Sideropenic syndrome in iron deficiency anemia. Iron deficiency conditions in gynecological and obstetric practice

The date: 01.07.2020

Iron - important element for our body. Without its normal content in the blood, various pathologies and diseases can develop, for example, sideropenic syndrome, which is fraught with various complications. It can develop in people of any gender and age, and pregnant women are also at risk.

sideropenic syndrome due to iron deficiency, which is fraught with a decrease in the activity of many vital enzymes. The syndrome occurs due to a lack of iron in the blood and, accordingly, a decrease in hemoglobin levels. The deficit itself develops due to a failure in its entry from the outside.

With iron deficiency anemia, which is the root cause of the hyposiderosis syndrome, there is no decrease in the quantitative index of red blood cells in the blood, and this is what distinguishes it from other types of anemia.

The main reasons for the development sideropenia syndrome are considered:

Improper nutrition with a violation of the balance of trace elements;
Various pathologies of the gastrointestinal tract;
Tumors of the lungs;
Profuse loss of blood;
The impact of helminths;
Hemangioma of internal organs;
The presence of an increased need for iron (especially often manifested in pregnant women and children).

However, at risk are:

newborns;
Children of small age;
Donors who donate blood frequently;
Women during pregnancy and lactation, as well as during menstrual bleeding.

The main group of people affected by sideropenic syndrome are pregnant and lactating women. In addition to their body, they must provide an important trace element and their child.

Also for the newborn, the source of iron is the mother's breast milk, which also causes a double need for an important trace element.

Symptoms

sideropenic syndrome may present with the following symptoms:

Ask your question to the doctor of clinical laboratory diagnostics

Anna Poniaeva. She graduated from the Nizhny Novgorod Medical Academy (2007-2014) and residency in clinical laboratory diagnostics (2014-2016).

Perversion of taste - a person begins to feel a desire to eat something that people usually do not like for its taste, or is not a food product at all. For example, it can be chalk, sand, toothpaste, raw meat or dough. Often occurs in adolescents and children, as well as women;
There is a special desire to eat as much salty, spicy and sour food as possible;
A change in smell - a person begins to feel cravings for aromas that are unpleasant for most people, such as paint, varnish, solvent, gasoline, naphthalene;
There is weakness in the muscles, increased fatigue, as well as muscle atrophy and a decrease in their tone. It is explained by the deficiency of the necessary proteins and enzymes in the tissues;
Abnormal changes in the skin - irritation, dryness, the appearance of cracks and peeling;
Abnormal changes in nails and hair - dull color, loss, brittleness, concavity of nails, their unevenness;
The appearance of angular stomatitis with the identification of cracks in the corners of the mouth;
The appearance of glossitis - this causes pain in the tongue, its tip turns red, the papillae begin to atrophy, caries and other dental diseases often appear;
Atrophy of the gastrointestinal mucosa begins, as indicated by dryness of the esophagus, difficulty in swallowing food, and subsequently the development of concomitant diseases;
A symptom of "blue sclera" is manifested, when the whites of the eyes acquire a bluish tint. This can be explained by the fact that with a lack of iron salts, a failure begins in the hydroxylation of amino acids and in the synthesis of collagen, the sclera becomes thin and transparent, the vessels of the eye shell become visible through it;
Uncontrolled urge to urinate, urinary incontinence during laughter or coughing, the appearance of urinary incontinence at night, which is explained by the weakening of the sphincter of the bladder;
The appearance of "sideropenic subfebrile condition", when the body temperature rises and stays at a high level for a long time, this includes susceptibility to infections, SARS and other diseases. It is caused by a violation in the work of leukocytes and a general decrease in immunity;
Decreased regeneration of tissues, skin and mucous membranes.

Iron is one of the elements without which the human body is not able to fully function. Nevertheless, there is a risk of violation of its reserves due to the influence of various factors and processes. One of the most common problems is iron deficiency anemia (IDA). It can develop in both children and adults, and even pregnant women are at risk. Given all the destructive potential of this disease, it is worth learning more about it.

What is meant by iron deficiency anemia?

Before studying sideropenic syndrome in iron deficiency anemia, it is necessary to touch on the essence of the problem associated with the lack of this trace element. Anemia of this type is a pathological condition that is characterized by a decrease in the level of hemoglobin in the blood due to a noticeable deficiency of iron in the body. The deficiency itself appears directly due to a violation of its intake and assimilation, or due to pathological losses of this element.

Iron deficiency anemia (aka sideropenic) differs from most other anemias in that it does not cause a decrease in red blood cells. In most cases, it is detected in women of reproductive age, pregnant women and children.

Causes of the disease

Initially, it is worth identifying risk factors for which iron deficiency may occur. Increased iron expenditure followed by anemia can be caused by repeated pregnancy, heavy menses, lactation, and rapid growth during puberty. Older people may have impaired iron utilization. Also, in old age, the number of diseases increases significantly, against the background of which anemia (renal failure, oncopathology, etc.) develops.

It is also worth worrying about such a problem as iron deficiency in the case when the absorption of this element at the level of erythrokaryocytes is disturbed (due to insufficient intake of iron along with food). As the cause of the development of iron deficiency anemia, it makes sense to consider any disease that leads to blood loss. These can be tumor and ulcerative processes in the gastrointestinal tract, endometriosis, chronic hemorrhoids, etc. In rare cases, there may be blood loss from the Meckel diverticulum of the small intestine, where a peptic ulcer develops due to the formation of peptin and hydrochloric acid.

