What is grade 1 anemia? Anemia. How to tell if you have anemia

Anemia is a decrease in the number of red blood cells in the blood - erythrocytes below 4.0x109 / l, or a decrease in hemoglobin below 130 g / l in men and below 120 g / l in women. Anemia during pregnancy is characterized by a decrease in hemoglobin below 110 g / l.

This is not an independent disease, anemia occurs as a syndrome in a number of diseases and leads to a disruption in the supply of oxygen to all organs and tissues of the body, which, in turn, provokes the development of many other diseases and pathological conditions.

Severity

Depending on the concentration of hemoglobin, it is customary to distinguish three degrees of severity of anemia:

• anemia of the 1st degree is recorded when the hemoglobin level decreases by more than 20% of the normal value;
• anemia of the 2nd degree is characterized by a decrease in hemoglobin by about 20-40% of the normal level;
• grade 3 anemia is the most severe form of the disease, when hemoglobin is reduced by more than 40% of the normal value.

It is unequivocal to show that the patient has 1 degree or a more severe stage can only be a blood test.

The reasons

What it is: anemia, that is, anemia, is nothing more than. Namely, hemoglobin carries oxygen to all tissues of the body. That is, anemia is caused precisely by a lack of oxygen in the cells of all organs and systems.

1. The nature of nutrition. With insufficient intake of iron-containing foods, it can develop, this is more typical for population groups where there is already a high level of alimentary anemia;
2. Violation of the gastrointestinal tract (with violations of the absorption process). Since iron absorption occurs in the stomach and upper small intestine, if the absorption process is disturbed, the mucous membrane of the digestive tract develops this disease.
3. Chronic blood loss (gastrointestinal bleeding, nosebleeds, hemoptysis, hematuria, uterine bleeding). Belongs to one of the most important causes of iron deficiency.

Iron-deficiency anemia

The most common form of anemia. It is based on a violation of the synthesis of hemoglobin (oxygen carrier) due to iron deficiency. It is manifested by dizziness, flashing flies before the eyes, palpitations. Dry skin, pallor, are noted. Typical manifestations are fragility and layering of nails, their transverse striation.

aplastic anemia

This is more often an acquired acute, subacute or chronic disease of the blood system, which is based on a violation of the hematopoietic function of the bone marrow, namely a sharp decrease in its ability to produce blood cells.

Sometimes aplastic anemia begins acutely and develops rapidly. But more often, the disease occurs gradually and does not manifest itself with bright symptoms for quite a long time. The symptoms of aplastic anemia include all the symptoms characteristic of, and.

B12 deficiency anemia

It occurs when there is a lack of vitamin B12 in the body, which is necessary for the growth and maturation of red blood cells in the bone marrow, as well as for the proper functioning of the nervous system. For this reason, one of the hallmark symptoms of B12 deficiency anemia is tingling and numbness in the fingers and a wobbly gait.

Hemolysis occurs under the influence of antibodies. These can be maternal antibodies directed against the child's erythrocytes in case of incompatibility between the child and the mother for the Rh antigen and much less often for antigens of the ABO system. Antibodies against one's own erythrocytes may be active at normal temperature or only when cooled.

They can appear for no apparent reason or in connection with the fixation on erythrocytes of incomplete haptens antigens alien to the body.

signs

We list the main signs of anemia that can disturb a person.

• pallor of the skin;
• increased heart rate and respiration;
• fast fatiguability;
• dizziness;
• noise in ears;
• spots in the eyes;
• muscle weakness;
• difficulty concentrating;
• irritability;
• lethargy;
• slight rise in temperature.

Symptoms of anemia

Among the symptoms of anemia, manifestations directly related to hypoxia are considered leading. The degree of clinical manifestations depends on the severity of the decrease in the number of hemoglobin.

1. With a mild degree (hemoglobin level 115-90 g / l), general weakness, increased fatigue, and a decrease in concentration may be observed.
2. With an average (90-70 g / l), patients complain of shortness of breath, palpitations, frequent headaches, sleep disturbance, tinnitus, loss of appetite, lack of sexual desire. Patients are characterized by pallor of the skin.
3. In the case of a severe degree (hemoglobin less than 70 g / l), they develop.

With anemia, symptoms in many cases do not manifest themselves. The disease can only be detected by laboratory blood tests.

Diagnosis of the disease

In order to understand how to treat anemia, it is important to determine its type and cause of development. The main method for diagnosing this disease is the study of the patient's blood.

Are considered:

• for men 130-160 grams per liter of blood.
• for women 120-147 g/l.
• for pregnant women, the lower limit of the norm is 110g / l.

Anemia treatment

Naturally, the methods of treating anemia radically differ depending on the type of anemia that caused its cause and severity. But the basic principle of treating anemia of any kind is the same - it is necessary to deal with the cause that caused the decrease in hemoglobin.

1. With anemia caused by blood loss, it is necessary to stop the bleeding as soon as possible. With a large blood loss that threatens life, a transfusion of donor blood is used.
2. With iron deficiency anemia, you should eat foods rich in iron, vitamin B12 and folic acid (they improve iron absorption and blood formation processes), the doctor may also prescribe medications containing these substances. Often folk remedies are effective.
3. In case of anemia provoked by infectious diseases and intoxication, it is necessary to treat the underlying disease, to carry out urgent measures to detoxify the body.

In the case of anemia, an important condition for treatment is a healthy lifestyle - proper balanced nutrition, alternation of stress and rest. It is also necessary to avoid contact with chemical or poisonous substances and oil products.

Food

An important component of the treatment is a diet with foods rich in substances and trace elements that are necessary for the process of hematopoiesis. What foods should be eaten with anemia in a child and an adult? Here is the list:

• meat, sausages;
• offal - especially the liver;
• fish;
• egg yolks;
• whole grain flour products;
• seeds - pumpkin, sunflower, sesame;
• nuts - especially pistachios;
• spinach, cabbage, Brussels sprouts, fennel, parsley leaves;
• beet;
• black currant;
• sprouts, wheat germ;
• apricots, prunes, figs, dates;

Drinks containing caffeine (eg, tea, coffee, cola) should be avoided, especially with meals, as caffeine interferes with iron absorption.

Iron supplements for anemia

Iron preparations for anemia are much more effective. The absorption of this trace element in the digestive tract from iron preparations is 15-20 times higher than from food.

This allows you to effectively use iron supplements for anemia: raise hemoglobin faster, restore iron stores, eliminate general weakness, fatigue and other symptoms.

1. Ferretab composite (0154g ferrous fumarate and 0.0005g folic acid). Additionally, it is desirable to take ascorbic acid in a daily dose of 0.2-0.3 g).
2. (0.32 g of ferrous sulfate and 0.06 g of vitamin C) is produced in a dragee daily dosage depending on the degree of anemia 2-3 times a day.
3. Totem - is available in bottles of 10 milliliters, the content of the elements is the same as in the sorbifer. It is used orally, it can be diluted with water, it is possible to prescribe it for intolerance to tablet forms of iron. Daily dose 1-2 doses.
4. (0.15g, ferrous sulfate, 0.05g vitamin C, vitamins B2, B6, 0.005g calcium pantothenate.
5. Vitamin B12 in 1 ml ampoules 0.02% and 0.05%.
6. Folic acid tablets 1mg.
7. Ampoule iron preparations for intramuscular and intravenous administration are sold only by prescription and require injections only in stationary conditions due to the high frequency of allergic reactions to these drugs.

You can not take iron supplements in conjunction with drugs that reduce their absorption: Levomycitin, Calcium preparations, Tetracyclines, Antacids. As a rule, iron preparations are prescribed before meals, if there is no vitamin C in the drug, then an additional intake of ascorbic acid in a daily dose of 0.2-0.3 g is required.

