescribing drugs for intravenous and intramuscular administration, first of all you should remember about allergic reactions (feeling of heat, palpitations, pain behind the sternum, lower back and calf muscles, metallic taste in the mouth) and possible development of anaphylactic shock.
Preparations for parenteral use in the treatment of iron deficiency anemia are prescribed only if there is complete certainty that this is IDA, and not another form of anemia, in which they may be contraindicated.
The indications for blood transfusion in IDA are very limited (Hb is below 50 g / l, but surgery or delivery is pending, oral intolerance and allergy to parenteral therapy). Transfused only thrice washed red cell mass!
In the area of special attention, of course, are small children and pregnant women.
Pediatricians consider nutrition to be the most important event for warning IDA in children under one year old: breastfeeding, iron-fortified mixtures (“artificials”), fruit and meat foods.
source products of iron for a healthy person
As for pregnant women, even with a normal level of hemoglobin in the last two months before delivery, they should take iron supplements.
Female fertile age should not forget about the prevention of IDA in the early spring and 4 weeks devote ferrotherapy.
If there are signs of tissue deficiency, without waiting for the development of anemia, preventive measures will be useful for other people to take (get 40 mg of iron per day for two months). In addition to pregnant women and nursing mothers, blood donors, adolescent girls, and people of both sexes who are actively involved in sports have resorted to such prevention.