Causes of iron deficiency anemia can be associated with glomic tumors in the lungs, pleura and diaphragm, as well as in the mesentery of the intestine and stomach. These tumors, which have a direct connection with the trailing arteries, can ulcerate and become a source of bleeding. The fact of blood loss is sometimes established in the case of acquired or hereditary pulmonary siderosis, which is complicated by hemorrhage. As a result of this process, iron in the human body is released, followed by its deposition in the lungs in the form of hemosiderin without the possibility of subsequent utilization. Loss of iron in the urine may be the result of a combination of diseases, such as acquired having an autoimmune nature.

Sometimes the causes of iron deficiency anemia, associated with the loss of iron along with the blood, are directly related to the influence of helminths, which, penetrating into the intestinal wall, cause damage to it and, as a result, microblood loss that can lead to the development of IDA. The risk of this type of anemia is real for those donors who donate blood frequently. And as another cause of blood loss worthy of attention, one can determine the hemangioma of the internal organs.

Iron in the human body can be poorly absorbed due to diseases of the small intestine, which occur in conjunction with intestinal dysbacteriosis and resection of a part of the small intestine. Previously, quite often it was possible to meet the opinion that atrophic gastritis, which has a reduced secretory function, should be considered as the real cause of iron deficiency anemia. In fact, such a disease can only have an auxiliary effect.

Latent iron deficiency (hidden, without clinical signs) can be detected at the biochemical level. Such a deficiency is characterized by the absence or a sharp decrease in the deposits of this microelement in bone marrow macrophages, which can be detected using special staining. It is worth repeating that at this stage, the loss of iron can only be recorded in the laboratory.

Another sign that allows you to detect a deficiency is a decrease in the content of ferritin in the blood serum.

Symptoms characteristic of iron-containing anemia

In order to make the symptoms more understandable, it makes sense to divide the process of formation of iron deficiency into 3 stages.

Speaking about the first stage, it is worth noting that it is not accompanied by clinical signs. It can be detected only by determining the amount of absorption of radioactive iron in the gastrointestinal tract and the amount of hemosiderin, which is contained in bone marrow macrophages.

The second stage can be characterized as a latent iron deficiency. It manifests itself through a decrease in exercise tolerance and significant fatigue. All these signs clearly indicate a lack of iron in the tissues due to a decrease in the concentration of iron-containing enzymes. In this state, two processes occur simultaneously: a decrease in the level of ferritin in erythrocytes and blood serum, as well as insufficient saturation of transferrin with iron.

The third stage should be understood as the clinical manifestation of IDA. The main symptoms of this period include trophic disorders of the skin, nails, hair, sideropenic signs and general weakness), an increase in muscle weakness, shortness of breath and signs of cerebral and heart failure (tinnitus, dizziness, pain in the heart, fainting).

The sideropenic symptoms during the third stage include the desire to eat chalk - geophagia, dysuria, urinary incontinence, craving for the smell of gasoline, acetone, etc. As for geophagy, in addition to iron deficiency, it may indicate a lack of magnesium and zinc in the body.

Describing the general signs of iron deficiency, you need to pay attention to symptoms such as weakness, loss of appetite, syncope, palpitations, headaches, irritability, low blood pressure flickering "flies" before the eyes, poor sleep at night and drowsiness during the day, a gradual increase in temperature, a decrease in attention and memory, as well as tearfulness and nervousness.

Influence of sideropenic syndrome

It is important to understand that iron is a component of many enzymes. For this reason, when its deficiency occurs, the activity of enzymes decreases and the normal course of metabolic processes in the body is disturbed. Thus, sideropenic syndrome is the cause of many symptoms:

Skin changes. When iron deficiency occurs, you may notice flaking and dry skin, which cracks over time. The occurrence of cracks is possible on the palms, in the corners of the mouth, on the feet and even in the anus. Hair with this syndrome turns gray early, becomes brittle and actively falls out. Approximately a quarter of patients are faced with brittleness, thinning and transverse striation of the nails. Tissue iron deficiency is actually the result of a lack of tissue enzymes.
Muscular changes. Iron deficiency leads to a lack of enzymes and myoglobin in the muscles. This leads to rapid fatigue and weakness. In adolescents, as well as in children, a lack of iron in enzymes provokes a delay in physical development and growth. Due to the fact that the muscular apparatus is weakened, the patient feels an imperative urge to urinate, difficulty with holding urine during laughter and coughing. Girls with iron deficiency often have to deal with bedwetting.

Sideropenic syndrome also leads to changes in the mucous membranes of the intestinal tract (cracks in the corners of the mouth, angular stomatitis, increased susceptibility to caries and periodontal disease). There is also a change in the perception of smells. With a similar syndrome, patients begin to like the smell of shoe polish, fuel oil, gasoline, gas, naphthalene, acetone, damp earth after rain, varnishes.

Changes also affect taste sensations. We are talking about a strong desire to taste such non-food products as tooth powder, raw dough, ice, sand, clay, minced meat, cereals.

With a disease such as sideropenic syndrome, the mucous membranes of the lower and upper membranes of the respiratory tract change. Such changes lead to the development of atrophic pharyngitis and rhinitis. The vast majority of people with iron deficiency develop blue sclera syndrome. As a result of a violation of the hydrocollation of lysine, a failure occurs in the process of collagen synthesis.

With a lack of iron, there is a risk of changes in the immune system. We are talking about lowering the level of certain immunoglobulins, B-lysines and lysozyme. There is also a violation of the phagocytic activity of neutrophils and cellular immunity.

