Hematocrit indicator: deviations from the norm, and what medications to buy to normalize the condition

Indications and preparation for analysis

The hematocrit indicator is always indicated in the results of a general blood test. This means that it can be assessed:

• During any medical examination or mandatory medical examination.
• In preparation for surgery.
• During hospitalization and before discharge.

But besides this, there are certain indications when it is necessary to determine the hematocrit. In this case, a direct measurement is performed: the plasma is separated by centrifuging the material and an accurate indicator is obtained. Indications for this:

• Bleeding.
• Blood clotting problems
• Dehydration of the body.
• Anemia.
• Polycythemia.

In order to get a reliable result, you should refuse food 6-10 hours before taking blood from a vein or from a finger. As a rule, the analysis is taken in the morning. It is also necessary to avoid drinking alcohol 2-3 days and refrain from smoking 2-3 hours before the procedure.

Where to take a blood test for hematocrit

The study of the hct level is part of the erythrocyte indices, which in turn are included in the CBC - a blood test that was previously called clinical, and within the framework of modern laboratory standards - general. This analysis examines white blood cells, platelets and red blood cells. Blood is not donated separately for hct, but a general examination (CBC) can be ordered at any medical clinic.

Also, to collect blood in a place convenient for you, at home or at a specified location, and then conduct a study with a transcript and detailed recommendations on the plan for introducing a micronutrient intake program, you can contact bioniq specialists:

• We conduct studies of up to 50 blood parameters and various indices;
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Norm

The hematocrit norm differs depending on age and gender. In newborns, the rate is considered high and the norm is 42% - 65%. As one grows older, it decreases; in older people, a minimum level of hematocrit is observed. For adults aged 18-65 years, the norm is:

• For men - 41% - 53%.
• For women - 36% - 46%.

Deviations from the norm can be observed during pregnancy. From about 20 weeks, the indicator decreases due to an increase in the amount of liquid part of the blood for physiological reasons. After childbirth, the hematocrit quickly returns to normal values ​​in the absence of pathologies.

Deviations towards increasing hematocrit are recorded:

• In smokers, due to oxygen starvation of tissues, which leads to an increase in the production of red blood cells.
• When rising to a high altitude, the production of red blood cells increases due to the body's adaptation to the reduced oxygen concentration in the air.
• For stress and traumatic shock, which is characterized by intense pain.
• When taking corticosteroid drugs and diuretics,

Deviations towards a decrease in hematocrit are recorded:

• With prolonged immobility.
• When taking antiplatelet agents and anticoagulants that thin the blood.
• Against the background of high fluid consumption.
• For chronic alcoholism.

Micronutrients for the hematopoietic system

Hematopoiesis - that is, hematopoiesis - is a set of stages in the transformation of a stem cell into one of the elements that make up the blood. Let us repeat that the role of vitamins B6, B9 and B12 and iron in these processes is a priority, and jumps in hct levels always one way or another lead to the conclusion about a lack of these substances.

In addition to these four, attention should be paid to other nutritional compounds.

• Vitamin E is a fat-soluble form and can accumulate in any tissue, but mainly in fat. Protects red blood cell membranes from damage due to oxidative stress;

• Vitamin C – adds iron to the process of hemoglobin synthesis, starting with the formation of red blood cells in the red bone marrow;
• Vitamin A (retinol) – helps transfer iron from “reserves”;
• Vitamin B2 (riboflavin) – helps not to remove the necessary iron prematurely through the genitourinary system;
• Vitamin D2 (ergocalciferol) - helps transport iron from storage cells to the red bone marrow, where hemoglobin is produced in the red blood cell;
• Copper - helps iron oxidize to the level of digestibility (ferrous);
• Omega 3 and Omega 6 fatty acids stimulate and regulate the formation of new cells in the process of erythropoiesis (the formation of red blood cells).

Often, if hct tests are questionable, you can turn to an additional blood test for vitamins and microelements that are involved in hematopoiesis. Based on detailed data, we can talk about developing a personal complex of micronutrients that will meet the needs within the framework of the individual characteristics of the body.

