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Clinic of iron deficiency anemia



The development of iron deficiency in the body has a clear staging. The following consistently developing stages of iron deficiency are distinguished:

• Preferred iron deficiency,

• latent iron deficiency,

• Iron-deficiency anemia.

Prelactive iron deficiency is the first stage of development of the iron deficiency state, characterized by depletion of iron reserves in the bone marrow and liver. The patient has no symptoms, indicators of the transport fund of iron and hemoglobin level remain within the age limits. Serum ferritin levels and iron in the bone marrow are reduced.

Latent iron deficiency (LAD) is the second stage of the iron deficiency state, characterized by iron deficiency in tissue depots and a decrease in its transport fund without reducing hemoglobin and developing anemia. Clinically, the LJ has no strictly delineated and specific pattern. Manifested in the form of morning headaches, loss of appetite, increased fatigue, emotional lability, tearfulness, reduced ability for long-term concentration of attention and mental activity, decrease in school performance, increased susceptibility to infections.

Paraclinical data from LJD are characterized by a decrease in serum ferritin level, changes in the iron transport fund parameters (decrease in serum iron, increase in serum total iron-binding capacity, decrease in transferrin saturation coefficient), with a normal hemoglobin level. The average content (MCH) and average concentration (MCHC) of hemoglobin in red blood cells are within the normal range.

Hidden iron deficiency is found not only in childhood, but can also develop in adolescents and young women. This circumstance is a strong argument in favor of the need to eliminate iron deficiency, even if it has a latent, benign character.

Iron deficiency anemia is the final, clinically manifest stage of iron deficiency.

IDA is a pathological condition characterized by a decrease in hemoglobin content due to iron deficiency in the body as a result of a violation of its supply, absorption, or pathological losses.

For the first time, the clinical picture of IDA was described by a German doctor Johann Lange in 1554 for a girl: “weak, pale,” heart fluttering, dyspnea when climbing stairs or when dancing are taking place. From 1615, the term “chlorosis” was used to state the greenish hue of pallor of the skin. In 1813, Lamery and Geoffroy established that iron is part of the blood, and in 1832 showed that the cause of chlorosis is iron deficiency in the body.

Clinical manifestations of IDA have age-related features and are characterized by two main syndromes: anemic and sideropenic.

Anemic syndrome is caused by insufficient supply of oxygen to tissues and is manifested by pallor of the skin and mucous membranes, decreased appetite, weakness, increased physical and mental fatigue, decreased performance, cardiovascular disorders (dizziness, tinnitus, muffled tones, systolic murmur during auscultation of the heart).

Sideropenic syndrome is caused by the presence of tissue deficiency of iron and suppression of redox processes in the cells of almost all organs and systems due to the deficiency of ferro-dependent and ferro-containing enzymes. It includes epithelial changes, taste and smell distortion, astheno-vegetative disorders, intestinal absorption disorders, dysphagia and dyspeptic changes, decreased local immunity (increased incidence of acute intestinal and respiratory infections).

Sideropenic symptoms related to changes in the skin, nails, hair, have long been used by doctors as clinical signs of assessing the depletion of the body with iron. These include: dryness, peeling of the skin; cracks in the ends of the fingers and toes; brittleness, sometimes hair loss. The nails usually lose their luster, become dull, thinned, exfoliate, flattened, with distinct transverse striation. At the same time, koilonikhia (spoon-like nails) in young children are not detected at all.

The perversion of taste, smell and appetite is observed in every third child with iron deficiency after 3 years of age.
So, children enjoy the smell of kerosene, gasoline, soap, exhaust gases. They prefer to eat spicy, salty, acidic foods, sometimes they have an overwhelming attraction to dry cereals and pasta, to inedible substances - chalk, clay, earth, starch (pikatsizm). Sometimes there is a predilection for the cold (pagophagy) - they eat snow and ice. These peculiar changes characteristic of iron deficiency are known as pica chlorotica and are mainly found in children and adolescents.

Sideropenic encephalopathy, depending on the age of children, is manifested by depletion of the emotional sphere, mental and motor development delay, slower reaction in game situations, emotional lability, tearfulness, negativism, bad mood, episodes of low blood pressure, weakening of all types of memory and cognitive ability, decrease progress, the development of astheno-vegetative syndrome.

Sideropenic dysphagia (Plummer-Vinson syndrome), is clinically manifested by difficulty in swallowing dry and dense food, a feeling of food getting stuck in the throat. The morphological substrate of these disorders are dystrophic changes of the mucous membrane and muscular layer of the esophagus.

Changes in the oral cavity, which can be attributed to sideropenic, relate to the mucous membrane of the cheeks, gums, tongue and teeth. There are dry mouth, decreased taste, tingling of the tip of the tongue. Often there are glossitis, gingivitis, and angular stomatitis (“sparrow mouth”) - painful cracks in the corners of the mouth. Dystrophic changes of the tongue are characteristic - atrophy of the filamentous and mushroom papillae (“lacquerous tongue”), aphthous phenomena up to the typical polished tongue (“günther's” glossitis). The teeth of the patient are prone to caries as a result of metabolic disorders in the enamel.