With such a problem as sideropenic syndrome, the appearance of dystrophic changes in internal organs is not excluded. These include secondary anemic sideropenic myocardial dystrophy. It manifests itself by strengthening the first tone at the apex of the heart and expanding the border of percussion dullness.

With iron deficiency, the condition of the digestive tract can also change. These are symptoms such as sideropenic dysphagia, dryness of the esophageal mucosa and, possibly, its destruction. Patients begin to feel difficulty in the process of swallowing in the evening or in a state of overwork. Perhaps a violation of tissue respiration, leading to a gradual atrophy of the gastric mucosa, in which atrophic gastritis develops. Sideropenic syndrome can also lead to a decrease in gastric secretion, which can result in achilia.

Why does iron deficiency anemia develop in pregnant women?

In women who are carrying a child, iron deficiency may be due to the appearance of extragenital and gynecological diseases before pregnancy, as well as a high need for iron during fetal development.

Many factors can affect the occurrence of a disease such as anemia. Iron deficiency in pregnant women usually develops for the following reasons:

the chronic ones mentioned above (heart defects, duodenal and stomach ulcers, atrophic gastritis, kidney pathology, helminthic invasions, liver diseases, diseases that are accompanied by nosebleeds, and hemorrhoids);
exposure to a woman's body of various chemicals and pesticides that can interfere with the absorption of iron;
congenital deficiency;
violations of the process of iron absorption (chronic pancreatitis, enteritis, resection of the small intestine, intestinal dysbacteriosis);
malnutrition, which is not able to ensure the supply of this microelement to the body in the required amount.

iron deficiency in children

Throughout the entire period of pregnancy in the child's body, the formation of the basic composition of this microelement in the blood takes place. However, in the third trimester, one can observe the most active intake of iron through the placental vessels. In a full-term baby, the normal level of its content in the body should be 400 mg. At the same time, in those children who were born before the required time, this indicator does not rise above 100 mg.

It is also important to take into account the fact that mother's milk contains enough of this trace element to replenish the reserves of the child's body before the age of 4 months. Therefore, if breastfeeding is stopped too soon, the baby may develop an iron deficiency. The causes of IDA in children may be associated with the prenatal period. We are talking about various infectious diseases of the mother during pregnancy, with late and early toxicosis, as well as hypoxia syndrome. Factors such as multiple pregnancies in fetal transfusion syndrome, chronic iron deficiency anemia during pregnancy, and uteroplacental bleeding may also affect iron depletion.

In the intranatal period, the danger is massive bleeding during delivery and premature ligation of the umbilical cord. As for the postpartum period, at this stage, iron deficiency can be the result of an accelerated growth rate of the child, early feeding with whole cow's milk and diseases that are accompanied by a violation of the absorption function of the intestine.

Blood test to detect IDA

This diagnostic method is necessary in order to determine the low level of hemoglobin and red blood cells. It can be used to identify hemolytic and iron deficiency anemia by fixing the morphological characteristics of erythrocytes and erythrocyte mass.

In the case of the development of IDA, a biochemical blood test will necessarily show a decrease in the concentration of serum ferritin, an increase in TI, a decrease in concentration, and a significantly lower saturation of this transferrin microelement compared to the norm.

It is important to know that you should not drink alcohol the day before the test. You should not eat 8 hours before the diagnosis, only clean water without gas is allowed.

Differential Diagnosis

In this case, the medical history can significantly help in making a diagnosis. Iron deficiency anemia often develops along with other diseases, so this information will be extremely useful. As for the differential approach to the diagnosis of IDA, it is carried out with those diseases that can cause iron deficiency. At the same time, thalassemia is characterized by clinical and laboratory signs of erythrocyte shemolysis (an increase in the size of the spleen, an increase in the level of indirect bilirubin, reticulocytosis and a high iron content in the depot and blood serum).

Treatment methods

In order to overcome such a problem as a lack of iron in the blood, it is necessary to correctly approach the recovery strategy. An individual approach should be shown to each patient, otherwise it is difficult to achieve the desired level of effectiveness of therapeutic measures.

With such a problem as iron deficiency in the body, treatment primarily involves the impact on the factor that provokes the occurrence of anemia. Correction of this condition with the help of medications also plays an important role in the recovery process.

Attention should also be paid to nutrition. The diet of patients with IDA should include foods that contain heme iron. These are rabbit meat, veal, beef. Do not forget about succinic, citric and ascorbic acids. To compensate for iron deficiency, the use of dietary fiber, calcium, oxalates and polyphenols (soy protein, tea, coffee, chocolate, milk) will help.

Regarding the topic of drug treatment in more detail, it is worth noting that iron preparations are prescribed in a course of 1.5 to 2 months. After the level of Hb is normalized, maintenance therapy is indicated with a half dose of the drug for 4-6 weeks.

Iron-containing drugs for anemia are taken at the rate of 100-200 mg / day. After the dosage is reduced to 30-60 g (2-4 months). The following drugs can be attributed to the most popular: "Tardiferon", "Maltofer", "Totema", "Ferroplex", "Sorbifer", "Ferrum Lek". As a rule, medication is taken before meals. The exception is patients diagnosed with gastritis and ulcers. The above medicines should not be washed down with products that can bind iron (milk, tea, coffee). Otherwise, their effect will be nullified. It is worth initially being aware of the harmless side effect that iron-containing drugs can produce in case of anemia (meaning the dark color of the teeth). You should not be afraid of such a reaction. As for the unpleasant consequences of drug treatment, gastrointestinal disorders (constipation, abdominal pain) and nausea may occur.

