Anemia: which doctor to contact. Symptoms and treatment of anemia

Chronic lack of iron in the body occurs due to iron deficiency and is characterized by impaired synthesis of hemoglobin, which is contained in red blood cells. The human body receives its first reserves of iron from the mother through the placenta; after birth, iron is replenished through food intake or iron-containing medications. Iron is removed from the body by the urinary and digestive systems, sweat glands and during menstruation in women. About 2 grams of iron are excreted per day, so in order to prevent depletion of reserves, it must be constantly replenished. According to WHO, every 3rd woman and every 6th man in the world suffers from iron deficiency anemia. Pregnant women, children under 3 years of age and teenage girls are at risk.

Causes of iron deficiency anemia (IDA)

insufficient intake of iron from food: fasting, vegetarianism, or a diet depleted in iron and protein, followed for a long time. In breastfed children, the cause may be iron deficiency anemia of the mother, early transfer to artificial feeding, late introduction of complementary foods
impaired iron absorption: enteritis (inflammation of the mucous membrane of the small intestine caused by infection or helminthic infestation), gastritis and peptic ulcer of the stomach and duodenum; hereditary diseases (cystic fibrosis and celiac disease); autoimmune damage to the intestinal mucosa and possibly the stomach (Crohn's disease); condition after removal of the stomach and/or duodenum; stomach and intestinal cancer
chronic blood loss. This is the most basic reason. This includes losses due to: gastric and duodenal ulcers, nonspecific ulcerative colitis, Crohn's disease, hemorrhoids and anal fissures, intestinal polyposis, bleeding from disintegrating tumors of any location and varicose veins of the esophagus; hemorrhagic vasculitis; pulmonary hemorrhages, pulmonary hemosiderosis; chronic pyelonephritis, polycystic disease and cancer of the kidneys and bladder; losses during hemodialysis; uterine fibroids, endometriosis, hyperpolymenorrhea, cervical cancer; nosebleeds
congenital deficiency of iron in the body (prematurity, birth from multiple pregnancy, severe iron deficiency anemia in the mother, pathological bleeding during pregnancy and childbirth, fetoplacental insufficiency)
alcoholism (the mucous membrane of the stomach and intestines is damaged, making it difficult to absorb iron)
use of medications: non-steroidal anti-inflammatory drugs (diclofenac, ibuprofen, aspirin) reduce blood viscosity and can promote bleeding, in addition, these drugs can provoke the occurrence of stomach and duodenal ulcers; antacids (Almagel, Gastal, Rennie) reduce the production of hydrochloric acid, which is necessary for effective absorption of iron; iron-binding drugs (desferal), these drugs bind and remove free iron and iron in ferritin and transferrin, and in case of overdose can lead to iron deficiency states
donation (with donations more than 4 times a year, iron deficiency develops)
disruption of transferrin synthesis. Transferrin is an iron transport protein that is synthesized in the liver.

Normal hemoglobin level in the blood: in women – 120-140 g/l, in men – 130-160 g/l

Sources

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Clinical manifestations of IDA

Anemic syndrome - occurs due to a decrease in the level of red blood cells and hemoglobin in the blood, reducing the saturation of cells and tissues with oxygen. The signs of anemic syndrome are difficult to recognize, but they help to suspect the presence of anemia and, in combination with the data of other examinations, make a diagnosis. These are general weakness, high fatigue and decreased performance, dizziness, tinnitus and flashing “spots” before the eyes, periodic palpitations, shortness of breath with little physical exertion, and fainting. Upon examination, pallor of the skin and visible mucous membranes, slight swelling of the legs, feet, face (mainly the area around the eyes), tachycardia, various types of arrhythmia, moderate heart murmurs, and muffled heart sounds are revealed.

Sideropenic syndrome - caused by iron deficiency in tissues, which causes a decrease in the activity of many enzymes (protein substances that regulate many vital functions), manifested by numerous symptoms:

change in taste (desire to eat unusual foods: sand, chalk, clay, tooth powder, ice, as well as raw minced meat, unbaked dough, dry cereals)
tendency to eat hot, salty, spicy foods
distortion of the sense of smell (attracted by the smell of gasoline, acetone, the smell of varnishes, paints, lime)
decreased muscle strength and atrophy
dry, flaky skin; fragility and hair loss; dullness, transverse striations, spoon-shaped concavity of nails; Minor injuries and abrasions do not heal for a long time
dryness and cracks in the corners of the mouth in 10-15% of patients
feeling of tongue fullness, redness and atrophy, frequent periodontal disease and caries
dryness of the esophageal mucosa, which causes pain when swallowing and difficulty swallowing solid food, the development of atrophic gastritis and enteritis
urgency to urinate, inability to hold urine when coughing, laughing, sneezing, episodes of bedwetting
the symptom of “blue sclera” is characterized by a bluish coloration of the sclera
prolonged increase in body temperature to subfebrile levels (37.0-37.9°C) for no apparent reason
frequent ARVI

