Iron is one of the elements, without which the human body is not able to function fully. Nevertheless, there is a risk of disruption of its stocks due to the impact of various factors and processes. One of the most common problems is iron deficiency anemia (IDA). It can develop both in children and in adults, and even pregnant women are at risk. Considering all the destructive potential of this disease, it is worth to learn more about it.
What should be understood as iron deficiency anemia?
Before studying sideropenic syndrome with iron deficiency anemia, it is necessary to touch upon the essence of the problem associated with the deficiency of this trace element. Anemia of this type is a pathological condition that is characterized by a decrease in the hemoglobin level in the blood because of a palpable iron deficiency in the body. Immediately, the deficit itself appears due to a violation of its intake and assimilation, or because of the pathological losses of this element.
Iron deficiency anemia (it is also sideropenic) differs from most other anemias in that it does not reduce the red blood cells in the blood. In most cases, it is detected in women of reproductive age, pregnant women and children.
Causes of the disease
Initially, it is necessary to identify the risk factors that may cause iron deficiency. The increased consumption of iron, followed by the development of anemia, can be caused by repeated pregnancy, profuse menstruation, lactation period and rapid growth during the pubertal period. In elderly people, a disruption of iron utilization is possible. Also in the senile age, the number of diseases increases significantly, against which anemia develops (diverticulosis of the intestine, renal failure, oncopathology, etc.).
To worry about such a problem as iron deficiency, it is worthwhile in the event that the absorption of this element is disrupted at the level of erythrocaryocytes (due to insufficient intake of iron along with food). As a cause of the development of iron deficiency anemia, it makes sense to consider any diseases that lead to blood loss. It can be tumorous and ulcerative processes in the gastrointestinal tract, endometriosis, chronic hemorrhoids, etc. In rare cases, loss of blood from the diverticulum of the Meckel of the small intestine, where a peptic ulcer develops due to the formation of peptic acid and hydrochloric acid, can be observed.
The causes of iron deficiency anemia can be associated with glomerular 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 to the terminal 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, after which it should be deposited in the lungs in the form of hemosiderin without the possibility of subsequent disposal. Loss of iron in the urine can be a consequence of a combination of diseases such as chronic glomerulonephritis and acquired hemosiderosis of the lungs, which is of an autoimmune nature.
Sometimes the causes of iron deficiency anemia associated with loss of iron along with blood are directly related to the influence of helminths, which, entering the intestinal wall, cause damage to it and, as a consequence, microcirculation, which can lead to the development of IDA. The risk of anemia of this type is real for those donors who often donate blood. And as another reason for blood loss, worthy of attention, you can determine the hemangioma of internal organs.
Iron in the human body can be poorly absorbed due to diseases of the small intestine that occur in conjunction with malabsorption syndrome with intestinal dysbacteriosis and resection of the small intestine. Previously, it was often enough to find an opinion according to which atrophic gastritis, having a decreased secretory function, should be considered as a real cause of iron deficiency anemia. In fact, such a disease can only have an auxiliary effect.
Latent iron deficiency (latent, without clinical signs) can be detected at the biochemical level. Characterized by such a deficit absence or a sharp decrease in the deposits of this trace element in the macrophages of the bone marrow, which can be detected using a special color. It is worth repeating that at this stage, the loss of iron can be fixed only in the laboratory.
Another sign that allows to detect a deficit is a decrease in serum ferritin content.
Symptoms typical for iron-containing anemia
In order for the symptomatology to be more understandable, it makes sense to divide the process of iron deficiency formation 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 digestive tract and the amount of hemosiderin contained in the macrophages of the bone marrow.
The second stage can be characterized as a latent iron deficiency. It manifests itself through a decrease in exercise tolerance and considerable fatigue. All these signs clearly indicate a lack of iron in 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 serum, as well as an insufficient saturation of transferrin with iron.
The third stage is to understand the clinical manifestation of IDA. The main symptoms of this period include trophic disorders of the skin, nails, hair, sideropenic signs (fatigue and general weakness), increased muscle weakness, shortness of breath and signs of cerebral and cardiac insufficiency (tinnitus, dizziness, pain in the heart, syncope ).