The main way to administer drugs for iron deficiency is by mouth. But in the case of the development of intestinal pathology, in which the absorption process is disturbed, parenteral administration is indicated.

Prevention

In the vast majority of cases, with the help of drug treatment, doctors manage to correct iron deficiency. Nevertheless, the disease can recur and develop again (extremely rare). To avoid such a development of events, prevention of iron deficiency anemia is necessary. This means annual monitoring of the parameters of a clinical blood test, the rapid elimination of any causes of blood loss and good nutrition. For those who are at risk, the doctor may prescribe the necessary medications for preventive purposes.

Obviously, the lack of iron in the blood is a very serious problem. Any medical history can confirm this. Iron deficiency anemia, no matter what the patient is, is a prime example of a highly devastating disease. Therefore, at the first symptoms of a deficiency of this microelement, it is necessary to consult a doctor and undergo a course of treatment in a timely manner.

Iron-deficiency anemia. Sideropenic syndrome Caused by a decrease in the activity of iron-containing enzymes Degenerative changes in the skin and its appendages (dry skin and hair, layering, change in the shape of nails, atrophic changes in the mucous membranes, dysphagia) Perversion of taste and smell (the desire to eat earth, the smell of gasoline seems pleasant) Muscular hypotension ( enuresis, urinary incontinence). Anemic syndrome Caused by the development of anemic hypoxia Paleness of the skin and mucous membranes Decrease in appetite Increased fatigue, decreased performance Dizziness, tinnitus Prolonged iron deficiency leads to a delay in psychomotor and physical development, an increased susceptibility to infectious diseases, reduced ability to learn, cognitive activity.

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Blood diseases

"Chronic leukemia" - The cervical and supraclavicular lymph nodes are usually enlarged first, then the axillary ones. Forecast. Clinical forms of CLL. The cervical and axillary lymph nodes are the first to enlarge. Symptoms develop gradually over a long period of time. RAI - classification of chronic lymphocytic leukemia. Chronic leukemias differ from acute ones in the differentiation of tumor cells and a longer staging course.

"DIC-syndrome" - Acute DIC syndrome. Acute bleeding. Assessment of the severity of acute massive blood loss. Hypocoagulation phase of DIC. hypercoagulable phase. hypocoagulation phase. Treatment. Classification. Disseminated intravascular coagulation. Hypercoagulable phase of DIC. Transfusion of a solution of crystalloids.

"Myeloma" - Such kidneys are called "myeloma shriveled kidneys". Myeloma cell infiltrates are observed in the internal organs. "Flaming" (fuchsile) myeloid cells. Bone lesion Clinical picture. Assessment of the degree of disability of patients. Results of instrumental examination of patients.

"Paraproteinemic hemoblastoses" - Paraproteinemic hemoblastoses: a group of neoplastic diseases. Anemia, swollen lymph nodes. Franklin's disease. Alpha heavy chain disease. The disease is very rare. General symptoms. Plasmapheresis. What changes in the bone marrow punctate will be in case of illness. interactive questions.

"Anemia in children" - Sideroblastic anemia. Asymptomatic carrier. Anemia Diamond. Coombs test. Diagnostics. Important for determining blood compatibility. inclusions in erythrocytes. Acquired hemolytic anemia. Acquired autoimmune hemolytic anemia. hereditary spherocytosis. Congenital aplastic anemia.

- a syndrome caused by iron deficiency and leading to a violation of hemoglobinopoiesis and tissue hypoxia. Clinical manifestations are general weakness, drowsiness, reduced mental performance and physical endurance, tinnitus, dizziness, fainting, shortness of breath on exertion, palpitations, and pallor. Hypochromic anemia is confirmed by laboratory data: a study of a clinical blood test, serum iron, FBC and ferritin. Therapy includes a therapeutic diet, taking iron supplements, and in some cases, a transfusion of red blood cells.

ICD-10

D50

General information

Iron deficiency (microcytic, hypochromic) anemia is an anemia caused by a lack of iron, which is necessary for the normal synthesis of hemoglobin. Its prevalence in the population depends on sex, age and climatic and geographical factors. According to generalized data, about 50% of young children, 15% of women of reproductive age and about 2% of men suffer from hypochromic anemia. Hidden tissue iron deficiency is detected in almost every third inhabitant of the planet. Microcytic anemia in hematology accounts for 80–90% of all anemias. Since iron deficiency can develop under a variety of pathological conditions, this problem is relevant for many clinical disciplines: pediatrics, gynecology, gastroenterology, etc.

The reasons

Every day, about 1 mg of iron is lost with sweat, feces, urine, and desquamated skin cells, and about the same amount (2-2.5 mg) enters the body with food. An imbalance between the body's need for iron and its intake or loss contributes to the development of iron deficiency anemia. Iron deficiency can occur both under physiological conditions and as a result of a number of pathological conditions and be due to both endogenous mechanisms and external influences:

Blood loss

Most often, anemia is caused by chronic blood loss: heavy menstruation, dysfunctional uterine bleeding; gastrointestinal bleeding from erosions of the mucous membrane of the stomach and intestines, gastroduodenal ulcers, hemorrhoids, anal fissures, etc. Hidden, but regular blood loss is observed with helminthiases, hemosiderosis of the lungs, exudative diathesis in children, etc.

A special group is made up of people with blood diseases - hemorrhagic diathesis (hemophilia, von Willebrand disease), hemoglobinuria. Perhaps the development of posthemorrhagic anemiacaused by simultaneous, but massive bleeding during injuries and operations. Hypochromic anemia can occur due to iatrogenic causes - in donors who often donate blood; CKD patients on hemodialysis.