Diagnosis of IDA

clinical blood test: decreased level of hemoglobin, red blood cells, decreased hemoglobin content in one red blood cell, often increased ESR
biochemical blood test: decrease in serum iron level, increase in total iron-binding capacity of serum, decrease in ferritin content in blood serum

If an iron deficiency is detected in the patient’s body using tests, then the next step will be to search for the causes of this deficiency. To identify the cause of iron deficiency, a comprehensive examination is carried out, including esophagogastroduodenoscopy, sigmoidoscopy, colonoscopy, bronchoscopy, chest x-ray, ultrasound examination of the abdominal organs, pelvis and kidneys, examination by a gynecologist, urologist, hematologist, stool analysis for occult blood and eggs. helminths, as well as examination of red bone marrow from the sternum or ilium (sternal puncture, trephine biopsy).

Iron metabolism

It is known that iron is an important trace element, which is used mainly as a component of heme in erythrocytes for oxygen transport, and is present in smaller quantities in muscles in the form of heme-myoglobin and in the liver in the form of ferritin [10]. Its sufficient level is necessary to maintain physiological homeostasis [11]. However, excess iron levels can lead to cell death through the formation of free radicals and lipid peroxidation of biological membranes, toxic damage to proteins and nucleic acids. It is important that both iron deficiency and overload can have catastrophic consequences for the body, therefore the content of this microelement is strictly regulated [7, 9, 12–14].

The body of a healthy person contains about 3–5 g of iron, most of which, 2100 mg, is found in blood cells and bone marrow. Approximately 2.5 g of this iron is present in hemoglobin for oxygen transport, and another 2 g is stored as ferritin, mainly in the bone marrow, liver and spleen [9]. In the bone marrow, iron is used to form hemoglobin, liver iron is the main reserve of the microelement, and reticuloendothelial cells of the spleen remove old red blood cells. Finally, relatively small amounts of iron (approximately 400 mg) are present in cellular proteins such as myoglobin and cytochromes, and approximately 3–4 mg is bound to transferrin in the circulation [10, 15]. Almost all metabolically active iron is bound to proteins, and free iron ions can be present in extremely low concentrations.

Under natural conditions, no more than 0.05% (<2.5 mg) of the total amount of iron is lost daily due to exfoliating epithelium of the skin and gastrointestinal tract (GIT), as a result of sweating [12, 13, 16, 17]. The processes of absorption, recycling and storage of iron reserves are regulated by a special hormone - hepcidin, which is produced by liver cells. Under physiological conditions, hepcidin production is controlled by a complex interaction of signals, primarily the level of iron in the blood and the degree of oxygenation of liver tissue. Under pathological conditions, its production is regulated by proinflammatory cytokines, of which interleukin-6 plays a major role [7, 12, 13, 18].

Iron deficiency is detected in people of all age and social groups, but more often in women of reproductive age, young children and the elderly [5, 6]. The main reasons for the development of iron deficiency include decreased food intake, decreased absorption and blood loss. In developed, resource-rich countries, adult diets are almost always adequate, and the most common cause of iron deficiency is blood loss [2, 6].

Complications of IDA

Complications arise with prolonged anemia without treatment and reduce the patient’s quality of life: decreased immunity, increased heart rate, which leads to heart failure; in pregnant women, the risk of premature birth and fetal growth retardation increases; in children, iron deficiency causes retarded growth and development; a rare and severe complication is hypoxic coma; hypoxia due to iron deficiency complicates the course of existing cardiopulmonary diseases (coronary artery disease, bronchial asthma, chronic cerebral ischemia, etc.) until the development of emergency conditions, such as acute or repeated myocardial infarction and acute cerebrovascular accident (stroke).

Treatment of IDA

The basic principles of treatment for iron deficiency anemia include eliminating the cause of iron deficiency, correcting the diet, and replenishing iron deficiency in the body.