For each patient, the daily need for iron is specially calculated, as well as the duration of the course of treatment, the absorption of the specific prescribed drug and the iron content in it are taken into account. Usually, long courses of treatment are prescribed, therapeutic doses are taken within 1.5-2 months, and prophylactic doses are taken in the next 2-3 months.

Effects

Iron deficiency anemia, if not treated early, can have serious consequences. A severe degree turns into heart failure, associated with,. Sometimes people end up in the hospital with a sharp loss of consciousness, the cause of which is undertreated or not detected in time anemia.

Therefore, if you suspect that you have this disease or are prone to low hemoglobin, then it is worth taking a control blood test every three months.

The patient can only hear the diagnosis of "anemia" from a doctor. It often raises a number of questions. The first of them - what does this concept mean? Anemia is a disorder in the hemostasis system, which is characterized by a decrease in hemoglobin levels. Hemoglobin is a protein substance that contains iron atoms in its composition. Hemoglobin is part of erythrocytes - red blood cells.

Normally, the hemoglobin level in a healthy person is 110-155 g / l. If, according to the results of the examination, hemoglobin values ​​​​are reduced to 110 g / l, they speak of anemia of the 1st degree. The maximum allowable hemoglobin norm for men is considered to be 110-120 g / l. However, this is not enough for the full functioning of the body.

Anemia 1 degree - how to determine?

It is possible to suspect anemia of the 1st degree by some symptoms, but this is not always possible. Often, pathology at such early stages of development does not give itself away. Therefore, a person learns about his diagnosis only in the doctor's office, having come for the results of a blood test.

The asymptomatic course of the disease should not be misleading. Outwardly, a person may look completely healthy. The absence of any signs only indicates that the body has launched compensatory mechanisms designed to block violations in the functioning of organs and systems, but sooner or later its reserves will be exhausted. The fact that anemia is dangerous should always be remembered.

Anemia 1 degree and hemoglobin level

Anemia can have several degrees. The first degree of anemia is considered the easiest. It is characterized by a decrease in hemoglobin to a level of 90-110 g / l. In this case, the symptoms of the disease may be absent during this period. A person continues to lead a normal life, not suspecting that his body suffers from a lack of hemoglobin.

Although some signs of anemia of the 1st degree still manifest themselves. However, they become noticeable in conditions of increased physical activity.

Should anemia be treated?

Anemia of 1 degree must be treated. Otherwise, the violation will progress and lead to serious health problems. Do not assume that anemia can go away on its own. Without therapy, it will go first to the second, and then to the third stage. It should be understood that anemia of the third degree is a life-threatening condition.

Anemia of the 1st degree can be present in a person for a long time. The level of erythrocytes often decreases slowly, but systematically. Sometimes it happens that a patient comes to the doctor with a severe degree of anemia and its multiple complications, and it all started with the usual malaise and fatigue.

Symptoms of anemia of the 1st degree are primarily due to the fact that organs and tissues begin to suffer from a lack of oxygen. Signs of hypoxia increase gradually, they depend on the stage of the disease.

In general, anemia of the 1st degree is characterized by the following symptoms:

During physical effort and during training, a person develops shortness of breath, which was not there before.

The patient notices that he began to get tired faster.

Possible pre-fainting state.

Often begins to disturb dizziness.

Another indirect sign of anemia is orthostatic tachycardia.

If you carefully listen to the signals that the body gives, you can diagnose anemia on your own, without visiting a doctor's office. Of course, this is not a reason for prescribing treatment. Therapy is selected only by the doctor and only on the basis of the tests performed. However, the sooner a person seeks medical help, the faster recovery will come.

If a patient develops normocytic normochromic anemia, then the ESR and the mean concentration of hemoglobin in the erythrocyte (MCHC) may remain within the normal range.

Normocytic normochromic anemia can develop for the following reasons:

Home treatments for anemia include:

Juice intake. The use of freshly squeezed juices allows you to get rid of anemia in the shortest possible time. However, you need to drink fresh juices, and not bought in stores. Otherwise, the effect will not be achieved. You can cook carrot, beetroot and apple juice. It is good to mix them, or dilute with vegetable juices. Honey can be added to the drink.

There is a rule regarding the intake of beetroot juice. So, it can not be consumed immediately after preparation. The drink must be kept. The exposure time is 2 hours, but not less. During this time, harmful substances will evaporate from it. Therefore, immediately after preparation, the juice does not need to be covered with a lid. Otherwise, don't twist it too tightly.

Beetroot juice can be drunk half an hour before a meal, or in between meals. Large volumes should not be consumed. It is enough to drink 2 tablespoons of juice 2-3 times a day. This is true for all drinks.

Infusion of yarrow. To prepare an infusion of yarrow, you need to pour the grass of the plant with boiling water and keep it in a thermos. Take the infusion should be 2 tablespoons 3 times a day.

Vitamin cocktail. It is very useful for anemia of the 1st degree to eat a vitamin mixture. For its preparation, you will need 100 g of dried fruits (raisins, dates, figs, prunes). The fruits are passed through a meat grinder, lemon juice and 3 tablespoons of honey are added to the resulting "minced meat". The mixture is stored in the refrigerator. Eat 2 teaspoons 2-3 times a day. Such a useful vitamin mixture will not only help get rid of anemia, but also saturate the body with vitamins.

Education: In 2013, he graduated from the Kursk State Medical University and received a diploma in General Medicine. After 2 years, the residency in the specialty "Oncology" was completed. In 2016, she completed postgraduate studies at the Pirogov National Medical and Surgical Center.

Anemia manifestations (due to insufficient supply of oxygen to tissues):

• pallor,
• lethargy,
• fatigue,
• capriciousness,
• learning disorder,
• headache,
• noise in ears,
• shortness of breath, palpitations,
• dizziness,
• darkening in the eyes and even fainting.

Enzymatic (due to iron deficiency, which is part of many enzymes, their work and metabolism are disrupted).

• Skin changes: this is dry skin, its peeling, over time, the appearance of jam on the lips, and in the later stages, cracks in the rectum and oral mucosa. At the same time, hair and nails become thin and brittle. Longitudinal stripes appear on the nail plates.
• Muscles become weaker and more fatigued. Growth and physical development may be delayed. The obturator muscle of the bladder does not cope with the work, which leads to involuntary urination when laughing or coughing, the urge to urinate becomes uncontrollable and becomes more frequent. Possibly nighttime incontinence.
• The most formidable manifestation of muscle damage is myocardial dystrophy that hits the heart. It is she who is afraid, trying to start treating anemia as early as possible. It is associated with systolic murmur when listening to the heart, increased heart rate and possible complications in the form of chronic heart failure, which not only will not allow the child to play sports, but can also turn him into a disabled person.
• Perverted sense of smell and taste. The child may begin to eat unusual things that do not contain iron, and which do not make up for his lack (chalk, watercolors, cardboard, flour, dry pasta). He may start to like certain, sometimes pungent smells.
• Changes in the enzymatic activity of saliva are conducive to dental caries. Atrophy of the oral and pharyngeal mucosa makes swallowing difficult The child may choke on food.
• In the mucous membranes of the stomach and intestines, atrophic processes begin, which leads to loss of appetite, stool problems, slow weight gain.

• The upper respiratory tract is also affected. In advanced cases, it is atrophic inflammation of the pharynx and larynx that causes chronic pathologies of the ENT organs.
• Decreased local and general immune response. The child is more susceptible to viral, bacterial and fungal infections.
• Blueish tint of the whites of the eyes- the result of defective formation of collagen fibers.

What causes anemia?

The causes of anemia in adults and children differ in the mechanism of the onset of pathology, by gender.

In women, anemia is most often associated with pregnancy. After all, the mother's body gives the unborn child after the thirtieth week of pregnancy 1/3 of all iron stores. If anemia is observed without pregnancy, then anemia is considered primary, requires additional examination and clarification of the cause.