Muscular hypotonia is sometimes so significant that neuropathologists often regard it as a miatonic syndrome.

Changes in the urinary system may manifest inability to maintain urine for a long time, and its incontinence is provoked by laughter, crying or coughing. Nocturnal incontinence may occur.

The severity of sideropenic symptoms, changes in cardiovascular (anemic myocardial dystrophy) and digestive (up to the development of atrophic gastritis) systems increase with age, while deviations from the nervous system, tendency to fainting and arterial hypotension, fever, pica chlorotica are observed more often in children of the younger age group.

It should be borne in mind that with mild IDA clinical manifestations are minimal and are often seen by pediatricians and parents. Due to the fact that the development of an iron deficiency state occurs in stages, slowly, children are usually well adapted to their condition, parents also get used to minor deviations in the health status of their children. Therefore, at the slightest suspicion of the possibility of developing anemia in a child, it is very important to conduct a clinical blood test in a timely manner, if only for a study of hemoglobin level.

A special place among IDA takes the so-called juvenile chlorosis - a rare disease of girls in the period of puberty, which develops against the background of the violation of the regime and endocrine dysfunction. The disease is manifested by weakness, fatigue, anorexia, pica chlorotica, dizziness, fainting, epigastric pain, nausea, vomiting, and constipation. Characterized by "alabaster", with a greenish tinge, pale skin, menstrual disorders (oligo-or amenorrhea). Recovery often spontaneous, possible relapses.

This is how the N.F. chlorosis clinic described. Filatov: “Among the characteristic features of this suffering is, among other things, the fact that it develops almost exclusively in girls during the period of sexual development. A further feature of this form of anemia is in its benign course, propensity for returns and its compliance with iron treatment. It is also remarkable that various nervous influences sometimes play a significant role in the etiology of chlorosis. Blood changes are characterized mainly by a significant decrease in hemoglobin with an almost normal number of red blood cells. ”

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Clinic of iron deficiency anemia