The diet for iron deficiency anemia consists of eating foods rich in iron. Patients are advised to have a nutritious diet with the obligatory inclusion in the diet of foods containing heme iron (veal, beef, lamb, rabbit meat, liver, tongue). Plant foods rich in iron include beans, beans, lentils, peas, spinach, cauliflower, potatoes, carrots, beets, bananas, apricots, peaches, apples, blueberries, raspberries, strawberries, almonds and walnuts. It should be remembered that ascorbic acid, which is found in bell peppers, cabbage, rose hips, currants, citrus fruits, sorrel, enhances the absorption of iron in the gastrointestinal tract, and oxalates and polyphenols (coffee, tea, soy protein, milk, chocolate) worsen the absorption of iron. calcium, dietary fiber and other substances. However, no matter how much meat we eat, only 2.5 mg of iron will enter the bloodstream per day - this is exactly how much the body can absorb. And 15-20 times more is absorbed from iron-containing complexes - that’s why the problem of anemia cannot always be solved with the help of diet alone, and therefore iron-containing drugs are prescribed
Oral iron supplements differ from other medications by special rules of administration: - short-acting iron-containing preparations are not taken immediately before or during meals. The medicine is taken 15-20 minutes after meals or in the pause between doses; prolonged medications (sorbifer durules, tardiferron-retard, etc.) can be taken before meals and at night (1-2 times a day); - iron supplements are not taken with milk and milk-based drinks (kefir, fermented baked milk, yogurt) - they contain calcium, which will inhibit the absorption of iron - tablets (except for chewable ones), dragees and capsules are not chewed, are swallowed whole and washed down with plenty of water, rosehip decoction or clarified juice without pulp Oral iron supplements (in tablets, drops, syrup, solution) are the initial treatment for mild to moderate anemia; if there is pregnancy, the intake is agreed with an obstetrician-gynecologist. The duration of treatment is 4–8 weeks until hemoglobin levels normalize, then the drug is taken for 4–6 weeks at half the dose. The most commonly prescribed: - sorbifer durules/fenuls 100 mg, 1-2 tablets 1-2 times a day until hemoglobin levels are restored (in pregnant women, for prevention, 1 tablet 1 time a day, for treatment, 1 tablet 2 times a day) - ferretab comp . 1 capsule per day, up to a maximum of 2-3 capsules per day in 2 divided doses, minimum period of use is 4 weeks - maltofer/actiferrin comes in three dosage forms (drops, syrup, tablets), intake 40-120 drops/10-30 ml syrup / 1-3 tablets per day in 1-2 doses - tardiferron 80 mg, 1-2 tablets per day, pregnant women 1 tablet per day, II-III trimester - totema (combined preparation of iron, copper and manganese) 2- 4 ampoules per day, solution diluted in 1 glass of water, taken for 3-6 months - ferlatum 15 ml 1-2 bottles per day in 2 divided doses
Injectable iron preparations (venofer, likfer, cosmofer, ferrinject) are used exclusively in the hospital (it is necessary to have the ability to provide anti-shock care), contraindicated during pregnancy and lactation
Hemotransfusion (transfusion of red blood cell-containing blood components) is performed in case of severe anemia, according to strict indications and in a hospital setting.

Absorption of iron in the body during anemia

The absorption of iron in the body worsens if it is taken simultaneously with tea, coffee, or milk. However, it is recommended to drink milk if nausea occurs after taking the pills. Calcium supplements and stomach medications also impair iron absorption.

If there is a choice, preference should be given to drugs in which iron is combined with ascorbic acid - it improves its absorption. You should not drink iron at the same time as zinc and copper, as they compete in the intestines for absorption.

According to recent studies, taking large doses of iron can reduce the body's resistance to bacterial infections. Therefore, treatment should be carried out under the supervision of a doctor.

Forecast and prevention of iron deficiency anemia

In most cases, iron deficiency anemia can be successfully corrected. However, if the cause is not addressed, iron deficiency may recur or progress. Iron deficiency anemia in infants and young children can cause delayed psychomotor and intellectual development.

In order to prevent iron deficiency anemia, annual monitoring of clinical blood test parameters, nutritious nutrition with sufficient iron content, and timely elimination of sources of blood loss in the body are necessary. Persons at risk may be advised to take prophylactic iron supplements.

Hidden anemia

Before iron deficiency anemia gives its first symptoms, it is in a hidden (latent) stage. During this period, the lack of iron is compensated by its reserves in the liver depot; this does not affect a person’s well-being in any way and the blood hemoglobin is within normal limits. Hidden anemia is most often discovered accidentally, after a blood test for ferritin. Many people remain in this stage of preanemia for years without knowing it.

An overt period of anemia occurs after iron stores have been completely depleted. Hemoglobin and the number of red blood cells in the blood decrease, and unpleasant symptoms appear.