Violation of the intake, absorption and transport of iron

Nutritional factors include anorexia, vegetarianism and following diets with restriction of meat products, poor nutrition; in children - artificial feeding, late introduction of complementary foods. A decrease in iron absorption is characteristic of intestinal infections, hypoacid gastritis, chronic enteritis, malabsorption syndrome, conditions after resection of the stomach or small intestine, gastrectomy. Much less often, iron deficiency anemia develops as a result of a violation of the transport of iron from the depot with insufficient protein-synthetic function of the liver - hypotransferrinemia and hypoproteinemia (hepatitis, liver cirrhosis).

Increased iron consumption

The daily need for a trace element depends on gender and age. The need for iron is highest in preterm infants, young children and adolescents (due to high rates of development and growth), women of the reproductive period (due to monthly menstrual losses), pregnant women (due to the formation and growth of the fetus), nursing mothers ( due to consumption in the composition of milk). It is these categories that are most vulnerable to the development of iron deficiency anemia. In addition, an increase in the need and consumption of iron in the body is observed in infectious and tumor diseases.

Pathogenesis

In terms of its role in ensuring the normal functioning of all biological systems, iron is an essential element. The supply of oxygen to cells, the course of redox processes, antioxidant protection, the functioning of the immune and nervous systems, etc., depend on the level of iron. On average, the iron content in the body is at the level of 3-4 g. More than 60% of iron (> 2 g) is in the composition of hemoglobin, 9% - in the composition of myoglobin, 1% - in the composition of enzymes (heme and non-heme). The rest of the iron in the form of ferritin and hemosiderin is located in the tissue depot - mainly in the liver, muscles, bone marrow, spleen, kidneys, lungs, heart. Approximately 30 mg of iron circulates continuously in plasma, being partially bound by the main plasma iron-binding protein, transferrin.

With the development of a negative balance of iron, the reserves of the microelement contained in tissue depots are mobilized and consumed. At first, this is enough to maintain an adequate level of Hb, Ht, and serum iron. As the tissue reserves are depleted, the erythroid activity of the bone marrow increases compensatory. With the complete depletion of endogenous tissue iron, its concentration begins to decrease in the blood, the morphology of erythrocytes is disturbed, and the synthesis of heme in hemoglobin and iron-containing enzymes decreases. The oxygen transport function of the blood suffers, which is accompanied by tissue hypoxia and degenerative processes in the internal organs (atrophic gastritis, myocardial dystrophy, etc.).

Classification

Iron deficiency anemia does not occur immediately. Initially, a pre-latent iron deficiency develops, characterized by the depletion of only the reserves of deposited iron, while the transport and hemoglobin pool is preserved. At the stage of latent deficiency, a decrease in the transport iron contained in the blood plasma is noted. Actually hypochromic anemia develops with a decrease in all levels of metabolic iron reserves - deposited, transport and erythrocyte. In accordance with the etiology, anemia is distinguished: posthemorrhagic, alimentary, associated with increased consumption, initial deficiency, insufficient resorption and impaired transport of iron. According to the severity of iron deficiency anemia are divided into:

Lungs(Hb 120-90 g/l). Occur without clinical manifestations or with their minimal severity.
Medium(Hb 90-70 g/l). Accompanied by circulatory-hypoxic, sideropenic, hematological syndromes of moderate severity.
Heavy(Hb

Symptoms

Circulatory-hypoxic syndrome is caused by a violation of hemoglobin synthesis, oxygen transport and the development of hypoxia in tissues. This finds its expression in a feeling of constant weakness, increased fatigue, drowsiness. Patients are haunted by tinnitus, flashing "flies" before the eyes, dizziness, turning into fainting. Characterized by complaints of palpitations, shortness of breath that occurs during exercise, increased sensitivity to low temperatures. Circulatory-hypoxic disorders can aggravate the course of concomitant coronary artery disease, chronic heart failure.

The development of sideropenic syndrome is associated with a deficiency of tissue iron-containing enzymes (catalase, peroxidase, cytochromes, etc.). This explains the occurrence of trophic changes in the skin and mucous membranes. Most often they are manifested by dry skin; striated, brittle and deformed nails; increased hair loss. On the part of the mucous membranes, atrophic changes are typical, which is accompanied by the phenomena of glossitis, angular stomatitis, dysphagia, atrophic gastritis. There may be an addiction to pungent odors (gasoline, acetone), a distortion of taste (the desire to eat clay, chalk, tooth powder, etc.). Signs of sideropenia are also paresthesia, muscle weakness, dyspeptic and dysuric disorders. Asthenovegetative disorders are manifested by irritability, emotional instability, decreased mental performance and memory.

Complications

Since IgA loses its activity in conditions of iron deficiency, patients become susceptible to frequent ARVI, intestinal infections. Patients are haunted by chronic fatigue, loss of strength, decreased memory and concentration. The long course of iron deficiency anemia can lead to the development of myocardial dystrophy, recognized by the inversion of the T waves on the ECG. With extremely severe iron deficiency, an anemic precoma develops (drowsiness, shortness of breath, a sharp pallor of the skin with a cyanotic tint, tachycardia, hallucinations), and then a coma with loss of consciousness and lack of reflexes. With massive rapid blood loss, hypovolemic shock occurs.

