Diseases

Depending on the degree of lack of hemoglobin in the body is divided into different degrees of severity. The most common of these are the first and second. The first degree is considered the easiest, since it causes minimal harm to health, but still significantly worsens the quality of life. Symptoms of the disease usually interfere with fully engaging in work activities, a person feels constantly tired, without any desire for active action. There is a general weakness. The hemoglobin level is 90 g/l and above.

Anemia 2nd degree

The disease of moderate severity has more pronounced symptoms and significantly worsens the general condition. Since the concentration of hemoglobin in the blood reaches only 70-90 g / l, there is an oxygen starvation of all organs, especially the brain. This is associated with constant malaise and frequent fainting. Treatment in this case, in addition to the correct diet, also involves the introduction of special drugs aimed at replenishing the missing component in the body. Other symptoms may include shortness of breath, palpitations, and headaches.

The disease occurs due to many factors. For example, due to insufficient consumption of certain foods in the diet, or the body itself is not able to produce the necessary cells. Anemia of the 1st degree, like the second, has the following causes:

• significant blood loss;
• insufficient production of red blood cells;
• iron deficiency;
• lack of folic acid;
• vitamin B12 deficiency.

Blood loss refers to the presence of diseases such as, or, which can cause it. It also includes difficult or multiple births, heavy menstruation. Sometimes the cause is chronic diseases and hemolysis.

If you feel weakness, malaise, dizziness for some time, which you cannot associate with anything, be sure to seek the advice of a specialist. With anemia of the 2nd degree, the development of a more complex form is possible, which in rare cases is not compatible with life. In this case, it will help:

The doctor will conduct an examination, listen to complaints, measure pressure and pulse. At the reception, he may ask:

1. How long ago did the symptoms start?
2. Do you sometimes feel dizzy?
3. Is there tinnitus?
4. Do heart pains bother you?
5. Do you have a good appetite?

If the doctor suspects you have anemia of the 1st degree or the second, he will send you for an additional blood test. It will show not only the level of hemoglobin in the blood, but also the size, number of red blood cells.

Treatment - healthy eating

Diet is the most effective treatment for mild forms of anemia. It involves increasing some food groups in the diet and excluding others. To increase the level of iron in the body, the diet without fail includes the following components.

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Anemia is a common disease affecting a quarter of the population. The symptoms depend on the stage, the easiest is anemia of the 1st degree, what it is, how to deal with it, the specialist will tell you after a detailed study of the tests and the general condition of the patient.

How and why is severity calculated?

It is quite difficult to establish the presence of pathology on your own; for this, it is necessary to undergo a diagnostic study. The reason for contacting a medical institution may be fatigue, constant fatigue after minor physical exertion. To make a diagnosis, you should pass a general and biochemical blood test, undergo a myelogram. These tests will help to establish the disease and determine the degree of anemia, since the complex of treatment will depend on these indicators.

The following data is taken into account:

• hemoglobin level (including the amount in individual red blood cells);
• color index;
• the level of iron in the blood serum;
• change in the shape and size of red blood cells.

Anemia and its severity in terms of hemoglobin levels entails a deterioration in the state of protein in the blood. The norm for an adult is 100-155 g / l, a decrease in this indicator to the lower limit or more is a sign of the disease.

How often do you take a blood test?

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Only by appointment of the attending physician 31%, 1742 vote

Once a year and I think it's enough 17%, 962 vote

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More than twice a year but less than six times 11%, 642 vote

I monitor my health and take it once a month 6%, 341 voice

I'm afraid of this procedure and try not to pass 4%, 237 votes

21.10.2019

The causes of the first, second or third degree of severity of anemia are:

• big blood loss;
• disturbed nutrition;
• changes in bowel function that interfere with the absorption of iron;
• the period of pregnancy and lactation (increased need for iron).