Common Causes

Conditions that are possible in both women and men:

• lack of sufficient content of vitamins, proteins and iron in food products (vegetarianism, inadequate diets);
• chronic diseases of the digestive system with ulcerative lesions of the mucosa (peptic ulcer, enterocolitis);
• blood clotting disorder;
• massive bleeding during accidents, during surgery.

For women, the situation is more complicated:

• frequent childbirth (with interruptions of up to two years) and the absence of the necessary recovery period;
• early or late pregnancy (before 17 and after 35 years);
• transferred miscarriages;
• prolonged bleeding with fibroids.

For men, the following matters:

• increased physical activity (sports, military service);
• bleeding in tumors of the urinary system.

Children, especially small ones, have their own, easily vulnerable, hematopoietic mechanisms that fail in such situations:

• iron malabsorption (diarrhea) due to bowel disease;
• physiological inferiority of hematopoietic organs;
• toxic effect of helminthic invasion;
• eating disorders;
• prematurity;
• frequent viral infections;
• the impact of complex environmental factors.

I just don't want to, but my mother doesn't understand

The reasons for the development of anemia lie in various areas of children's life. The disease can be triggered by hereditary factors, occur during gestation, develop against the background of pregnancy pathology, and manifest itself due to gene mutation. The list of possible reasons looks like this:

• malfunctions in the functioning of the digestive system;
• liver pathology;
• kidney disease;
• infection of the body;
• malignant formations;
• large blood loss due to a serious injury or after surgery;
• a sharp change in hormonal levels during puberty and intensive growth.

Children's doctor Komarovsky notes that anemia in infancy may be associated with physical inactivity. If the baby sleeps a lot, is inactive due to tight swaddling, is deprived of freedom of movement, then his body slows down the production of red blood cells. Lack of physical activity leads to a decrease in hemoglobin.

We will study the most common anemia - iron deficiency. Iron deficiency anemia in children is marked by a decrease in hemoglobin in erythrocytes, a drop in the level of serum iron and an increase in its iron-binding properties. A healthy newborn baby up to 3 months is enough to develop iron stores obtained in utero, but after 4 months, babies need more iron. As a rule, the missing amount of iron is obtained from food. A baby under 3 years old needs 8 mg of an element per day, after 3 years - 12-15 mg.

Only 10% of iron is absorbed by the baby's body from food. In addition, this indicator is affected by the fact that the quality of products can vary. A lot of iron contains fish, chicken, soy, in them its amount reaches 20-22%. For better assimilation of the element, the child is given food containing substances such as copper, fluorine, cobalt, vitamin C, animal protein. They interfere with the proper absorption of iron, calcium salts, tetracycline, phytin, phosphorus.

Despite the obvious benefits of calcium, with iron deficiency anemia it is better to reduce its amount in the child's diet.

The process of iron deficiency in the body at an early age is divided into three important stages, based on blood counts. The breakdown by stages is necessary for doctors to organize effective treatment of the disease and determine the severity of the disease. The identified stages are described as follows:

• prelatent - iron deficiency was detected, but there are no visible changes in the blood composition (serum iron and hemoglobin concentration);
• latent deficiency - the level of hemoglobin is normal, but there is not enough serum iron;
• the latter - all blood counts undergo changes, deviating from the norm.

The disease is accompanied by well-marked symptoms, manifested in the behavior and appearance of a small patient. Any deviations from the norm should attract the attention of parents. To help adults, we give a detailed description of all manifestations of the disease:

• rapid fatigue, frequent headaches provoked by chronic fatigue;
• brittle nails and hair loss;
• dysplepsy, a perverse change in taste (the child begins to eat chalk or earth);
• shortness of breath after little physical exertion, palpitations, pale skin.

The establishment of iron deficiency anemia is based on the results of the tests. If they show a decrease in hemoglobin to 110 g / l and serum iron below 14.3 μmol / l, and iron-binding serum rises above 78 μmol / l, then the doctor ascertains the presence of a deficient type of anemia. After making sure that the changes have occurred, the doctor develops a method for treating the patient.

Blood sampling is required to diagnose anemia.

Method of treatment

Treatment of deficiency anemia consists of two directions: medication and changes in the organization of the regimen of a son or daughter. Parents should ensure that the baby spends more time outdoors, gets proper nutrition, does gymnastics, and takes massage courses. Drug therapy consists of taking vitamins and iron supplements.

The drugs prescribed to the patient are taken one hour after the baby has eaten. For a mild and moderate degree of the disease, tablets are prescribed, a severe form is treated parenterally. The main course of treatment is 3-4 weeks and is aimed at achieving an obvious improvement. Having eliminated the manifestations of the disease, the specialist prescribes iron preparations in prophylactic doses to the small patient.

When taking iron preparations, an additional intake of ascorbic acid, sorbitol, copper preparations is necessary in order to improve the absorption of the main drug. Liquids containing calcium and phosphorus (fruit juices, milk, coffee) should not be used to drink medicines. Parenteral administration of iron preparations is justified when the patient is diagnosed with malabsorption syndrome, gastric ulcer, intolerance to the agent.

Nutrition Features

A special diet plays a big role in the fight against various anemia. Parents should know which foods contain iron and include them in their child's diet.

• Liver, egg yolk, oatmeal - 5 mg per 100 grams of the product.
• Chicken meat, red caviar, apples, beef, oatmeal, buckwheat - 1-4.5 mg per 100 grams.
• Milk, carrots, strawberries - less than 1 mg.
• If you look at the rate and percentage of iron absorption, then the child should increase the intake of foods such as soy, meat, fish.

Iron-rich foods should definitely appear on the child's table regularly.

The main reason for the development of anemia in young children is iron deficiency, which is why they are also called iron deficiency.

Iron, along with participation in the transport of oxygen by hemoglobin, takes part in the formation of many enzyme systems of the body that are involved in tissue respiration, redox reactions occurring in the body, in the synthesis of protein and blood cells. Insufficient intake of iron leads to depletion of its natural "depots" in the body - bone marrow, liver, muscles.

Such anemia can be caused by many reasons. Among prenatal causes, multiple pregnancy, a significant and prolonged iron deficiency in the body of a pregnant woman, impaired uteroplacental circulation, and prematurity are noted. Bleeding during childbirth, premature or late cord ligation can also contribute to the development of anemia.

Of greater importance are postpartum factors - insufficient intake of iron with food, early artificial feeding, late introduction of complementary foods, long-term non-diverse, mainly dairy diet, plant foods devoid of animal protein, frequent illnesses of the child, rickets. There may be iron absorption disorders in the intestines as a result of various causes, including dysbacteriosis, malabsorption syndrome (impaired intestinal absorption syndrome), in children with food allergies, diseases of the gastrointestinal tract - gastritis and gastroduodenitis, diseases of the liver and pancreas , small and large intestines, loss of iron with an increased need for the child's body in it with accelerated growth rates, with impaired iron metabolism as a result of hormonal changes, with bleeding (nose, wound).

In addition to iron, microelements such as copper and cobalt play an important role in the processes of normal hematopoiesis, and to a lesser extent manganese, nickel, zinc, molybdenum, chromium, etc. Copper promotes the utilization of iron for the formation of hemoglobin, cobalt is involved in the production of erythropoietin, a the formation of erythrocytes.

During the day, 0.5-1.2 mg of iron should enter the child's body. From the moment of puberty, when the child is rapidly catching up with adults in terms of its weight parameters, 2 mg for boys and 4 mg for menstruating girls. A maximum of 2 mg of iron can be absorbed from food per day (10-15% of that received with food). From about one to one and a half grams of iron can be contained in the depot. Thus, the issue of iron intake should be broken down by age.

babies

For newborns and children under one year old, the volumes of iron that they have accumulated by the time of birth are very important. In utero, iron is delivered to the fetus through the placenta. The peak of activity of this process occurs from 28 to 32 weeks of pregnancy. By the time of birth, a full-term baby should accumulate 300-400 mg, and a premature baby at least 100-200 mg of a microelement.