To the sideropenic symptoms during the third stage is the desire to eat chalk - geophagia, dysuria, urinary incontinence, craving for the smell of gasoline, acetone, etc. As for geophagy, it besides iron deficiency can indicate a deficiency in the body of magnesium and zinc.
Describing common signs of iron deficiency, you need to pay attention to symptoms such as weakness, worsening appetite, syncopal conditions, palpitations, headaches, irritability, low blood pressure flashing "flies" before your eyes, poor sleep at night and drowsiness during the day, gradual increase in temperature, decreased attention and memory, as well as tearfulness and nervousness.
Influence of sideropenic syndrome
It is important to understand that iron is a constituent of many enzymes. For this reason, when there is a deficit, the activity of the enzymes decreases and the normal course of metabolic processes in the body is disrupted. Thus, sideropenic syndrome is the cause of many symptoms:
- Skin Changes. When there is a deficiency of iron, you can see the peeling and dryness of the skin, over which cracks appear over time. The occurrence of cracks is possible on the palms, in the corners of the mouth, on the feet and even in the anal opening. Hair in this syndrome early turn gray, become brittle and actively fall out. Approximately a quarter of patients face brittleness, thinning and transverse striation of the nails. Tissue deficiency of iron is actually a consequence of a lack of tissue enzymes.
- Muscular changes. The lack of iron 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, the 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 imperative urges to urinate, difficulties with holding the urine during laughter and coughing. Girls with iron deficiency often have to face night urinary incontinence.
Sideropenic syndrome also leads to a change in the mucous membranes of the intestinal tract (cracks in the corners of the mouth, angular stomatitis, increased tendency to caries and periodontitis). There is also a change in the perception of odors. With a similar syndrome, the patient begins to like the smell of gutalin, fuel oil, gasoline, gas, naphthalene, acetone, wet earth after rain, varnishes.
Changes affect the taste. We are talking about a strong desire to taste such non-food products as dental powder, raw dough, ice, sand, clay, minced meat, cereals.
With a disease such as sideropenic syndrome, the mucous membranes of the lower and upper respiratory tract membranes change. Such changes lead to the development of atrophic pharyngitis and rhinitis. The overwhelming majority of people with a lack of iron, there is a blue sclera syndrome. As a result of the disruption of hydrosylation of lysine, the collagen synthesis fails.
With a lack of iron, there is a risk of changes in the immune system. It is a question of lowering the level of some immunoglobulins, B-lysines and lysozyme. There is also a violation of phagocytic activity of neutrophils and cellular immunity.
With such a problem as sideropenic syndrome, the appearance of dystrophic changes in internal organs is not ruled out. These include secondary anemic sideropenic myocardial dystrophy. It manifests itself by strengthening the first tone on the apex of the heart and widening the border of percussion dullness.
When the iron deficiency can also change and the state of the digestive tract. 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 lead to a decrease in gastric secretion, which can result in achilia.
Why does iron deficiency anemia develop in pregnant women?
In women who carry a child, a lack of iron can be due to the emergence of extragenital and gynecological diseases before pregnancy, as well as a high demand for iron during fetal development.
Many factors can affect the appearance of a disease, such as anemia. Iron deficiency in pregnant women, as a rule, develops for the following reasons:
- the aforementioned chronic extragenital diseases (heart defects, duodenal ulcer and stomach, atrophic gastritis, kidney pathology, helminthic invasions, liver diseases, diseases that are accompanied by epistaxis, and hemorrhoids);
- the effect on the body of a woman of various chemicals and pesticides that are capable of interfering with the assimilation of iron;
- congenital deficiency;
- violations of the absorption of iron (chronic pancreatitis, enteritis, resection of the small intestine, intestinal dysbiosis);
- malnutrition, which is not able to ensure the supply of this trace element in the body in the required quantity.
Lack of iron in children
During the entire period of pregnancy in the child's body, the basic composition of this microelement in the blood is formed. However, in the third trimester, one can observe the most active intake of iron through the placental vessels. At the full-term child, the normal level of its content in the body should be equal to 400 mg. Moreover, in those children who were born before the desired period, this indicator does not rise above 100 mg.