But the development of anemia is characteristic not only with a decrease in hemoglobin in the blood. Exists, varieties have both similarities and differences:

• B12-deficient and folate-deficient. Due to the lack of these substances, a slight itching appears in the upper and lower extremities, inflammation and burning of the tongue, the skin acquires a yellowish tint, appetite decreases, and the person becomes irritated.
• Iron deficiency. Most often, unpleasant symptoms occur after physical exertion. This is fatigue, shortness of breath, slight tachycardia, pallor of the skin, increased brittleness of nails, hair, etc.
• Aplastic. It appears against the background of an insufficient number of red blood cells in the bone marrow, therefore, the characteristic symptoms are frequent dizziness, general malaise, lack of air, heart palpitations, tinnitus, etc. With this disease, bruises easily remain on the skin, the risk of nosebleeds and bleeding gums increases.
• Hemolytic. Due to hereditary pathologies, there is an increased destruction of red blood cells, which lead to weakness, tachycardia, and mild pain in the left hypochondrium.
• Posthemorrhagic. Occurs after a large blood loss. The chronic form may be the result of a small bleeding with a stomach ulcer or during menstruation, as a result of which it passes into iron deficiency. It is accompanied by a decrease in working capacity, weakness, and the appearance of shortness of breath.

First mild degree

Mild anemia is quite difficult to determine visually, as a person looks healthy at first glance. Testing is required to make a diagnosis. The hemoglobin level is 90-110 g / l, and this indicator is more often characteristic only because of physical exertion.

Iron deficiency anemia (IDA) used to be better known as anemia (now this term is outdated and is used by our grandmothers out of habit). The name of the disease is clear indicates a deficiency in the body of such a chemical element as, the depletion of the reserves of which in the organs that deposit it, leads to a decrease in the production of an important for the body complex protein (chromoprotein) - (Hb), which is contained in red blood cells -. Such a property of hemoglobin as its high affinity for oxygen underlies the transport function of erythrocytes, which hemoglobin delivers oxygen to breathing tissues.

Although the erythrocytes themselves in the blood with iron deficiency anemia may be enough, but, circulating through the bloodstream "empty", they do not bring the main component to the tissues for breathing, which is why they begin to experience starvation (hypoxia).

Iron in the human body

Iron deficiency anemia (IDA) the most common form of all currently known anemia, which is due to a large number of causes and circumstances that can lead to iron deficiency, which will lead to various disorders that are unsafe for the body.

Iron (ferrum, Fe) is a very important element for ensuring the normal functioning of the human body.

In men (of average height and weight), it contains approximately 4 - 4.5 grams:

• 2.5 - 3.0 g is in the Hb heme;
• in tissues and parenchymal organs, from 1.0 to 1.5 g (approx. 30%) is deposited in reserve, this is a reserve - ferritin;
• and respiratory enzymes take on themselves 0.3 - 0.5 g;
• some proportion is present in ferrum-transporting proteins (transferrin).

Daily losses in males, of course, also take place: about 1.0-1.2 g of iron is lost through the intestines every day.

In women, the picture is somewhat different (and not only because of height and weight): their iron content is in the range of 2.6 - 3.2 g, only 0.3 g is deposited, and losses are not only daily through the intestines. Losing 2 ml of blood during menstruation, the female body loses 1 g of this important element, so it is clear why such a condition as iron deficiency anemia, more common in females.

In children, hemoglobin and its iron content change with age, however, in general, up to a year of life they are noticeably lower, and in children and adolescents up to 14 years of age 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 and a little along the small intestine. Ferrum does not enter into any interaction with the large intestine and does not react to it, therefore, once there, it transits and is excreted from the body. By the way, you don’t have to worry that by consuming a lot of iron with food, we can “overeat” it - a person has special mechanisms that will stop the absorption of excess iron in a timely manner.

iron metabolism in the body (scheme: myshared, Efremova S.A.)

Reasons, shortcomings, violations ...

In order for the reader to understand the important role of iron and hemoglobin, we will try, often using the words “cause”, “deficiency” and “violations”, to describe the relationship of various processes that constitute the essence of IDA:

erythrocyte and hemoglobin molecules

Thus, the cause of these disorders is iron deficiency and lack of it in the reserve (ferritin), which hinders the synthesis of heme and, accordingly, the production of hemoglobin. If the hemoglobin formed in the bone marrow is not enough to fill the young red blood cells, then the blood cells will have no choice but to leave the “birthplace” without it. However, circulating in the blood in such an inferior state, red blood cells will not be able to provide oxygen to the tissues, and they will experience starvation (hypoxia). And it all started with an 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 that can ensure the normal synthesis of heme and hemoglobin, or due to some circumstances, this chemical element is removed along with red blood cells and already formed hemoglobin, which occurs during bleeding.