How the disease develops and is diagnosed

In the early stages, with the latent course of the disease, the iron depot is already depleted (low ferritin) and iron transport is impaired (low transferrins), but the clinical manifestations are minimal:

• fatigue,
• mild shortness of breath
• poor exercise tolerance.

An expanded clinic of iron deficiency anemia already includes any signs of anemia in children from anemic and enzymatic syndromes.

To establish the diagnosis, the most commonly used general blood test:

• It determines the levels of red blood cells and hemoglobin. In the form of the analysis performed by the analyzer, they are designated as (RBC) and (HGB).
• Previously, there was such a criterion as a color index (iron deficiency anemia was considered hypochromic), but today the diagnosis of anemia in children is based on indicators:
  • McV (mean volume of erythrocytes) and
  • McH (mean erythrocyte hemoglobin content).
    Their values ​​below the norm correspond to hypochromic anemia. After the start of treatment with iron preparations, they may be within the normal range. Then anemia will be considered normochromic.

A slight decrease in the number of red blood cells in the blood leads to a decrease in the transport of hemoglobin and oxygen. Insufficient iron levels are actually a symptom of other pathologies that disrupt the balance of hematopoiesis. A blood test shows how serious the 1st degree of anemia is, what it is and what caused it - says the therapist or hematologist, who sends for other examinations.

For the production of red blood cells in the body, three conditions are required:

• healthy bone marrow;
• normal serum erythropoietin levels (a hormone produced by the kidneys that stimulates the formation of red blood cells in response to hypoxia or oxygen starvation of tissues);
• adequate iron levels.

Most often, a mild degree of anemia is associated with the following factors:

• deficiency of iron, vitamin B12, folic acid in the diet;
• chronic stress;
• bleeding outside the menstrual cycle;
• acute infections or prolonged inflammation;
• disorders in the thyroid gland and adrenal glands;
• pregnancy due to an increase in blood volume.

Aplastic anemia, which develops after viral infections and exposure to radiation, leads to a significant decrease in iron levels. Hemolytic anemia can be hereditary or acquired as a result of autoimmune diseases, blood transfusions incompatible with Rh, intoxication and infections. With mild severity, if the bone marrow has time to produce red blood cells, the symptoms will be minimal. Anemia is possible after injuries and operations.

Features of diagnostics

Mild anemia is detected if hemoglobin is lowered to 90 g/l. The norm for men is 130-164 g / l, for women - 120-145 g / l, which is associated with a difference in the concentration of testosterone and anabolic steroids. The acceptable lower value during pregnancy is 110 g / l.

The doctor must be informed about chronic diseases, any changes in the state of health:

• a lack of vitamin B12 appears after surgery, with gastritis and malnutrition, with helminthic invasion, disruption of the flora in the intestine and with malignant processes;
• against the background of diseases of the kidneys and liver, long courses of treatment with analgesics, diuretics, nitrofurans, sulfonamides;
• frequent miscarriages, too early or late pregnancy contribute to the fall of hemoglobin, as well as fibroadenomas accompanied by bleeding.

A person with chronic fatigue does not realize that such a condition is a manifestation of anemia of the 1st degree. The doctor asks about lifestyle, regularity and quality of nutrition, working conditions and contact with chemicals, heavy metals, physical exertion and hypothermia, the presence of pets, smoking and alcohol abuse.

Other causes of anemia

Chemotherapy courses inhibit hematopoiesis. Against the background of oncological diseases, anemia occurs, caused by a decrease in sensitivity to erythropoietin. Bacterial infections after two days reduce the level of iron, suppress the production of red blood cells and iron. Hidden chronic inflammation leads to mild anemia.

With an inadequate diet, the hemoglobin level decreases by 10-30 g / l due to a lack of protein and a decrease in metabolism. When normal nutrition is restored, blood plasma volume is restored, and symptoms of anemia become apparent.

With hypothyroidism, the hemoglobin level drops to 110-120 g / l, the absorption of iron and folic acid is disturbed, and appetite also disappears. Anemia due to stress is associated with exhaustion of the adrenal glands with chronic overproduction of cortisol.

Signs of iron deficiency

Erythroblastic or iron deficiency anemia of the 1st degree is accompanied by an anemic syndrome affecting all organs and tissues. At an easy stage, the changes are insignificant:

• murmurs in the heart in the area of ​​the pulmonary artery;
• fast fatiguability;
• drowsiness;
• performance degradation at work.

Signs of cerebral hypoxia, such as dizziness, pain and weakness in the body, appear as anemia increases.

The lack of oxygen disrupts the trophism of tissues, therefore, dryness and lethargy of the skin is mildly manifested, brittle nails increase, and hair loss increases. A low level of iron can affect the local immunity of the mucous membranes, the development of periodontal disease, stomatitis, pharyngitis, bronchitis.

Signs of B12 and Folic Acid Deficiency

The megaloblastic type of anemia is associated with a lack of vitamin B12 and folic acid, changes the production of DNA and RNA and the process of hematopoiesis. Most often, the cause is a violation of the absorption of vitamins in the gastrointestinal tract against the background of celiac disease, diverticulosis, and helminthic infection. With prolonged heat treatment, the content of B12 in food decreases, the body experiences a shortage of substances. Drugs such as methotrexate, acyclovir can also cause folate deficiency.

At an early stage, megaloblastic anemia is manifested by impaired coordination of movement, spasms and convulsions, and difficulty with memorization. There is a rumbling of the abdomen with nausea and bloating, appetite decreases. One of the symptoms is a burning tongue. A person is prone to depression, impaired gait, pallor.

Features of therapy

To treat anemia, you need to find out what happens in the body and disrupts the function of hematopoiesis or the breakdown of red blood cells. Without identifying the underlying cause, any medication will relieve the symptoms.

The diet is designed to replenish iron stores in the body. Nutrition is adjusted with an emphasis on meat products: liver and veal. Legumes, soybeans, peas, buckwheat, spinach, parsley and whole grain bread are added to the diet. From food, the body is able to receive no more than 3-5 mg of a substance per day, therefore the doctor prescribes drugs (Feramid, Zhektofer and others).

Doses that are ten times higher than the iron content of foods help increase the absorption capacity of the intestinal walls. Divalent iron is absorbed, and trivalent iron only irritates the mucous membranes. Treatment can last from 2 to 12 months. A blood test is performed 2-3 weeks after the start of therapy, and the iron level stabilizes after about a month. The patient's condition improves much earlier, since the cellular reserves of the substance are restored first. If peptic ulcer or enteritis worsens during therapy, the drugs are administered intravenously, which leads to an increase in hemoglobin levels a week earlier. In the form of injections, trivalent iron is introduced.

Anemia caused by B12 deficiency is treated comprehensively. First, normal bowel function is restored, because helminthic infestations are a common cause. A diet to increase iron levels should include: kidneys and liver, fish and seafood, milk and cheese, eggs.

The intensity of neurological symptoms is the main guideline for the selection of therapy, which is carried out in several stages:

1. Deworming with Fenasal or fern extract.
2. Normalization of the gastrointestinal tract with diarrhea (calcium carbonate) and enzymes (Festal, Pancreatin).
3. Restoring the intestinal microflora with a diet that excludes foods that cause fermentation (sugar, muffins, fatty meats).
4. Refusal of alcohol, a balanced diet with sufficient protein content.
5. Intravenous cyanocobalamin, corticosteroids are sometimes prescribed in the presence of antibodies to gastromucoprotein.

