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Iron deficiency anemia

Diagnosis

Deficit of iron arises at decrease in its general contents in an organism, and this decrease can be shown as in the form of reduction of reserves of iron without functional disturbances, and a starvation of stocks with development of heavy anemia.

Stage

Synonyms

Iron reserves

Anemia

Exhaustion of reserves of iron

Prelatentny deficit of iron

Are reduced

No

Iron deficiency erythrogenesis

Latent deficit of iron

No

No

 

Deficit of iron without anemia

 

 

Iron deficiency anemia

 

No

Is

 

Deficit of iron — the frequent reason of anemia at the hospitalized patients. Diagnosis is based on results of the corresponding laboratory researches. The optimum choice of tests is defined by a clinical situation. With definition of erythrocyte indexes, serumal ferritin and saturation of transferrin ambulatories can have a sufficient for establishment of the diagnosis blood test. However the hospitalized patients with associated diseases the best diagnostic method often have research of marrow. At detection of deficit of iron it is important to establish its reasons; the scale of additional inspection depends on a clinical situation.

Ability of an organism to increase absorption of iron is limited to its consumption with food. Therefore it is no wonder that deficit of iron arises most often at increase in need for it as a result of the accelerated growth (the early childhood) or intensive loss (periods, pregnancy and a lactation).

концентрация сывороточного ферритина

Fig. 5. Influence of age on concentration of serumal ferritin.

 

Prevalence of iron deficiency states

Deficit of iron remains the most frequent reason of alimentary anemias in many countries of the world. Assume that the same geographical features are characteristic of prevalence of iron deficiency states and at people of the senior age groups though the risk of emergence of such states at old men is less, than at children or at women during periods.

According to some western data, among the elderly people who are not receiving medical care, anemia (a hemoglobin content less than 110 or 120 g/l) occurs at 1,1 — 5,0% of men and 1,5 — 16,0% of women; according to researches in which sexual distinctions were not considered, the frequency of anemia makes 4,0 — 4,4%.

The specific reasons causing decrease in level of hemoglobin in clinically healthy elderly faces need specification, the provided supervision demonstrate that at the elderly persons living in industrially developed countries, an iron deficiency anemia except for special cases, it is hardly caused by food factors.

The iron deficiency anemia is much more often diagnosed for the persons asking for medical care. In the table the results of several inspections concerning the frequency of anemias at the elderly hospitalized patients are provided.

Table. Prevalence of anemia among patients of hospitals

Criterion
diagnosis
anemias
(hemoglobin, g/l)

Anemia
(%)

 

Deficit
gland
(%)

Etiology
deficit of iron

 

<104

18,6

35

Blood loss in more than 50% of cases

<117

41

94

Blood loss in 78% of cases

<119

37

21

Blood loss in 50% of cases

<120
men

33

26

Blood loss in 51%
cases

<115
women

 

 

 

<120

32

48

It is not established

<117

33

60

It is not established

<100

6,4

67

Blood loss in 44% of cases

<114

16

85

It is not established

<110

21

45

The reason of blood loss is established in 24% of cases

<110

15

30

Blood loss

<120

41

42

Blood loss in 69% of cases

 

and the Frequency (%) of deficit of iron at patients with anemia.
New growths as the reason of blood loss are excluded.

 

From 6,4 to 41% of such patients had anemia, and in 21 — 90% of cases anemia was caused by deficit of iron. Unfortunately, the selection of patients and criteria used for identification both anemia and an iron deficiency state, significantly differed in different inspections. In one works the assessment of an iron deficiency state was based on the exact information obtained when studying marrow or results of therapy by iron preparations. In others such criteria as content of serumal iron and iron-binding ability of serum were used. Anyway, it is necessary to recognize that though deficit of iron occurs at healthy faces infrequently, at the hospitalized patients of the same age such deficit is the usual reason of severe forms of anemia, and for its identification it is necessary to use adequate diagnostic receptions.

Etiology

Food factors. It is possible to explain with insufficient consumption of iron with food an iron deficiency anemia only in those groups of the population where the general prevalence of alimentary anemia is very high and also when poverty, living conditions or other factors considerably limit the choice of power supplies.

Absorption disturbance. Even at extensive damage of a digestive tract if the stomach and an upper part of a small bowel do not suffer, absorption of iron is not broken. Most often disturbance of absorption arises owing to stomach operations. The iron deficiency state can develop not less than at 80% of the patients who underwent stomach operation though in the majority of researches it is reported about detection of such states only at 30 — 50% operated.
Deficit of iron arises much more often at the patients who transferred a resection of a stomach and a gastroyeyunostomiya. In such cases disturbance of absorption of iron develops, first, because of loss of reservoir function of a stomach and receipt of its contents in a small bowel, passing proximal department of a duodenum where iron absorption as much as possible, and, secondly, because of the termination of secretion of Acidum hydrochloricum. Despite disturbance of absorption of food iron, absorption of its soluble salts does not worsen.