Meanwhile, IDA should not be attributed acute posthemorrhagic anemia that occurs with massive blood loss (severe injuries, childbirth, criminal abortions and other conditions, the cause of which was mainly damage to large vessels). With a favorable set of circumstances, BCC (volume of circulating blood) will be restored, red blood cells and hemoglobin will rise and everything will fall into place.

The cause of iron deficiency anemia can be the following pathological conditions:

Obviously, iron deficiency anemia is most of all a “female” disease, since it often develops due to or frequent childbirth, as well as an “adolescent” problem that creates intensive growth and rapid sexual development (in girls in puberty). A separate group is made up of babies whose iron deficiency was noticed even before the age of one.

At first, the body still copes

In the formation of iron deficiency states the speed of development of the process, the stage of the course of the disease and the degree of compensation are of great importance, after all, IDA has different causes and can come from another disease (for example, repeated bleeding with a stomach or duodenal ulcer, gynecological pathology or chronic infections). Stages of the course of the pathological process:

1. Hidden (latent) deficiency does not turn into IDA in an instant. But in a blood test, it is already possible to detect a lack of an element if serum iron is examined, although hemoglobin will still be within normal values.
2. For tissue sideropenic syndrome, clinical manifestations are characteristic: gastrointestinal disorders, trophic changes in the skin and derivatives (hair, nails, sebaceous and sweat glands);
3. With the depletion of one's own reserves of the element, IDA can be determined by the level of hemoglobin - it begins to fall.

stages of development of IDA

Depending on the depth of iron deficiency, there are 3 severity levels of IDA:

• Light - hemoglobin values ​​​​are in the range of 110 - 90 g / l;
• Average - the content of Hb ranges from 90 to 70 g / l;
• Severe - the hemoglobin level falls below 70 g / l.

A person begins to feel bad 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 in full, it will take another 8-10 years, and only then a person who is little interested in his health will know that he has anemia, that is, when hemoglobin will noticeably decrease.

How does iron deficiency manifest itself?

The clinical picture at the first stage usually does not manifest itself, the latent (hidden) period of the disease gives minor changes (mainly due to oxygen starvation of tissues), which have not yet been identified with clear symptoms. Circulatory-hypoxic syndrome: weakness, with physical exertion, sometimes ringing in the ears, cardialgia - many people present with similar complaints. But few people would think of taking a biochemical blood test, where, among other indicators, serum iron will appear. And yet, at this stage, the development of IDA can be suspected if stomach problems appear:

1. The desire to eat food disappears, a person does it rather out of habit;
2. Taste and appetite become perverted: instead of normal food, you want to try tooth powder, clay, chalk, flour;
3. There are difficulties with swallowing food and some vague and incomprehensible sensations of discomfort in the epigastrium.
4. Body temperature may rise to subfebrile values.

Due to the fact that in the initial stage of the disease, symptoms may be absent or mild, in most cases people do not pay attention to them until the development of sideropenic syndrome. Is it possible that at some professional examination a decrease in hemoglobin will be found and the doctor will begin to ascertain the anamnesis?

Signs of sideropenic syndrome already give reason to assume an iron deficiency state, since the clinical picture begins to acquire a color characteristic of IDA. The skin and its derivatives suffer first, a little later, due to constant hypoxia, internal organs are involved in the pathological process:

• The skin is dry, flaky on the arms and legs;
• Exfoliating nails are flat and dull;
• Jamming in the corners of the mouth, cracks on the lips;
• Salivation at night;
• Hair splits, grows poorly, loses its natural shine;
• The tongue hurts, wrinkles appear on it;
• The slightest scratches heal with difficulty;
• Low resistance of the body to infectious and other adverse factors;
• Weakness in the muscles;
• Weakness of physiological sphincters (urinary incontinence when laughing, coughing, straining);
• Nested atrophy along the esophagus and stomach (esophagoscopy, fibrogastroduodenoscopy - FGDS);
• Imperative (sudden desire that is difficult to contain) urge to urinate;
• Bad mood;
• Intolerance to stuffy rooms;
• Drowsiness, lethargy, swelling of the face.