Other types of anemia and their treatment

With a decrease in iron levels against the background of folic acid deficiency, appropriate medications are prescribed. The recommended dose for women is 5 mg per day for a month. At the same time, fresh fruits, greens, broccoli and other cruciferous, whole grain cereals are introduced into the diet.

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2013

Iron deficiency anemia, unspecified (D50.9)

Hematology

general information

Short description

Approved by the minutes of the meeting
Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan
No. 23 dated 12/12/2013

Iron deficiency anemia (IDA)- clinical and hematological syndrome, characterized by a violation of hemoglobin synthesis as a result of iron deficiency, which develops against the background of various pathological (physiological) processes, and manifests itself with signs of anemia and sideropenia (L.I. Dvoretsky, 2004).

Protocol name:

IRON-DEFICIENCY ANEMIA

Protocol code:

ICD-10 code(s):
D 50 Iron deficiency anemia
D 50.0 Posthemorrhagic (chronic) anemia
D 50.8 Other iron deficiency anemias
D 50.9 Iron deficiency anemia, unspecified

Protocol development date: 2013

Abbreviations used in the protocol:
J - iron deficiency
DNA - deoxyribonucleic acid
IDA - iron deficiency anemia
WDS - iron deficiency state
CPU - color indicator

Protocol Users: hematologist, therapist, gastroenterologist, surgeon, gynecologist

Classification

There is currently no generally accepted classification of iron deficiency anemia.

Clinical classification of iron deficiency anemia (for Kazakhstan).
In the diagnosis of iron deficiency anemia, it is necessary to highlight 3 points:

Etiological form (to be specified after additional examination)
- Due to chronic blood loss (chronic post-hemorrhagic anemia)
- Due to increased iron consumption (increased iron requirement)
- Due to insufficient initial iron levels (in newborns and young children)
- Alimentary (nutritive)
- due to inadequate intestinal absorption
- Due to impaired iron transport

stages
A. Latent: reduced Fe in the blood serum, iron deficiency without anemia clinic (latent anemia)
B. Clinically detailed picture of hypochromic anemia.

Severity
Light (Hb content 90-120 g/l)
Medium (Hb content 70-89 g/l)
Severe (Hb content below 70 g/l)

Example: Iron deficiency anemia, postgastrectomy, stage B, severe.

Diagnostics

List of main diagnostic measures:

1. Complete blood count (12 parameters)
2. Biochemical blood test (total protein, bilirubin, urea, creatinine, ALT, AST, bilirubin and fractions)
3. Serum iron, ferritin, TIBC, blood reticulocytes
4. General urine analysis

List of additional diagnostic measures:

1. Fluorography
2. Esophagogastroduodenoscopy,
3. Ultrasound of the abdomen, kidneys,
4. X-ray examination of the gastrointestinal tract according to indications,
5. X-ray examination of the chest organs according to indications,
6. Fibrocolonoscopy,
7. sigmoidoscopy,
8. Ultrasound of the thyroid gland.
9. Sternal puncture for differential diagnosis, after consulting a hematologist, according to indications

Diagnostic criteria*** (description of reliable signs of the disease depending on the severity of the process).

1) Complaints and anamnesis:

History information:
Chronic posthemorrhagic IDA

1. Uterine bleeding . Menorrhagia of various origins, hyperpolymenorrhea (menses for more than 5 days, especially with the appearance of the first menstruation up to 15 years, with a cycle of less than 26 days, the presence of blood clots for more than a day), impaired hemostasis, abortion, childbirth, uterine fibroids, adenomyosis, intrauterine contraceptives, malignant tumors .

2. Bleeding from the gastrointestinal tract. If chronic blood loss is detected, a thorough examination of the digestive tract "from top to bottom" is carried out with the exception of diseases of the oral cavity, esophagus, stomach, intestines, and helminthic invasion by hookworm. In adult men, women after menopause, the main cause of iron deficiency is bleeding from the gastrointestinal tract, which can provoke: peptic ulcer, diaphragmatic hernia, tumors, gastritis (alcohol or due to treatment with salicylates, steroids, indomethacin). Violations in the hemostasis system can lead to bleeding from the gastrointestinal tract.

3. Donation (in 40% of women it leads to a latent iron deficiency, and sometimes, mainly in female donors with many years of experience (more than 10 years), it provokes the development of IDA.

4. Other blood loss : nasal, renal, iatrogenic, artificially induced in mental illness.

5. Hemorrhages in confined spaces : pulmonary hemosiderosis, glomic tumors, especially with ulceration, endometriosis.

IDA associated with increased iron requirements:
Pregnancy, lactation, puberty and intensive growth, inflammatory diseases, intensive sports, vitamin B 12 treatment in patients with B 12 deficiency anemia.
One of the most important pathogenetic mechanisms for the development of anemia in pregnant women is inadequately low production of erythropoietin. In addition to the states of hyperproduction of pro-inflammatory cytokines caused by pregnancy itself, their hyperproduction is possible in concomitant chronic diseases (chronic infections, rheumatoid arthritis, etc.).

IDA associated with impaired iron intake
Malnutrition with a predominance of flour and dairy products. When collecting an anamnesis, it is necessary to take into account the peculiarities of nutrition (vegetarianism, fasting, diet). In some patients, impaired intestinal absorption of iron may be masked by general syndromes such as steatorrhea, sprue, celiac disease, or diffuse enteritis. Iron deficiency often occurs after resection of the intestine, stomach, gastroenterostomy. Atrophic gastritis and concomitant achlorhydria can also reduce iron absorption. Poor absorption of iron can be facilitated by a decrease in the production of hydrochloric acid, a decrease in the time required for iron absorption. In recent years, the role of Helicobacter pylori infection in the development of IDA has been studied. It is noted that in some cases, the exchange of iron in the body during the eradication of Helicobacter pylori can be normalized without additional measures.

IDA associated with impaired iron transport
These IDA are associated with congenital antransferrinemia, the presence of antibodies to transferrin, a decrease in transferrin due to a general protein deficiency.

a. General anemic syndrome:weakness, fatigue, dizziness, headaches (more often in the evening), shortness of breath on exertion, palpitations, syncope, flickering of “flies” before the eyes with a low level of blood pressure, There is often a moderate increase in temperature, often drowsiness during the day and poor falling asleep at night, irritability, nervousness, conflict, tearfulness, memory and attention loss, loss of appetite. The severity of complaints depends on adaptation to anemia. The slow rate of anemization contributes to better adaptation.

b. Sideropenic Syndrome:

- changes in the skin and its appendages(dryness, peeling, easy cracking, pallor). Hair is dull, brittle, split, turns gray early, falls out intensely, changes in nails: thinning, brittleness, transverse striation, sometimes spoon-shaped concavity (koilonychia).
- Mucosal changes(glossitis with atrophy of the papillae, cracks in the corners of the mouth, angular stomatitis).
- Changes in the gastrointestinal tract(atrophic gastritis, atrophy of the esophageal mucosa, dysphagia). Difficulty swallowing dry and hard food.
- Muscular system. Myasthenia gravis (due to the weakening of the sphincters, there is an imperative urge to urinate, the inability to hold urine when laughing, coughing, sometimes bedwetting in girls). Myasthenia gravis may also result in miscarriage, complications during pregnancy and childbirth (decrease in the contractility of the myometrium
Addiction to unusual smells.
Perversion of taste. It is expressed in the desire to eat something inedible.
- Sideropenic myocardial dystrophy- Tendency to tachycardia, hypotension.
- Disturbances in the immune system(the level of lysozyme, B-lysins, complement, some immunoglobulins decreases, the level of T- and B-lymphocytes decreases, which contributes to a high infectious morbidity in IDA and the appearance of secondary immunodeficiency of a combined nature).