  1. Iron deficiency anemia
    Iron deficiency anemia (IDA) is a clinical and hematological syndrome, based on a violation of hemoglobin synthesis due to iron deficiency. IDA is the most common anemic syndrome and accounts for approximately 80% of all anemias. According to WHO, the number of people suffering from iron deficiency reaches 200 million people. Most often, IDA is detected in young children,
  2. Laboratory criteria for the diagnosis of iron deficiency anemia
    Diagnosis of IDA is based on the establishment of laboratory signs of anemia itself and iron deficiency in the body. Iron deficiency anemia is hypochromic, microcytic anemia. During the analysis of peripheral blood on a hematology analyzer, the following disorders are noted in IDA: • a decrease in hemoglobin of less than 110 g / l to 6 years, less than 120 g / l over 6 years, • a decrease in average
  3. IRON DEFICIENCY ANEMIA
    Iron deficiency anemia is the most common type of anemia (more than 80% of all forms), caused by a deficiency of serum iron, bone marrow and depot, which leads to trophic disorders in the tissues. Normally, the iron content in the plasma is 14-32 µmol / l. The lack of iron in the blood plasma is sideropenia, the lack of it in the tissues is called hyposiderosis. Depletion of tissue
  4. IRON DEFICIENCY ANEMIA
    The group of iron deficiency anemia combines numerous, different etiologies of anemic syndromes, the main pathogenetic factor of which is the lack of iron in the body (sideropenia, hyposiderosis). Hyposiderosis in the broad sense of the word means not only anemia on the basis of impaired hemoglobin formation. Depletion of tissue reserves of iron leads to frustration
  5. SYMPTOMATIC IRON DEFICIENCY ANEMIA, CHLORANEMIA
    Symptomatic iron deficiency anemia develops against the background of a specific etiologic factor: chronic enteritis, chronic nephritis (hloranemiya "braytikov"), in relation to gastric resection (agastricheskaya hloranemiya), occult blood loss (with hiatal hernia, "hernial" disease), malignant neoplasms ( cancrosis hyposiderosis), chronic infection
  6. Prevention of iron deficiency anemia
    Prevention of iron deficiency in children and adolescents is a very urgent problem of pediatrics, especially in the first year of life. It is very important to raise the awareness of pediatricians and parents about possible latent iron deficiency in order to guarantee the earliest possible start of treatment in all children. Targeted and effective prevention of IDA
  7. Treatment of iron deficiency anemia
    The goal of treatment of iron deficiency is to eliminate iron deficiency and restore its reserves in the body. Etiological treatment involves the elimination of causes leading to the development of iron deficiency. Mode. An important link in the treatment of IDA is the proper organization of the regime and nutrition. An effective treatment and preventive measure is a long stay in the fresh air. Children
  8. Treatment of iron deficiency anemia
    Treatment of IDA should be comprehensive. Etiological treatment involves the elimination of causes leading to the development of iron deficiency. Regime The important links in complex therapy are proper organization of the regimen and nutrition. An effective treatment and preventive measure is a long stay in the fresh air. Children need sparing mode: physical exercise restriction,
  9. Prevention of iron deficiency anemia
    Antenatal prophylaxis of IDA is reduced to the observance of the correct mode and nutrition of the pregnant woman, measures against premature birth, elimination of toxicosis, timely detection and treatment of anemia in pregnant women. Iron preparations are prescribed to women from risk groups: ¦ women of reproductive age who suffer from heavy and prolonged menstrual blood loss; ¦ staffing
  10. Risk factors for iron deficiency anemia and contraindications for pregnancy
    Prevention of anemia is primarily necessary for pregnant women with a high risk of its development. The following main etiological factors for the development of iron deficiency anemia are distinguished. 1. Alimentary factor: • reduction of iron intake in the body with food (veggie diet, anorexia). 2. Burdened somatic history: • chronic diseases of internal organs (rheumatism, heart defects,
  11. The role of the nutritional factor in the development of iron deficiency anemia
    Nutritional disorders occupy an important place among the causes of iron deficiency anemia. These disorders can lead to a decrease in iron intake in the child’s body, a breakdown in iron absorption, or an increase in its elimination from the body. When considering the issue of iron intake with food in the body of children, a separate analysis is necessary in children who are on the chest and artificial
  12. Iron deficiency anemia and methods of their prevention
    Health so far outweighs all the other benefits of life, that a truly healthy beggar is happier than a sick king. Arthur Schopenhauer. Anemia. Hemoglobin. Erythrocytes. Iron exchange. Iron rich foods. Anemia (from the Greek. An + haima - lack of + blood) or anemia - a pathological condition of the body, which reduces the amount of hemoglobin per unit volume of blood, which
  13. ANEMIA UNDER CONDITIONS OF FUNCTIONAL AGASTRY (AGASTRAL ANEMIA)
    In contrast to the actual agastric anemia associated with partial or complete anatomical removal of the stomach, we distinguish anemia that develops in conditions of functional agastria, when the anatomically preserved stomach partially or completely turns off from the physiological process of digestion and, in particular, loses the ability to assimilate the external antianemic factor - Vitamin B12.
  14. ANEMIA DUE TO TOXIC EXPOSURE OF THE BONE MARROW (MYETHOXICAL ANEMIA)
    THYROORTHEUS ANEMIA Thyroid stimulation anemia is anemia that develops on the basis of hypothyroidism. Experimental work confirms the important role of thyroid hormone - thyroxin - in stimulating normal blood formation. Animals deprived of the thyroid gland, quickly anemiziruyutsya, the introduction of the same thyroid drugs to thyroidectomized animals cures them from the effects of thyroid-induced
  15. Anemia associated with impaired synthesis of DNA and RNA (megaloblastic anemia)
    Megaloblastic anemia unites a group of acquired and hereditary anemias, a common feature of which is the presence of megaloblasts in the bone marrow. Regardless of the etiology of the patients, hyperchromic anemia with characteristic changes in the erythrocyte morphology is revealed - oval red blood cells, large (up to 12-14 microns or more). There are red blood cells with basophilic cytoplasm, in many of
  16. Anemia associated with impaired synthesis or utilization of porphyrins (sideroachrestic, sideroblastic anemia)
    This is a heterogeneous group of diseases, hereditary and acquired, associated with a violation of the activity of enzymes involved in the synthesis of porphyrins and heme. The term "sideroahresticheskaya anemia" was introduced by Iewer (1957). In case of sideroachrestric anemia, serum iron levels are elevated. In the bone marrow detect ring-shaped sideroblasts - nucleated red blood cells with a nucleolus corolla,
  17. IRON-DEFICIENCY ANEMIA
    Normally, the content of hemoglobin and red blood cells is: - in men: red blood cells 4.5 million hemoglobin 140 g / l; - in women: red blood cells 4.2 million hemoglobin 120 g / l. Iron reserves in the body are 6-8 g, of which 3 g are part of hemoglobin, 2 g are part of myoglobin and cytochromes, 0.8 g (0.4 g for women) - in the depot in the form of ferritin and hemosiderin. Iron-deficiency anemia -
  18. Anemia due to bone marrow drainage, hypothyroidism, and aplastic anemia. MYELOPLASTIC SYNDROME
    Despite the large number of studies devoted to the study of hypo-and aplastic anemias, it is still not possible to create a rational classification of these conditions, since not only the issues of pathomorphogenesis, but even the definition of the very concept of "hypo (a) plastic anemia" is debatable. In accordance with modern concepts of the genesis of hypo- and
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