This 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 deficiency continues to deepen if the root cause is not affected and gives a more pronounced clinic: all of the above symptoms + severe shortness of breath, muscle weakness, constant tachycardia, decreased ability to work.

Iron deficiency anemia in children and pregnant women

IDA in children under 2-3 years of age is 4-5 times more common than other deficient conditions. As a rule, it is caused by nutritional deficiency, where improper feeding, unbalanced nutrition for the baby leads not only to a 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 2-3 times.

The most prone to developing iron deficiency are premature babies, twins or triplets, babies who are heavier and taller at birth, and who gain weight rapidly in the first months of life. Artificial feeding, frequent colds, a tendency to diarrhea are also factors that contribute to the reduction of this element in the body.

How IDA will proceed in children depends on the degree of anemia and compensatory possibilities child's body. The severity of the condition is determined, mainly, not by the level of Hb - to a greater extent it depends on speed fall in hemoglobin. Without treatment, iron deficiency anemia, with good adaptation, can last for years without showing significant impairment.

The main signs in the diagnosis of iron deficiency in children can be considered: pallor of the mucous membranes, waxy color of the auricles, dystrophic changes in the false integument and skin derivatives, indifference to food. Symptoms such as weight loss, growth retardation, low-grade fever, frequent colds, enlarged liver and spleen, stomatitis, fainting may also be present with IDA, but are not mandatory for it.

In women, iron deficiency anemia is most dangerous during pregnancy: mainly for the fetus. If the poor health of a pregnant woman is due to oxygen starvation of tissues, then one can imagine what suffering the organs and, first of all, the central nervous system of the child () have. In addition, with IDA in women who are expecting a baby, there is a high likelihood of preterm birth and a high risk of developing infectious complications in the postpartum period.

Diagnostic search for the cause

Bearing in mind the patient's complaints and information about a decrease in hemoglobin in history, IDA can only be assumed, therefore:

1. The first stage of the diagnostic search will be proof the fact that in the body there really is a lack of this chemical element, which is the cause of anemia;
2. The next stage of diagnosis is the search for diseases that have become prerequisites for the development of an iron deficiency state (the cause of deficiency).

The first stage of diagnosis, as a rule, is based on various additional (except for the hemoglobin level) laboratory tests, proving that there is not enough iron in the body:

• : low Hb level - anemia, an increase in the number of red blood cells that have an unnaturally small size, with a normal number of red blood cells - microcytosis, a decrease in color index - hypochromia, the content of reticulocytes is likely to be increased, although it may not go away from normal values;
• Serum iron, the norm of which in men is in the range of 13 - 30 μmol / l, in women from 11 to 30 μmol / l (with IDA, these figures will decrease);
• Total iron-binding capacity (OZHSS) or total (norm 27 - 40 µmol / l, with IDA - the level increases);
• The saturation of transferrin with iron in the deficiency of the element decreases below 25%;
• (reserve protein) in iron-deficient conditions in men becomes below 30 ng/ml, in women - below 10 ng/ml, which indicates the depletion of iron stores.

If an iron deficiency has been identified in the patient's body with the help of analyzes, then the next step will be to search for the causes of this deficiency:

1. History taking (perhaps the person is a strict vegetarian or has been on a weight loss diet for too long and unwisely);
2. It can be assumed that there is bleeding in the body, which the patient does not know or knows about, but does not attach much importance to it. In order to detect the problem and fix the status of the cause behind it, the patient will be offered to undergo a lot of various examinations: FGDS, sigmoidoscopy and colonoscopy, bronchoscopy, the woman will definitely be sent to the gynecologist. There is no certainty that even these, by the way, rather unpleasant procedures, will clarify the situation, but you will have to look until the source of the piled up grief is found.

The patient must go through these stages of diagnosis before prescribing ferrotherapy. There is no random treatment for iron deficiency anemia.