2) physical examination:
. pallor of the skin and mucous membranes;
. "blue" sclera due to their dystrophic changes, slight yellowness of the area of ​​the nasolabial triangle, palms as a result of a violation of carotene metabolism;
. koilonychia;
. cheilitis (seizures);
. indistinct symptoms of gastritis;
. involuntary urination (due to weakness of the sphincters);
. symptoms of damage to the cardiovascular system: palpitations, shortness of breath, chest pain and sometimes swelling in the legs.

3) laboratory research

Laboratory indicators for IDA

	Laboratory indicator	Norm	Changes in IDA
1	Morphological changes in erythrocytes	normocytes - 68% microcytes - 15.2% macrocytes - 16.8%	Microcytosis is combined with anisocytosis, poikilocytosis, anulocytes, plantocytes are present
2	color indicator	0,86 -1,05	Hypochromia score less than 0.86
3	Hemoglobin content	Women - at least 120 g / l Men - at least 130 g / l	reduced
4	SIT	27-31 pg	Less than 27 pg
5	ICSU	33-37%	Less than 33%
6	MCV	80-100 fl	lowered
7	RDW	11,5 - 14,5%	enlarged
8	Mean erythrocyte diameter	7.55±0.099 µm	reduced
9	Reticulocyte count	2-10:1000	Not changed
10	Efficient erythropoiesis coefficient	0.06-0.08x10 12 l / day	Not changed or reduced
11	Serum iron	Women - 12-25 microml / l Men -13-30 µmol/l	Reduced
12	Total iron-binding capacity of blood serum	30-85 µmol/l	Increased
13	Serum latent iron-binding capacity	Less than 47 µmol/l	Above 47 µmol/l
14	Transferrin saturation with iron	16-15%	reduced
15	Desferal test	0.8-1.2 mg	Decrease
16	The content of protoporphyrins in erythrocytes	18-89 µmol/l	Upgraded
17	Painting on iron	Bone marrow contains sideroblasts	Disappearance of sideroblasts in punctate
18	ferritin level	15-150 µg/l	Decrease

4) instrumental studies (X-ray signs, EGDS - a picture).
In order to identify sources of blood loss, pathology of other organs and systems:
- X-ray examination of the gastrointestinal tract according to indications,
- X-ray examination of the chest organs according to indications,
- fibrocolonoscopy,
- sigmoidoscopy,
- Ultrasound of the thyroid gland.
- Sternal puncture for differential diagnosis

5) indications for consultation of specialists:
gastroenterologist - bleeding from the organs of the gastrointestinal tract;
dentist - bleeding from the gums,
ENT - nosebleeds,
oncologist - a malignant lesion that causes bleeding,
nephrologist - exclusion of kidney diseases,
phthisiatrician - bleeding on the background of tuberculosis,
pulmonologist - blood loss against the background of diseases of the bronchopulmonary system, gynecologist - bleeding from the genital tract,
endocrinologist - decreased thyroid function, the presence of diabetic nephropathy,
hematologist - to exclude diseases of the blood system, the ineffectiveness of the conducted ferrotherapy
proctologist - rectal bleeding,
infectiologist - if there are signs of helminthiasis.

Differential Diagnosis

Criteria	IDA	MDS (RA)	B12-deficient	Hemolytic anemia
				Hereditary	AIGA
Age	Most often young, up to 60 years	Over 60 years old	Over 60 years old	-	After 30 years
RBC shape	Anisocytosis, poikilocytosis	Megalocytes	Megalocytes	Sphero-, ovalocytosis	Norm
color indicator	lowered	Normal or increased	Promoted	Norm	Norm
Price-Jones curve	Norm	Shift right or normal	shift right	Normal or Right Shift	Shift left
Longevity of Erythra.	Norm	Normal or shortened	shortened	shortened	shortened
Coombs test	Negative	Negative sometimes positive	Negative	Negative	Positive
Osmotic resistance Er.	Norm	Norm	Norm	Increased	Norm
Peripheral blood reticulocytes	Relates magnification, absolute decrease	Reduced or increased	lowered, on the 5-7th day of treatment reticulocyte crisis	Enlarged	Increase
Peripheral blood leukocytes	Norm	Reduced	Possible downgrade	Norm	Norm
Platelets in peripheral blood	Norm	Reduced	Possible downgrade	Norm	Norm
Serum iron	Reduced	Increased or normal	Upgraded	Increased or normal	Increased or normal
Bone marrow	Increase in polychromatophils	Hyperplasia of all hematopoietic lineages, signs of cell dysplasia	Megaloblasts	Increased erythropoiesis with an increase in mature forms
Blood bilirubin	Norm	Norm	Possible increase	Increasing the indirect fraction of bilirubin
urine urobilin	Norm	Norm	Possible appearance	Persistent increase in urine urobilin

Differential diagnosis of iron deficiency anemia is carried out with other hypochromic anemias caused by impaired hemoglobin synthesis. These include anemia associated with a violation of the synthesis of porphyrins (anemia with lead poisoning, with congenital disorders of the synthesis of porphyrins), as well as thalassemia. Hypochromic anemia, unlike iron deficiency anemia, occurs with a high content of iron in the blood and depot, which is not used to form heme (sideroachresia); in these diseases, there are no signs of tissue iron deficiency.
The differential sign of anemia due to a violation of the synthesis of porphyrins is hypochromic anemia with basophilic puncture of erythrocytes, reticulocytes, enhanced erythropoiesis in the bone marrow with a large number of sideroblasts. Thalassemia is characterized by a target-like shape and basophilic puncture of erythrocytes, reticulocytosis, and the presence of signs of increased hemolysis.

Treatment

Treatment goals:
- Correction of iron deficiency.
- Comprehensive treatment of anemia and complications associated with it.
- Elimination of hypoxic conditions.
- Normalization of hemodynamics, systemic, metabolic and organ disorders.

Treatment tactics***:

non-drug treatment
With iron deficiency anemia, the patient is shown a diet rich in iron. The maximum amount of iron that can be absorbed from food in the gastrointestinal tract is 2 g per day. Iron from animal products is absorbed in the intestines in much greater quantities than from plant products. Divalent iron, which is part of the heme, is best absorbed. Meat iron is absorbed better, and liver iron is worse, since iron in the liver is found mainly in the form of ferritin, hemosiderin, and also in the form of heme. Small amounts of iron are absorbed from eggs and fruits. The patient is recommended the following products containing iron: beef, fish, liver, kidneys, lungs, eggs, oatmeal, buckwheat, beans, porcini mushrooms, cocoa, chocolate, herbs, vegetables, peas, beans, apples, wheat, peaches, raisins , prunes, herring, hematogen. It is advisable to take koumiss in a daily dose of 0.75-1 l, with good tolerance - up to 1.5 l. In the first two days, the patient is given no more than 100 ml of koumiss for each dose, from the 3rd day the patient takes 250 ml 3-4 times a day. It is better to take koumiss 1 hour before and 1 hour after breakfast, 2 hours before and 1 hour after lunch and dinner.
In the absence of contraindications (diabetes mellitus, obesity, allergies, diarrhea), honey should be recommended to the patient. Honey contains up to 40% fructose, which increases the absorption of iron in the intestines. Iron is best absorbed from veal (22%), from fish (11%); from eggs, beans, fruits, 3% of iron is absorbed, from rice, spinach, corn - 1%.

drug treatment
Separately list
- list of essential medicines
- list of additional medicines
*** in these sections, it is necessary to provide a link to a source that has a good evidence base, indicating the level of reliability. Links should be indicated in square brackets with numbering as they occur. This source should be listed in the list of references under the appropriate number.