Diagnostics

The appearance of the patient may indicate the presence of iron deficiency anemia: pale skin with an alabaster tint, pastosity of the face, legs and feet, edematous "bags" under the eyes. Auscultation of the heart reveals tachycardia, deafness of tones, a quiet systolic murmur, and sometimes arrhythmia. In order to confirm anemia and determine its causes, a laboratory examination is performed.

Laboratory tests. In favor of the iron deficiency nature of anemia is evidenced by a decrease in hemoglobin, hypochromia, micro- and poikilocytosis in the general blood test. When evaluating biochemical parameters, there is a decrease in the level of serum iron and ferritin concentration (60 µmol/l), a decrease in transferrin saturation with iron (
Instrumental techniques. To establish the cause of chronic blood loss, an endoscopic examination of the gastrointestinal tract (EGDS, colonoscopy,), X-ray diagnostics (irrigoscopy, radiography of the stomach) should be carried out. Examination of the organs of the reproductive system in women includes ultrasound of the small pelvis, examination on the armchair, according to indications - hysteroscopy with WFD.
Study of bone marrow punctate. A smear microscopy (myelogram) shows a significant decrease in the number of sideroblasts, characteristic of hypochromic anemia. Differential diagnosis is aimed at excluding other types of iron deficiency conditions - sideroblastic anemia, thalassemia.

Treatment

The main principles of the treatment of iron deficiency anemia include the elimination of etiological factors, correction of the diet, replenishment of iron deficiency in the body. Etiotropic treatment is prescribed and carried out by specialists gastroenterologists, gynecologists, proctologists, etc.; pathogenetic - by hematologists. In iron-deficient conditions, a full-fledged diet is shown with the obligatory inclusion in the diet of products containing heme iron (veal, beef, lamb, rabbit meat, liver, tongue). It should be remembered that ascorbic, citric, succinic acid contribute to the strengthening of ferrosorption in the gastrointestinal tract. Iron absorption is inhibited by oxalates and polyphenols (coffee, tea, soy protein, milk, chocolate), calcium, dietary fiber, and other substances.

At the same time, even a balanced diet is not able to eliminate the already developed iron deficiency, so patients with hypochromic anemia are shown replacement therapy with ferropreparations. Iron preparations are prescribed for a course of at least 1.5-2 months, and after normalization of the Hb level, maintenance therapy is carried out for 4-6 weeks with a half dose of the drug. For the pharmacological correction of anemia, preparations of ferrous and ferric iron are used. In the presence of vital indications resort to blood transfusion therapy.

Forecast and prevention

In most cases, hypochromic anemia is successfully corrected. However, if the cause is not eliminated, iron deficiency can recur and progress. Iron deficiency anemia in infants and young children can cause a delay in psychomotor and intellectual development (IDD). In order to prevent iron deficiency, annual monitoring of the parameters of a clinical blood test, good nutrition with sufficient iron content, and timely elimination of sources of blood loss in the body are necessary. It should be borne in mind that iron, contained in meat and liver in the form of heme, is best absorbed; non-heme iron from plant foods is practically not absorbed - in this case, it must first be restored to heme iron with the participation of ascorbic acid. Persons at risk may be shown to take iron supplements as prescribed by a specialist.

Publications

Medical newspaper No. 37 05/19/2004

iron deficiency anemia during pregnancy

BUTNEMIA - clinical and hematological syndrome, caused by a decrease in the content of hemoglobin and, in most cases, erythrocytes per unit volume of blood. In the structure of morbidity in pregnant women, iron deficiency anemia (IDA) occupies a leading position and accounts for 95-98%. According to WHO, the frequency of IDA in pregnant women does not depend on their social status and financial situation and ranges from 21% to 80% in different countries. In the last decade in Russia, the frequency of IDA has increased by 6.3 times.

BIOLOGICAL SIGNIFICANCE OF IRON

IDA is characterized by a decrease in the amount of iron in the body (in the blood, bone marrow and depot), which disrupts the synthesis of heme, as well as proteins containing iron (myoglobin, iron-containing tissue enzymes). The biological significance of iron in the body is very high. This microelement is a universal component of a living cell, participating in many metabolic processes, body growth, the functioning of the immune system, as well as in the processes of tissue respiration. Iron makes up only 0.0065% of body weight in a woman weighing 60 kg - about 2.1 g (35 mg / kg of body weight).

The main source of iron for humans are food products of animal origin (meat, pork liver, kidneys, heart, yolk), which contain iron in the most easily digestible form (as part of heme). The amount of iron in food with a full and varied diet is 10-15 mg / day, of which only 10-15% is absorbed. Its exchange in the body is due to many factors.

Iron absorption occurs mainly in the duodenum and proximal jejunum, where in an adult, about 1-2 mg per day is absorbed from food, iron is more easily absorbed as part of the heme. Absorption of non-heme iron is determined by diet and gastrointestinal secretion.

Iron absorption is inhibited by tannins contained in tea, carbonates, oxalates, phosphates, ethylenediaminetetraacetic acid used as a preservative, antacids, tetracyclines. Ascorbic, citric, succinic and malic acids, fructose, cysteine, sorbitol, nicotinamide increase the absorption of iron. Heme forms of this element are little affected by nutritional and secretory factors. The easier absorption of heme iron is the reason for its better utilization from animal products compared to plant products. The degree of absorption of iron depends on both its amount in the food consumed and its bioavailability.

Transport to iron tissues is carried out by a specific carrier - the plasma protein transferrin. Almost all iron circulating in the blood plasma is rigidly but reversibly connected with the latter. Transferrin transports iron to the main depots of the body, in particular to the bone marrow, where it is bound by erythroblasts and used for the synthesis of hemoglobin and proerythroblasts. In a smaller volume, it is transported to the liver and spleen.