Make iron stay in the body

In order for the impact on the disease to be rational and effective, one should adhere to the basic principles of the treatment of iron deficiency anemia:

• It is impossible to stop iron deficiency anemia with nutrition alone. without the use of iron preparations (limited absorption of Fe in the stomach);
• It is necessary to follow the sequence of treatment, consisting of 2 stages: the 1st - the relief of anemia, which takes 1 - 1.5 months (an increase in hemoglobin levels begins from the 3rd week), and the 2nd, designed to replenish the Fe depot (it will continue 2 months);
• Normalization of hemoglobin levels does not mean the end of treatment - the entire course should last 3-4 months.

At the first stage (5 - 8 days) of the treatment of iron deficiency anemia, the so-called reticulocyte crisis- a significant increase (by 20 - 50 times) in the number of young forms of erythrocytes ( - norm: approx. 1%).

When prescribing iron preparations for oral administration (by mouth), it is important to remember that only 20-30% of the dose taken will be absorbed, the rest will be excreted through the intestines, so the dose must be calculated correctly.

Ferrotherapy must be combined with a diet rich in vitamins and protein. The patient's diet should include lean meats (veal, beef, hot lamb), fish, buckwheat, citrus fruits, apples. Ascorbic acid at a dose of 0.3 - 0.5 g per dose, an antioxidant complex, vitamins A, B, E, the doctor usually prescribes separately in addition to ferrotherapy.

Iron preparations differ from other medicines in special rules for taking:

• Ferrum-containing short-acting preparations are not consumed immediately before meals and during it. The medicine is taken 15-20 minutes after a meal or in a pause between doses, prolonged drugs (ferrogradum, ferograd, tardiferron-retard, sorbifer-durules) can be taken before meals and at night (1 time per day);
• Iron preparations are not washed down with milk and milk-based drinks (kefir, fermented baked milk, yogurt) - they contain calcium, which will inhibit the absorption of iron;
• Tablets (with the exception of chewables), dragees and capsules are not chewed, swallowed whole and washed down with plenty of water, rosehip broth or clarified juice without pulp.

Small children (up to 3 years) are preferably given iron supplements in drops, a little older (3-6 years) in syrups, and children over 6 years old and adolescents are well "led" to chewable tablets.

The most common iron preparations

Currently, a wide range of drugs that increase the iron content in the body is presented to the attention of doctors and patients. They are available in various pharmaceutical forms, so their oral administration does not cause any particular problems, even in the treatment of iron deficiency anemia in young children. Some of the most effective medications for increasing iron levels include:

The list of ferrum-containing drugs is not a guide to action; it is up to the attending physician to prescribe and calculate the dose. Therapeutic doses are prescribed until the hemoglobin level normalizes, then the patient is transferred to prophylactic doses.

Preparations for parenteral administration are prescribed for violation of iron absorption in the gastrointestinal tract (gastric resection, peptic ulcer of the stomach and 12 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 need to remember about allergic reactions(feeling hot, palpitations, pain behind the sternum, in the lower back and calf muscles, metallic taste in the mouth) and possible development anaphylactic shock.

Preparations for parenteral use in the treatment of iron deficiency anemia are prescribed only if there is full confidence that it is IDA, and not another form of anemia in which they can be contraindicated.

Indications for blood transfusion in IDA are very limited (Hb below 50 g/l, but surgery or childbirth is expected, intolerance to oral and allergy to parenteral therapy). Only thrice-washed erythrocyte mass is transfused!

Prevention

In the zone of special attention, of course, are small children and pregnant women.

Pediatricians consider nutrition to be the most important measure to prevent IDA in children under one year old: breastfeeding, iron-fortified mixtures (for “artists”), fruit and meat complementary foods.

iron sources for a healthy person

As for pregnant women, even those with normal hemoglobin levels in the last two months before giving birth should take iron supplements.

Women of childbearing age should not forget about the prevention of IDA in early spring and devote 4 weeks to ferrotherapy.

When signs of tissue deficiency appear, without waiting for the development of anemia, it will be useful for other people to take preventive measures ( get 40 mg of iron per day for two months). In addition to pregnant women and nursing mothers, blood donors, adolescent girls and both sexes who are actively involved in sports resort to such prevention.

Video: iron deficiency anemia, RIA Novosti story

Video: lecture on IDA

Video: Komarovsky about iron deficiency

Anemia is a syndrome characterized by low levels (compared to the norm) of hemoglobin in the blood, and not only the total value is taken into account, but its amount in one erythrocyte.