Treatment of IDA should include the following steps:

1. Relief of anemia.
   B. Saturation therapy (recovery of iron stores in the body).
   B. Supportive care.

The daily dose for the prevention of anemia and the treatment of a mild form of the disease is 60-100 mg of iron, and for the treatment of severe anemia - 100-120 mg of iron (for iron sulfate).
The inclusion of ascorbic acid in iron salt preparations improves its absorption. For iron (III) polymaltose hydroxide doses can be higher, about 1.5 times in relation to the latter, because. the drug is non-ionic, it is tolerated much better than iron salts, while only the amount of iron that the body needs and only in an active way is absorbed.
It should be noted that iron is better absorbed with an "empty" stomach, so it is recommended to take the drug 30-60 minutes before a meal. With adequate administration of iron preparations in a sufficient dose, an increase in reticulocytes is noted on days 8-12, the Hb content increases by the end of the 3rd week. Normalization of red blood counts occurs only after 5-8 weeks of treatment.

All iron preparations are divided into two groups:
1. Ionic iron-containing preparations (salt, polysaccharide compounds of ferrous iron - Sorbifer, Ferretab, Tardiferon, Maxifer, Ranferon-12, Aktiferin, etc.).
2. Non-ionic compounds, which include ferric iron preparations, represented by an iron-protein complex and a hydroxide-polymaltose complex (Maltofer). Iron (III)-hydroxide polymaltose complex (Venofer, Kosmofer, Ferkail)

Table. Essential Iron Oral Medicines

A drug	Additional components	Dosage form	The amount of iron, mg
Monocomponent preparations
Aristoferon	ferrous sulfate	syrup - 200 ml, 5 ml - 200 mg
Ferronal	iron gluconate	tab., 300 mg	12%
Ferrogluconate	iron gluconate	tab., 300 mg	12%
Hemopher prolongatum	ferrous sulfate	tab., 325 mg	105 mg
iron wine	iron saccharate	solution, 200 ml 10 ml - 40 mg
Heferol	ferrous fumarate	capsules, 350 mg	100 mg
Combined drugs
Aktiferin	ferrous sulfate, D,L-serine ferrous sulfate, D,L-serine, glucose, fructose ferrous sulfate, D,L-serine, glucose, fructose, potassium sorbate	caps., 0.11385 g syrup, 5 ml-0.171 g drops, 1 ml - 0.0472 g	0.0345 g 0.034 g 0.0098 g
Sorbifer - durules	ferrous sulfate, ascorbic acid	tab., 320 mg	100 mg
Ferrstab		tab., 154 mg	33%
Folfetab	ferrous fumarate, folic acid	tab., 200 mg	33%
Ferroplect	ferrous sulfate, ascorbic acid	tab., 50 mg	10 mg
Ferroplex	ferrous sulfate, ascorbic acid	tab., 50 mg	20%
Fefol	ferrous sulfate, folic acid	tab., 150 mg	47 mg
Ferro foil	ferrous sulfate, folic acid, cyanocobalamin	caps., 100 mg	20%
Tardiferon - retard	ferrous sulfate, ascorbic	dragee, 256.3 mg	80 mg
	acid, mucoproteosis
Gino-Tardiferon	ferrous sulfate, ascorbic acid, mucoproteose, folic acid	dragee, 256.3 mg	80 mg
2Macrofer	ferrous gluconate, folic acid	effervescent tablets, 625 mg	12%
Fenyuls	ferrous sulfate, ascorbic acid, nicotinamide, vitamins group B	caps.,	45 mg
Irovit	ferrous sulfate, ascorbic acid, folic acid, cyanocobalamin, lysine monohydro- chloride	caps., 300 mg	100 mg
Ranferon-12	Ferrous fumarate, ascorbic acid, folic acid, cyanocobalamin, zinc sulfate	Caps., 300 mg	100 mg
Totem	Ferrous gluconate, manganese gluconate, copper gluconate	Ampoules with solution for drinking	50 mg
Globiron	Ferrous fumarate, folic acid, cyanocobalamin, pyridoxine, sodium docusate	Caps., 300 mg	100 mg
Gemsineral-TD	Ferrous fumarate, folic acid, cyanocobalamin	Caps., 200 mg	67 mg
Ferramin-Vita	Ferrous Aspartate, Ascorbic Acid, Folic Acid, Cyanocobalamin, Zinc Sulfate	Tablet, 60 mg
Maltofer		Drops, syrup, 10 mg Fe in 1 ml; Tab. chewable 100 mg
Maltofer Fall	iron polymaltose hydroxyl complex, folic acid	Tab. chewable 100 mg
Ferrum Lek	iron polymaltose hydroxyl complex	Tab. chewable 100 mg

For relief of mild IDA:
Sorbifer 1 tab. x 2 p. per day 2-3 weeks, Maxifer 1 tab. x 2 times a day, 2-3 weeks, Maltofer 1 tablet 2 times a day - 2-3 weeks, Ferrum-lek 1 tab x 3 r. in d. 2-3 weeks;
Moderate severity: Sorbifer 1 tab. x 2 p. per day 1-2 months, Maxifer 1 tab. x 2 times a day, 1-2 months, Maltofer 1 tablet 2 times a day - 1-2 months, Ferrum-lek 1 tab x 3 r. in d. 1-2 months;
Severe severity: Sorbifer 1 tab. x 2 p. per day 2-3 months, Maxifer 1 tab. x 2 times a day, 2-3 months, Maltofer 1 tablet 2 times a day - 2-3 months, Ferrum-lek 1 tab x 3 r. in d. 2-3 months.
Of course, the duration of therapy is influenced by the level of hemoglobin on the background of ferrotherapy, as well as a positive clinical picture!

Table. Iron preparations for parenteral administration.

Trade name	INN	Dosage form	The amount of iron, mg
Venofer IV	Iron III hydroxide sucrose complex	Ampoules 5.0	100 mg
Fercale i/m	Iron III dextran	Ampoules 2.0	100 mg
Cosmofer i/m, i/v		Ampoules 2.0	100 mg
Novofer-D in / m, in / in	Iron III hydroxide-dextran complex	Ampoules 2.0	100 mg/2ml

Indications for parenteral administration of iron preparations:
. Intolerance to iron preparations for oral administration;
. Iron malabsorption;
. Peptic ulcer of the stomach and duodenum during the period of exacerbation;
. Severe anemia and the vital need to quickly replenish iron deficiency, for example, preparation for surgery (refusal of hemocomponent therapy)
For parenteral administration, ferric iron preparations are used.
The course dose of iron preparations for parenteral administration is calculated by the formula:
A \u003d 0.066 M (100 - 6 Hb),
where A is the course dose, mg;
M is the patient's body weight, kg;
Hb is the content of Hb in the blood, g/l.

IDA treatment regimen:
1. At a hemoglobin level of 109-90 g/l, a hematocrit of 27-32%, prescribe a combination of drugs:

A diet that includes iron-rich foods - beef tongue, rabbit meat, chicken, porcini mushrooms, buckwheat or oatmeal, legumes, cocoa, chocolate, prunes, apples;

Salt, polysaccharide compounds of ferrous iron, iron (III)-hydroxide polymaltose complex in a total daily dose of 100 mg (oral intake) for 1.5 months with the control of a complete blood count 1 time per month, if necessary, extending the course of treatment up to 3 months;

Ascorbic acid 2 others x 3 r. in the house 2 weeks

2. If the hemoglobin level is below 90 g/l, hematocrit is below 27%, consult a hematologist.
Salt or polysaccharide compounds of ferrous iron or iron (III)-hydroxide polymaltose complex in a standard dosage. In addition to previous therapy, give iron (III)-hydroxide polymaltose complex (200 mg/10 ml) intravenously every other day. The amount of iron administered should be calculated according to the formula given in the manufacturer's instructions or iron dextran III (100 mg/2 ml) a day, intramuscularly (calculated according to the formula), with an individual selection of the course depending on hematological parameters, at this moment the intake of oral iron preparations is temporarily stopped;

3. When the hemoglobin level is normalized more than 110 g/l and the hematocrit is more than 33%, prescribe a combination of preparations of salt or polysaccharide compounds of ferrous iron or iron (III)-hydroxide polymaltose complex 100 mg 1 time per week for 1 month, under the control of hemoglobin levels, ascorbic acid 2 others x 3 r. in d. 2 weeks (not applicable for pathology of the gastrointestinal tract - erosion and ulcers of the esophagus, stomach), folic acid 1 tab. x 2 p. in d. 2 weeks.