Chronic blood loss — one of the important reasons of iron deficiency states. As concerning nasal bleedings, a pneumorrhagia, hamaturia and uterine bleedings of the patient sees a doctor long before development of anemia, most often deficit of iron in an organism arises because of gastrointestinal bleedings.

The most important reasons of gastrointestinal bleedings:

Drugs: non-steroidal anti-inflammatory drugs, anticoagulants
Peptic ulcer of a stomach, duodenum
Tumors: polyps, carcinoma of the stomach, colon cancer
Other causes: hernia of an esophageal opening of a diaphragm, esophagitis, hernial bag, vascular disorders, ischemic colitis, hemorrhoids, divertuculosis.

Effects of deficit of iron

Anemia — the most frequent clinical consequence of deficit of iron; there is an expressed communication between weight of anemia and degree of pallor of skin and mucous membranes. At the same time thanks to the compensatory mechanisms improving supply effectiveness oxygen, the symptoms caused by a fabric hypoxia can not be shown up to falling of level of hemoglobin lower than 80 g/l. Strong young people at moderately expressed anemia can perform even a hard work, but at heavy anemia physical effeciency decreases.

At elderly people functional disturbances at moderate anemia are more expressed owing to decrease in adaptable mechanisms and insufficient blood supply of fabrics. The size of cordial emission often decreases because of coronary heart disease. With age gradually also level 2-3-DFG decreases. Besides, even small decrease in oxygenation of fabrics can provoke the corresponding symptoms, at the same time heart and a brain most often are surprised. Both congestive heart failure, and a left ventricular failure are observed. Stenocardia is observed seldom. Often dizziness meets, faints can be observed.

Clinical manifestations

The iron deficiency anemia seldom happens an independent disease. The brightest symptoms in many clinical situations can be connected with the main pathological process. A constant symptom of anemia — pallor of integuments which expressiveness clearly correlates with concentration of hemoglobin. Unfortunately, doctors often do not pay attention to pallor of skin at elderly people. At this age cardiovascular and brain symptoms usually dominate. Tachycardia, short wind and peripheral hypostases are typical; dizziness, slackness and confusion of consciousness can be result of air hunger of a brain. Without having results of blood test, it is easy to underestimate an anemia contribution to development of these symptoms. The symptoms which are not connected directly with anemia such as a glossitis, a cheilosis and angular stomatitis, are less specific, and the painful dysphagy associated with a syndrome of Paterson — Kelly, meets seldom.

Treatment of an iron deficiency anemia

At most of patients the iron deficiency state can be eliminated by means of simple salt of iron. The cheapest drug are the ferrous sulfate tablets containing about 60 mg of iron usually them accept 2 — 3 times a day. Also other salts of iron, such as a gluconate are equally well soaked up, fumarates also a lactate. As the food reduces absorption of inorganic iron by 20 — 60%, treatment renders faster effect at reception of iron to food.

It is important to control effect of treatment by iron preparations. Concentration of hemoglobin weekly increases on average on 5 g/l. For completion of reserves of iron treatment needs to be continued within 3 — 6 months after normalization of level of hemoglobin. Determination of concentration of serumal ferritin should be used, whenever possible, as a useful control facility of replenishment of reserves of iron.

Parenteral therapy by iron preparations is shown in rare instances of the confirmed iron absorption disturbance, the patient with an inborn teleangiectasia at which the level of blood loss can demand so large amount of iron that it cannot be provided by administration of drugs inside, and also at heavy side effects which do not manage to be reduced change of a dose of medicine or purpose of the prolonged drug. Most often use an iron complex with a dextran. It can be entered intramusculary, but it is better — intravenously. If at intravenous administration of a small trial dose reaction is absent, medicine can be entered 250 — 500 mg slowly in the form of repeated injections or by injection of all dose. When using the last method calculate the general need for iron and part the corresponding quantity of a dextran of iron in isotonic solution of sodium chloride to the concentration which is not exceeding 5%. Pour in solution during 4 — 6 h. The major side effect is the anaphylaxis and though it arises seldom, when carrying out therapy it is necessary to have near at hand all necessary for reanimation. Arthralgias, in particular at patients with a pseudorheumatism are sometimes observed.

It is necessary to abstain from purpose of iron preparations to persons in whom anemia is found, but indicators of content of iron are not established and the possibility of blood loss is not excluded. The second danger connected with unreasonable therapy by iron preparations consists in an opportunity to lose sight of the concealed gastrointestinal hemorrhages which are the reason of deficit of iron.

 
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