The function of hemoglobin and its norms

Hemoglobin is a protein that has an iron atom in its composition, capable of binding oxygen molecules. It is found only in red blood cells. Outside these cells, this protein is rapidly degraded. Normal indicators are considered to be an interval from 110 to 155 g per liter (for women - 110-145, and for men - 120-155). A drop below 110 is anemia. The fact is that hemoglobin from 110 to 120 in men is considered the maximum permissible, although abnormal.

Degrees of anemia

Causes and forms of the disease

The causes leading to the development of the disease determine its form.

1. Acute anemia. They are always associated with a rapid loss of red blood cells. There are two reasons for this: bleeding and the rapid destruction of red blood cells. The latter circumstance is observed, for example, in case of poisoning. A rapid decrease in the level of hemoglobin exceeds the rate of development of the body's compensatory capabilities. Therefore, anemia of the 1st degree can occur even at rest.

2. Chronic anemia accounts for more than 80-85% of all diseases of this type, so their causes are the most common. These are a number of diseases, for example, a deficiency of any factor at any stage of hemoglobin synthesis, pathology of the structure of erythrocytes and their diseases. Deficiency factors include lack of iron, cyanocobalamin, cytochromes, porphyrin. Pathology of erythrocytes can be congenital or acquired. In the first case, erythrocytes are either formed with defects that lead to a decrease in the level of hemoglobin in them, or they themselves are very unstable and prone to rapid destruction. Often, the first signs appear even when a person has grade 1 anemia. Acquired pathology occurs as a result of various diseases leading to the early destruction of red blood cells. One such example is malaria.

Clinical manifestations of chronic anemia

Regardless of the level of hemoglobin, chronic anemia, the severity of which is determined only by the severity of the manifestations, has a certain set of symptoms.

Dizziness, tinnitus and flashing "flies" before the eyes.

Pale skin.

Fragility of nails, change in their shape and color.

· Dry skin and hair loss.

All these signs are not mandatory for one person. So, anemia of the 1st degree in some can be manifested only by pallor and dry skin, while others may experience brittle nails and hair loss with normal

Prevalence of anemia among surgical diseases

The problem of anemia is not only therapeutic, a small percentage of its cases occur in surgical practice. And often anemia is the first sign of any pathology that requires emergency intervention by a surgeon. One of the frequent such conditions is bleeding from the organs of the digestive tube.

Anemia of the 1st degree is the easiest manifestation of a whole complex of diseases that are characterized by a decrease in the concentration of hemoglobin or the number of red blood cells. As a result of anemia, many changes begin in the body, which are caused by insufficient oxygen supply to organs and tissues. Manifestations and pathological changes in the body directly depend on the severity of the course of the disease.

Classification

The classification of anemia is quite simple. They are distinguished depending on the causes of occurrence into the following types:

• Posthemorrhagic anemia, which develops as a result of a decrease in the number of blood cells, erythrocytes, as a result of acute or chronic blood loss. Their causes may be trauma, heavy and frequent childbirth, heavy menstruation, stomach ulcers. In infants, posthemorrhagic anemia most often develops as a result of birth trauma, internal hemorrhages, placental bleeding, and hemorrhagic diathesis.
• Hemolytic anemia results from the abnormal breakdown of red blood cells. This form of the disease is quite rare and occurs under the influence of various autoimmune and hereditary factors.
• Deficiency anemia due to impaired erythropoiesis. This group of anemias is the most common. It includes iron deficiency anemia, which occurs in the vast majority of cases, megaloblastic anemia, due to a lack of vitamin or folic acid. Sometimes so-called multifactorial anemia develops, caused by a simultaneous deficiency of iron and B12.
• Hypoplastic and aplastic anemia resulting from impaired bone marrow function. This variety is extremely rare. It is either hereditary or develop after severe chronic diseases, the action of drugs, chemicals.

In addition, to prescribe the correct treatment regimen, it is required to determine the degree of anemia by hemoglobin. This is calculated based on the deviation of the hemoglobin value from the norm. Hemoglobin is the main iron-containing coloring element of red blood cells, which is "responsible" for the transport of oxygen with blood throughout the body.