4. If the hemoglobin level is less than 70 g/l, inpatient treatment in the hematology department, in case of exclusion of acute gynecological or surgical pathology. Mandatory preliminary examination by a gynecologist and surgeon.

With severe anemic and circulatory-hypoxic syndromes, leukofiltered erythrocyte suspension, further transfusions strictly according to absolute indications, according to the Order of the Minister of Health of the Republic of Kazakhstan dated July 26, 2012 No. 501. Minister of Health of the Republic of Kazakhstan dated November 6, 2009 No. 666 "On approval of the Nomenclature, Rules for the procurement, processing, storage, sale of blood and its components, as well as the Rules for the storage, transfusion of blood, its components and preparations"

In the preoperative period, in order to quickly normalize hematological parameters, transfusion of leukofiltered erythrocyte suspension, according to order No. 501;

Salt or polysaccharide compounds of ferrous iron or iron (III) hydroxide polymaltose complex (200 mg / 10 ml) intravenously every other day according to calculations according to the instructions and under the control of hematological parameters.

For example, the scheme for calculating the amount of the administered drug relative to Cosmofer:
Total dose (Fe mg) = body weight (kg) x (necessary Hb - actual Hb) (g / l) x 0.24 + 1000 mg (Fe reserve). Factor 0.24 = 0.0034 (iron content in Hb is 0.34%) x 0.07 (blood volume 7% of body weight) x 1000 (transition from g to mg). Heading dose in ml (with iron deficiency anemia) in terms of body weight (kg) and depending on Hb values ​​(g/l), which corresponds to:
60, 75, 90, 105 g/l:
60 kg - 36, 32, 27, 23 ml, respectively;
65 kg - 38, 33, 29, 24 ml, respectively;
70 kg - 40, 35, 30, 25 ml, respectively;
75 kg - 42, 37, 32, 26 ml, respectively;
80 kg - 45, 39, 33, 27 ml, respectively;
85 kg - 47, 41, 34, 28 ml, respectively;
90 kg - 49, 42, 36, 29 ml, respectively.

If necessary, treatment is signed in stages: emergency care, outpatient, inpatient.

Other treatments- No

Surgical intervention

Indications for surgical treatment are ongoing bleeding, an increase in anemia, due to causes that cannot be eliminated by drug therapy.

Prevention

Primary prevention is carried out in groups of people who do not currently have anemia, but there are circumstances predisposing to the development of anemia:
. pregnant and breastfeeding;
. adolescent girls, especially those with heavy periods;
. donors;
. women with profuse and prolonged menstruation.

Prevention of iron deficiency anemia in women with heavy and prolonged menstruation.
2 courses of prophylactic therapy lasting 6 weeks are prescribed (the daily dose of iron is 30-40 mg) or after menstruation for 7-10 days every month during the year.
Prevention of iron deficiency anemia in donors, children of sports schools.
1-2 courses of preventive treatment are prescribed for 6 weeks in combination with an antioxidant complex.
During the period of intensive growth of boys, iron deficiency anemia may develop. At this time, preventive treatment with iron preparations should also be carried out.

Secondary prevention is carried out for persons with previously cured iron deficiency anemia in the presence of conditions that threaten the development of a recurrence of iron deficiency anemia (heavy menstruation, uterine fibromyoma, etc.).

These groups of patients after the treatment of iron deficiency anemia are recommended a prophylactic course lasting 6 weeks (daily dose of iron - 40 mg), then two 6-week courses per year or taking 30-40 mg of iron daily for 7-10 days after menstruation. In addition, it is necessary to consume at least 100 g of meat daily.

All patients with iron deficiency anemia, as well as persons with risk factors for this pathology, should be registered with a general practitioner at a polyclinic at the place of residence with a mandatory general blood test and a study of serum iron content at least 2 times a year. At the same time, dispensary observation is also carried out, taking into account the etiology of iron deficiency anemia, i.e. the patient is on the dispensary account for the disease that caused iron deficiency anemia.

Further management
Clinical blood tests should be done monthly. In severe anemia, laboratory monitoring is carried out every week; in the absence of positive dynamics of hematological parameters, an in-depth hematological and general clinical examination is indicated.

Information

Sources and literature

1. Minutes of the meetings of the Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan, 2013
   1. List of used literature: 1. WHO. Official annual report. Geneva, 2002. 2. Iron deficiency anemia assessment, prevention and control. A guid for program managers - Geneva: World Health Organization, 2001 (WHO/NHD/01.3). 3. Dvoretsky L.I. IDA. Newdiamid-AO. M.: 1998. 4. Kovaleva L. Iron deficiency anemia. M: Doctor. 2002; 12:4-9. 5. G. Perewusnyk, R. Huch, A. Huch, C. Breymann. British Journal of Nutrition. 2002; 88:3-10. 6. Strai S.K.S., Bomford A., McArdle H.I. Iron transport across cell membranes:molecular holding of duodenal and placental iron uptake. Best Practice & Research Clin Haem. 2002; 5:2:243-259. 7. Schaeffer R.M., Gachet K., Huh R., Krafft A. Iron letter: recommendations for the treatment of iron deficiency anemia. Hematology and Transfusiology 2004; 49(4):40-48. 8. Dolgov V.V., Lugovskaya S.A., Morozova V.T., Pochtar M.E. Laboratory diagnosis of anemia. M.: 2001; 84. 9. Novik A.A., Bogdanov A.N. Anemia (from A to Z). A guide for doctors / ed. Acad. Yu.L. Shevchenko. - St. Petersburg: "Neva", 2004. - 62-74 p. 10. Papayan A.V., Zhukova L.Yu. Anemia in children: hands. For doctors. - St. Petersburg: Peter, 2001. - 89-127 p. 11. Alekseev N.A. anemia. - St. Petersburg: Hippocrates. - 2004. - 512 p. 12. Lewis S.M., Bane B., Bates I. Practical and laboratory hematology / transl. from English. ed. A.G. Rumyantsev. - M.: GEOTAR-Media, 2009. - 672 p.

Information

List of protocol developers with qualification data

A.M. Raisova - head. otd. therapy, Ph.D.
O.R. Khan - Assistant of the Department of Therapy of Postgraduate Education, Hematologist

Indication of no conflict of interest: No

Reviewers:

Indication of the conditions for the revision of the protocol: every 2 years.

Attached files

Attention!

• By self-medicating, you can cause irreparable harm to your health.
• The information posted on the MedElement website and in the mobile applications "MedElement (MedElement)", "Lekar Pro", "Dariger Pro", "Diseases: a therapist's guide" cannot and should not replace an in-person consultation with a doctor. Be sure to contact medical facilities if you have any diseases or symptoms that bother you.
• The choice of drugs and their dosage should be discussed with a specialist. Only a doctor can prescribe the right medicine and its dosage, taking into account the disease and the condition of the patient's body.
• The MedElement website and mobile applications "MedElement (MedElement)", "Lekar Pro", "Dariger Pro", "Diseases: Therapist's Handbook" are exclusively information and reference resources. The information posted on this site should not be used to arbitrarily change the doctor's prescriptions.
• The editors of MedElement are not responsible for any damage to health or material damage resulting from the use of this site.