The plasma iron level is about 18 µmol/l, and the total serum iron-binding capacity is 56 µm/l. Thus, transferrin is saturated with iron by 30%. When transferrin is completely saturated in plasma, low molecular weight iron begins to be determined, which is deposited in the liver and pancreas, causing their damage. After 100-120 days, erythrocytes in the system of monocytes and macrophages in the liver, spleen and bone marrow disintegrate. The iron released in this process is used to form hemoglobin and other iron compounds, that is, the body does not lose it.

The higher the saturation of transferrin with iron, the higher the utilization of the latter by tissues. The deposition of iron is carried out by the proteins ferritin and hemosiderin, and is stored in cells in the form of ferritin. In the form of hemosiderin, iron accumulates, as a rule, in the liver, spleen, pancreas, skin and joints. The physiological loss of iron in the urine, sweat, feces, through the skin, hair and nails does not depend on gender and is 1-2 mg / day, in women during menstruation - 2-3 mg / day.

Thus, the exchange of iron in the human body is one of the most highly organized processes, while almost all of the iron released during the breakdown of hemoglobin and other iron-containing proteins is reutilized. Iron metabolism is highly dynamic, with a complex cycle of storage, use, transport, breakdown, and reuse.

IRON DEFICIENCY IN THE BODY

Iron deficiency is a common clinical and hematological syndrome observed due to the low content of this element in the body. Currently, the following three forms of iron deficiency conditions are conditionally distinguished.

Prelatent iron deficiency (reserve iron deficiency) is characterized by a decrease in iron stores, primarily plasma ferritin, maintaining the level of serum iron, hemoglobin fund and the absence of sideropenic syndrome.

Latent iron deficiency ("anemia without anemia", deficiency of transport iron) is characterized by the preservation of the hemoglobin fund, the appearance of clinical signs of sideropenic syndrome, a decrease in the level of serum iron (hypopherremia), an increase in the iron-binding capacity of the serum, the presence of microcytic and hypochromic erythrocytes.

Iron-deficiency anemia occurs with a decrease in the hemoglobin fund of iron. At the same time, anemia observed before pregnancy and anemia diagnosed during gestation are distinguished.

The development of IDA before pregnancy is promoted by endogenous iron deficiency associated not only with alimentary factors, but also with various diseases (gastric ulcer, hiatal hernia, impaired iron absorption due to enteritis, helminthic invasions, hypothyroidism, etc.) .

Pregestational IDA adversely affects pregnancy, contributing to the risk of miscarriage, miscarriage, weakness of labor, postpartum hemorrhage, and infectious complications.

Pregnancy predisposes to the onset of an iron deficiency state, since during this period there is an increased consumption of iron, which is necessary for the development of the placenta and fetus. During pregnancy, the development of anemia can also be associated with hormonal changes, the development of early toxicosis, which prevents the absorption of iron, magnesium, and phosphorus in the gastrointestinal tract, which are necessary for hematopoiesis. In this case, the main reason is a progressive iron deficiency associated with its utilization for the needs of the fetoplacental complex and to increase the mass of circulating erythrocytes.

The average iron content in the human body is 4.5-5 g. No more than 1.8-2 mg is absorbed from food per day. During gestation, iron is intensively consumed due to the intensification of metabolism: in the 1st trimester, the need for it does not exceed the need before pregnancy and is 0.6-0.8 mg / day; in the 2nd trimester increases to 2-4 mg; in the 3rd trimester increases to 10-12 mg / day. For the entire gestational period, 500 mg of iron is consumed for hematopoiesis, of which 280-290 mg for the needs of the fetus, 25-100 mg for the placenta.

By the end of pregnancy, iron depletion of the mother's body inevitably occurs due to its deposition in the fetoplacental complex (about 450 mg), an increase in the volume of circulating blood (about 500 mg) and in the postpartum period due to physiological blood loss in the 3rd stage of labor (150 mg ) and lactation (400 mg). The total loss of iron by the end of pregnancy and lactation is 1200-1400 mg.

The process of iron absorption during pregnancy increases and amounts to 0.6-0.8 mg/day in the 1st trimester, 2.8-3 mg/day in the 2nd trimester, and up to 3.5-4 mg/day in the 3rd trimester. mg/day However, this does not compensate for the increased consumption of the element, especially during the period when the bone marrow hematopoiesis of the fetus begins (16-20 weeks of pregnancy) and the mass of blood in the mother's body increases. Moreover, the level of deposited iron in 100% of pregnant women decreases by the end of the gestational period. It takes at least 2-3 years to restore iron stores spent during pregnancy, childbirth and lactation.

Latent iron deficiency is detected in 20-25% of women. In the 3rd trimester of pregnancy, it is found in almost 90% of women and persists after childbirth and lactation in 55% of them. In the second half of pregnancy, anemia is diagnosed almost 40 times more often than in the first weeks, which is undoubtedly associated with impaired hematopoiesis due to changes caused by gestation. According to WHO experts, anemia in puerperas should be considered a condition in which the hemoglobin level is less than 100 g / l, in pregnant women - less than 110 g / l in the 1st and 3rd trimesters and less than 105 g / l in the 2nd trimester.