For an adult male, the hemoglobin concentration is 135 - 160 g / l. For women, this value is somewhat lower and ranges from 120 to 140 g/l. For children, the norm of hemoglobin content depends on age. These values ​​are shown in the table:

Age

For teenagers over 16 years old, adult rules apply.

The reasons

Most of the iron contained in the body is part of the erythrocytes, there are also reserves of this substance in the muscles, liver and bone marrow. The daily requirement of an adult for iron is about 10-15 mg. Of this amount, no more than 1.5 mg is absorbed into the blood, approximately the same amount is normal daily physiological losses with sweat, urine and feces. For children, the daily iron requirement for an infant is 0.5-1.2 mg, which increases with age, and a two-year-old child needs about 10 mg of iron per day.

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Torsunov O.G. About the causes of iron deficiency anemia

The causes of iron deficiency anemia are most often not too abundant, but chronic blood loss during hemorrhoidal bleeding, acute peptic ulcer, strong menstruation and other similar conditions. In the development of iron deficiency anemia, insufficient intake of iron with food or a violation of its absorption after undergoing surgery on the stomach also plays a certain role.

Often, iron deficiency anemia develops in premature babies, since many of the substances necessary for normal hematopoiesis are formed precisely in the last two months of pregnancy. The cause of this disease in infants may also be iron deficiency anemia of varying severity in a woman during the period of bearing a child.

B12 - deficiency anemia develops due to insufficient intake of this vitamin with food, since it is not synthesized in the body. B12 is absorbed in the gastrointestinal tract with the help of a special enzyme called gastromucoprotein (also called the Castle factor). After resection of the stomach, with gastritis, chronic alcohol consumption, the secretion of the Castle factor sharply decreases and, as a result, B12 deficiency develops.

There are certain reserves of folic acid in our body. It also comes from food and is absorbed in the duodenum and ileum. This process can be disturbed under the influence of alcohol, long-term use of hormonal contraceptives, anticonvulsants, certain antibacterial drugs, in particular trimethoprim or sulfamethoxazole.

Clinical manifestations

Symptoms largely depend on the severity of the disease. Moreover, with each subsequent stage, existing symptoms are aggravated and new ones may appear.

• Anemia of the first degree is almost asymptomatic. Sometimes a person complains of mild weakness, malaise, fatigue. There is a noticeable pallor of the skin, sweating, loss of appetite. Mild anemia in infants is characterized by increased excitability of the child, tearfulness, profuse regurgitation after feeding (or vomiting in older children).
• Anemia of moderate severity is manifested by headaches, dizziness associated with insufficient oxygen supply. Children with this form of anemia get tired very quickly, they can hardly endure even the lightest physical exertion. A child under one year old may even experience a regression in the development of motor skills. Roughness or dryness of the skin is noted, very painful cracks in the corners of the mouth, digestive disorders may occur, which manifest themselves in the form of diarrhea or constipation, flatulence. From the side of the cardiovascular system, tachycardia, heart murmurs may be noted.
• Anemia of the 3rd degree is characterized by changes in the structure of nails and hair (they become dull and become very brittle), hair loss, a feeling of cold and numbness of the extremities, a perverted perception of smells and tastes. Stomatitis and caries (up to tooth decay) may appear. Children may lag behind in physical and psychological development. On ultrasound of the abdominal organs, an increase in the liver and spleen is noticeable. If left untreated, severe anemia is dangerous and can cause extremely serious consequences.

The severity of symptoms may vary depending on the general condition of the child or adult suffering from anemia. Also, the likelihood of a particular clinical sign depends on the cause of the disease.

Diagnostics

It is possible to assume the development of this disease in oneself or in a child by a simple clinical blood test, which can be taken without a doctor's referral in any laboratory. When the concentration of hemoglobin drops below normal, it is imperative to contact a general practitioner or pediatrician.

Then a biochemical blood test is prescribed. There is a decrease in the amount of serum iron, the level of ferritin (a protein that maintains the supply of iron), and the saturation of transferrin with iron.

Naturally, the doctor pays attention to the general symptoms of anemia and conducts a comprehensive examination to determine what changes this disease has caused in the body.