It is important to take into account the fact that the milk contains enough of this microelement to replenish the reserves of the child's organism before the onset of 4-month-old age. Therefore, if it is too early to stop breastfeeding, the child may develop 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. Affect the depletion of iron reserves can also factors such as multiple pregnancies with fetal transfusion syndrome, chronic iron deficiency anemia during pregnancy and uteroplacental bleeding.
In the intrapartum period, the danger is massive bleeding during delivery and premature bandaging of the umbilical cord. With regard to the postpartum period, at this stage, the lack of iron can be a consequence of the accelerated growth rate of the child, early supplementary feeding with whole cow milk and diseases that are accompanied by a violation of the absorptive function of the intestine.
A blood test for the identification of IDA
This diagnostic method is necessary in order to determine the reduced level of hemoglobin and erythrocytes. With its help it is possible 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 serum ferritin concentration, an increase in OCSS, a decrease in serum iron concentration, and a significantly lower saturation with the transferrin microelement compared to the norm.
It is important to know that you can not drink alcohol one day before taking the test. Do not eat 8 hours before the diagnosis, only clean water without gas is allowed.
In this case, the history of the disease is very helpful in making the diagnosis. Iron deficiency anemia often develops against other diseases, so this information will be extremely useful. As for the differential approach to diagnosing IDA, it is carried out with those diseases that can lead to a lack of iron. Thalassemia is characterized by clinico-laboratory signs of erythrocyte schemolysis (enlarged spleen, increased level of indirect bilirubin, hypochromic anemia, reticulocytosis and high iron content in the depot and serum).
Methods of treatment
In order to overcome such a problem as a lack of iron in the blood, it is necessary to competently approach the recovery strategy. Each patient should have an individual approach, otherwise it will be difficult to achieve the desired level of effectiveness of therapeutic measures.
With a problem such as iron deficiency in the body, treatment primarily involves affecting the factor that triggers the onset of anemia. Correction of this condition with the help of medicines also plays an important role in the process of recovery.
Attention should be paid to nutrition. In the diet of patients with IDA should be included products that contain heme iron. This is rabbit meat, veal, beef. Do not forget about amber, lemon and ascorbic acid. Replenish the deficiency of iron will help the use of dietary fiber, calcium, oxalates and polyphenols (soy protein, tea, coffee, chocolate, milk).
Concerning the topic of drug treatment in more detail, it is worth noting that iron preparations are prescribed by the course from 1.5 to 2 months. After the Hb level has been normalized, maintenance therapy is shown 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). Among the most popular are the following drugs: Tardiferon, Maltofer, Totema, Ferroplex, Sorbifer, and Ferrum Lek. Usually, the medication is taken before meals. The exception is patients who have gastritis and ulcers. The above medicines can not be washed down with products that can bind iron (milk, tea, coffee). Otherwise, their effect will be brought to nothing. It should initially be aware of a harmless side effect that can produce iron-containing drugs in anemia (meaning the dark color of the teeth). Do not be afraid of such a reaction. As for the unpleasant consequences of drug treatment, there may be the occurrence of gastrointestinal disorders (constipation, abdominal pain) and nausea.
The main way of administering drugs with iron deficiency is inside. But in the case of development of intestinal pathology, at which the absorption process is disrupted, parenteral administration is indicated.
In the vast majority of cases, with the help of drug treatment, doctors manage to correct the lack of iron. Nevertheless, the disease is capable of recurring and developing again (very rarely). To avoid such a development of events, it is necessary to prevent iron deficiency anemia. This means conducting annual monitoring of the parameters of the clinical blood test, rapid elimination of any causes of blood loss and adequate nutrition. Those who are at risk, the doctor can prescribe the intake of the necessary drugs for preventive purposes.
Obviously, a lack of iron in the blood is a very serious problem. This can be confirmed by any medical history. Iron deficiency anemia, regardless of which patient in question, is a vivid example of an extremely devastating disease. Therefore, with the first symptoms of a deficiency of this trace element, it is necessary to consult a doctor and take a course of treatment in time.