Increased hematocrit

Many people are interested in the question of when the hematocrit is increased, what does it mean. First of all, the indicator increases with the accelerated production of red blood cells by the bone marrow. An increase in the size of red blood cells can also lead to deviations above normal. This occurs in various pathological conditions, namely:

• Primary erythrocytosis, which occurs against the background of overactive production of red blood cells, most often indicates tumor processes in the bone marrow.
• Secondary erythrocytosis is associated with pathologies of the respiratory and cardiovascular systems, in particular, it develops with respiratory failure or heart disease.

A decrease in plasma volume, and, consequently, an increase in hematocrit may indicate the development of peritonitis, leukemia or kidney pathologies. This also happens with extensive burns. The cause of dehydration is often uncompensated diabetes mellitus.

Erythrocytosis at the initial stage, when the hematocrit is slightly increased, is asymptomatic. In most cases, abnormalities are discovered accidentally during a routine medical examination. But with a significant increase, it is discovered by chance, when taking a blood test for other reasons. Only with a significant increase in hematocrit do warning signs arise:

• Pain in joints and muscles.
• Shortness of breath, weakness and increased sweating.
• Dizziness.
• Increased pressure.

Since symptoms are not specific, if they appear, you should undergo a full examination in order to make a correct diagnosis. Treatment can only be successful if the cause of the increase in the number of red blood cells in the total blood volume is established.

Decreased hematocrit

A decreased hematocrit occurs when the number of red blood cells or their size decreases - erythrocytopenia. The cause may also be the accumulation of water in the body when the blood becomes thinner - hyperhydration, as well as hyperproteinemia or the accumulation of proteins in the plasma, which contributes to fluid retention.

Causes

A decrease in hematocrit is facilitated by prolonged immobility, fasting or a strict diet, taking anticoagulants and antiplatelet agents, and intravenous infusions in large volumes; heavy drinking, chronic alcoholism, excessive salt intake, menstruation in women.

Also, a downward change in the indicator may indicate the following pathologies:

• iron-, B12- or folate-deficiency anemia;
• severe bleeding;
• impaired hemoglobin production in sickle cell anemia;
• fibrous degeneration of the liver - cirrhosis;
• disruption of the urinary system;
• hemolysis of erythrocytes - destruction of red blood cells due to hereditary mutation, autoimmune processes or toxic effects on blood cells;
• malaria, typhoid fever;
• oncological diseases of the bone marrow or its metastatic lesions from other organs;
• an increase in the amount of protein in plasma due to vomiting, diarrhea, blood cancer and other conditions.

During pregnancy, a decrease in hematocrit can be observed in the case of toxicosis, a very young age of the mother, multiple pregnancies, a short period of time between pregnancies, and also after the 20th week of gestation due to a physiological increase in fluid in the body.

Symptoms

A decrease in hematocrit in the blood is accompanied by hypoxia of various organs, since it is the red blood cells that normally carry oxygen throughout the body. This condition is manifested by the following symptoms:

• fast fatiguability;
• general weakness;
• drowsiness;
• increased heart rate and breathing;
• feeling of lack of air;
• headache, dizziness;
• decreased memory and concentration;
• hair loss;
• marbling or pallor of the skin.

Treatment

A decrease in hematocrit in an adult to 35-30% requires outpatient medical supervision, exclusion of possible serious diseases, and dietary adjustments with increased consumption of animal products, in particular, red meat and liver, and leafy greens. An indicator below 13% is typical for life-threatening pathologies and is usually detected in patients in serious condition in the hospital. Patient management tactics are determined by the underlying disease that led to a change in hematocrit level.