Treatment of anemia of the first degree

Anemia of the 1st degree in children and adults is usually very mild and in most cases does not require medical correction. It is enough to make certain changes in the diet and daily routine. Long walks in the fresh air, moderate physical activity are recommended.

If anemia of the 1st degree is detected, then the diet for children and adults should be based on the following principles:

• Increase your protein intake. To do this, you need to eat eggs, dairy products, liver, kidneys, fish and meat.
• Limit milk and strong tea, as these drinks slow down the absorption of iron from the gastrointestinal tract. Preservatives, oxalates, phosphates and some drugs, such as antacids and antibiotics of the tetracycline group, have the same effect.
• Instead of animal fats, vegetable fats should be preferred. It is necessary to use butter, dress salads with a variety of vegetable oils (sunflower, olive, grape and the like).
• If the problem with being overweight is not acute, then the amount of carbohydrates in the diet can not be limited.
• Vitamins C and group B contribute to better absorption of iron. Therefore, it is advisable to introduce products that contain them into the menu. These are citrus fruits, herbs, legumes, many berries, etc.
• The use of iron-containing foods (beef liver, rabbit and turkey meat, buckwheat and oatmeal, millet, caviar).

It is worth noting that it is imperative to monitor the dynamics of the blood and control the level of hemoglobin. In most cases, with proper dieting, its value rises to normal numbers, and further prescription of drugs is not required.

Treatment of anemia 2 and 3 degrees

Therapy of anemia of moderate and more severe forms consists in the appointment of special medications, depending on the cause of the development of the disease. Thus, iron deficiency anemia requires long-term treatment with iron preparations at a dosage of 100-120 mg per day. It is worth noting that medication should be continued even after the patient's condition is normalized and hemoglobin levels are restored. This is due to the fact that in addition to eliminating the state of deficiency, it is necessary to replenish iron stores in the body. In most cases, for the convenience of the patient, medications are prescribed in tablets. Parenteral administration is indicated for violation of the absorption of this element in the digestive tract.

Treatment of B12 deficiency anemia is carried out with the help of injections of cyanocobalamin or hydroxocobalamin at a dosage of 400-500 mcg per day during the first week. Then they switch to maintenance therapy, during which the same injection is done once every 7 days. The total duration of therapy is about two months. In the event that the cause of such anemia cannot be eliminated, then it is necessary to give prophylactic injections of cyanocobalamin several times a year to maintain a normal level of B12.

Treatment of 2 and 3 degrees of folate deficiency anemia is the same. Assigned to 5 mg of folic acid three times a day.

Therapy for rarer forms of anemia is much more difficult. With hemolytic anemia, a long course of prednisolone is indicated. Aplastic anemia was previously considered incurable and often ended in death. At the moment, the treatment of this disease is carried out with the help of bone marrow transplantation.

Features of the treatment of anemia in children

Therapy of anemia should be carried out under the strict supervision of a physician. If babies are bottle-fed, then special mixtures with a high iron content are recommended. A child with iron deficiency anemia is advised to introduce complementary foods a few weeks earlier and start with applesauce and oatmeal and buckwheat porridge.

Anemia of the 2nd degree in children is not treated with a simple correction of nutrition. Requires the use of drugs that contain ferric iron. These are maltofer, ferrum lek, ferlatum, etc. With this form of the disease, they are given in the form of drops or syrup. Parenteral administration of drugs is indicated for anemia of the third degree. In parallel with these medications, multivitamin complexes are also prescribed, because this disease is accompanied by beriberi.

With the development of severe anemia in infants, recombinant human erythropoietin is also prescribed. These are drugs such as recormon, eprex, epokrin. The same drugs are also prescribed for premature babies born 4 to 5 weeks ahead of schedule. Usually the dosage of such drugs is 250 IU per kg of body weight three times a week, but the younger the child, the greater the dose required for effective treatment.

In addition to drug therapy, long walks, a strict daily regimen, and the elimination of psychological stress are recommended. The effect of the treatment of anemia in children is noticeable already on the seventh day. If there is no effect after two weeks of therapy, then a second examination is carried out or the dose of medication is adjusted.

In general, the most common types of deficiency anemia are easily treatable, even at the most severe stage of the course. However, taking medications can be avoided with a proper diet and an active lifestyle.