Iron deficiency anemia is characterized by a decrease in hemoglobin fund. The main laboratory criteria for IDA are a low color index (< 0,85), гипохромия эритроцитов, снижение средней концентрации гемоглобина в эритроците, микроцитоз и пойкилоцитоз эритроцитов (в мазке периферической крови), уменьшение количества сидеробластов в пунктате костного мозга, уменьшение содержания железа в сыворотке крови (< 12,5 мкмоль/л), повышение общей железосвязывающей способности сыворотки (ОЖСС) >85 µmol/l (an indicator of "starvation"), a decrease in serum ferritin (<15 мкг/л).

The severity of the course of the disease is judged by the level of hemoglobin. A mild degree of anemia is characterized by a decrease in hemoglobin to 110-90 g/l, an average degree - from 89 g/l to 70 g/l, a severe one - 69 g/l and below. Physiological hemodilution, or hydremia of pregnant women, caused by hyperplasma, usually within 28-30 weeks, should be distinguished from anemia of pregnancy.

Physiological hyperplasmia is observed in 40-70% of pregnant women. Starting from the 28-30th week of a physiological pregnancy, there is an uneven increase in the volume of circulating blood plasma and the volume of red blood cells. As a result of these changes, the hematocrit index decreases from 0.40 to 0.32, the number of erythrocytes decreases from 4.0 x 1012 / l to 3.5 x 1012 / l, the hemoglobin index from 140 g / l to 110 g / l (from 1st to 3rd trimester). The main difference between these changes and true anemia is the absence of morphological changes in erythrocytes. A further decrease in red blood counts should be regarded as true anemia. Such changes in the picture of red blood, as a rule, do not affect the condition and well-being of the pregnant woman and do not require treatment. After childbirth, the normal blood picture is restored within 1-2 weeks.

Risk groups for the development of IDA during pregnancy are due to many factors, among which past diseases should be distinguished (frequent infections: acute pyelonephritis, dysentery, viral hepatitis); extragenital background pathology (chronic tonsillitis, chronic pyelonephritis, rheumatism, heart defects, diabetes mellitus, gastritis); menorrhagia; frequent pregnancies; pregnancy during lactation; teenage pregnancy; anemia in previous pregnancies; vegetarian diet; hemoglobin level in the 1st trimester of pregnancy is less than 120 g/l; complications of pregnancy (early toxicosis, viral diseases, the threat of interruption); multiple pregnancy; polyhydramnios.

CLINIC

Clinical symptoms of IDA usually appear with anemia of moderate severity. With a mild course, a pregnant woman usually does not show any complaints, and only laboratory indicators serve as objective signs of anemia. The clinical picture of IDA consists of general symptoms caused by hemic hypoxia (general anemic syndrome) and signs of tissue iron deficiency (sideropenic syndrome).

The general anemic syndrome is manifested by pallor of the skin and mucous membranes, weakness, increased fatigue, dizziness, headaches (more often in the evening), shortness of breath during exercise, palpitations, fainting, flickering "flies" before the eyes at a low level of blood pressure. Often, a pregnant woman suffers from drowsiness during the day and complains of poor falling asleep at night, irritability, nervousness, tearfulness, decreased memory and attention, loss of appetite are noted.

sideropenic syndrome includes the following:

1. Changes in the skin and its appendages (dryness, peeling, easy cracking, pallor). Hair is dull, brittle, split, turn gray early, fall out intensively. In 20-25% of patients, changes in the nails are noted: thinning, brittleness, transverse striation, sometimes spoon-shaped concavity (koilonychia).

2. Changes in the mucous membranes (glossitis with atrophy of the papillae, cracks in the corners of the mouth, angular stomatitis).

3. Damage to the gastrointestinal tract (atrophic gastritis, atrophy of the esophageal mucosa, dysphagia).

4. Imperative urge to urinate, inability to hold urine when laughing, coughing, sneezing.

5. Addiction to unusual smells (gasoline, kerosene, acetone).

6. Perversion of taste and smell sensations.

7. Sideropenic myocardial dystrophy, tendency to tachycardia, hypotension, shortness of breath.

8. Disturbances in the immune system (the level of lysozyme, B-lysins, complement, some immunoglobulins, the level of T- and B-lymphocytes decreases), which contributes to a high infectious morbidity in IDA.

9. Functional liver failure (hypoalbuminemia, hypoprothrombinemia, hypoglycemia occur).

10. Fetoplacental insufficiency (with anemia, dystrophic processes develop in the myometrium and placenta, which lead to a decrease in the level of hormones produced - progesterone, estradiol, placental lactogen).

Iron deficiency anemia is accompanied by numerous complications during pregnancy and childbirth for the mother and fetus. In the early stages of gestation with IDA, the risk of miscarriage is high. In the presence of severe disorders of erythropoiesis, the development of obstetric pathology is possible in the form of premature detachment of the placenta, bleeding during childbirth and the postpartum period. IDA has an adverse effect on the development of contractile activity of the uterus, therefore, either prolonged, protracted labor or fast and rapid labor is possible. True anemia of pregnant women may be accompanied by a violation of the coagulation properties of the blood, which is the cause of massive blood loss. A constant oxygen deficiency can lead to the development of dystrophic changes in the myocardium in pregnant women, which are manifested by pain in the heart and changes in the ECG. Often, anemia in pregnant women is accompanied by vegetative-vascular dystonia of a hypotonic or mixed type.

One of the severe consequences of anemia in pregnant women is the birth of immature children with low body weight. Hypoxia, malnutrition and anemia of the fetus are often noted. Chronic fetal hypoxia can result in death during childbirth or the postpartum period. Maternal iron deficiency during pregnancy affects the growth and development of the child's brain, causes serious deviations in the development of the immune system, and in the neonatal period of life causes a high risk of infectious diseases.