Author:

Baktyshev Alexey Ilyich, General Practitioner (family doctor), Ultrasound Doctor, Chief Physician

Iron deficiency anemia in infants and young children

Anemia and anemic syndrome, caused by many causes, can be mentioned among the most common pathological conditions that general pediatricians have to deal with every day. This group includes various diseases and pathological conditions characterized by a decrease in the content of hemoglobin and/or red blood cells per unit volume of blood, leading to disruption of the oxygen supply to tissues. The following laboratory criteria for anemia are applied (N.P. Shabalov, 2003). Depending on the age of the children, the hemoglobin level is:

• 0–1 day of life - < 145 g/l;
• 1–14 days of life - < 130 g/l;
• 14–28 days of life - < 120 g/l;
• 1 month - 6 years - < 110 g/l.

Of all anemias, the most common is iron deficiency (IDA), which accounts for approximately 80% of all anemias. According to the World Health Organization (WHO), more than 500 thousand people worldwide suffer from IDA. The prevalence of IDA in children in Russia and developed European countries is: about 50% in young children; more than 20% - in older children.

IDA is a clinical and hematological syndrome characterized by impaired hemoglobin synthesis as a result of iron deficiency, developing against the background of various pathological (physiological) processes, and manifested by signs of anemia and sideropenia.

Iron is one of the main microelements in the human body. Normally, the adult body contains 3–5 g of iron in bound form. 70% of the total amount of iron is part of hemoproteins. The iron in these compounds is bound to porphyrin. The main representative of this group is hemoglobin (58% iron); Iron is also contained in myoglobin (8%), cytochromes, peroxidases, catalases - up to 4%. Iron is also part of non-heme enzymes (xanthine oxidase, nicotinamide adenine dinucleotide (NADH) dehydrogenase, aconitase, localized in mitochondria); transport form of iron (transferrin, lactoferrin). Iron reserves in the body exist in two forms: in the form of ferritin (up to 70%) and hemosiderin (up to 30%). The peculiarity of iron distribution in young children is that they have a higher iron content in erythroid cells and less iron in muscle tissue.

Iron absorption occurs predominantly in the duodenum and proximal jejunum. The daily diet usually contains about 5–20 mg of iron, and only about 1–2 mg per day is absorbed. The degree of iron absorption depends both on its amount in food consumed and bioavailability, and on the state of the gastrointestinal tract (GIT).

Iron is more easily absorbed in heme (meat products) - 9–22%. Absorption of non-heme iron is determined by diet and gastrointestinal secretion patterns.

Iron absorption is especially active from breast milk, although its content is low - only 1.5 mg per liter; The bioavailability of iron in breast milk is up to 60%. This is facilitated by the special form in which it is presented - in the form of the iron-containing protein lactoferrin. In the lactoferrin molecule, two active binding sites for Fe3+ ions are identified. Lactoferrin is found in breast milk in saturated and unsaturated forms. The ratio of lactoferrin forms varies depending on the lactation period. During the first 1–3 months of life, the saturated iron transport form of lactoferrin predominates. The presence of specific receptors for lactoferrin on the epithelial cells of the intestinal mucosa promotes the adhesion of lactoferrin to them and its more complete utilization. In addition, lactoferrin, by binding excess iron that is not absorbed in the intestine, deprives the opportunistic microflora of the microelement necessary for its life and triggers nonspecific bactericidal mechanisms. It has been established that the bactericidal function of immunoglobulin A is realized only in the presence of lactoferrin.

Physiological losses of iron in urine, sweat, feces, through the skin, hair and nails do not depend on gender and amount to 1-2 mg per day, in women during menstruation - 2-3 mg per day. In children, iron loss is 0.1–0.3 mg per day, increasing to 0.5–1.0 mg per day in adolescents.

The daily requirement of a child's body for iron is 0.5–1.2 mg per day. In young children, due to rapid growth and development, there is an increased need for iron. During this period of life, iron reserves are quickly depleted due to increased consumption from the depot: in premature infants by the 3rd month, in full-term infants by the 5th–6th month of life. To ensure the normal development of a child, the daily diet of a newborn should contain 1.5 mg of iron, and for a child 1–3 years old - at least 10 mg.

Iron deficiency in children leads to an increase in infectious diseases of the respiratory system and gastrointestinal tract. Iron is necessary for the normal functioning of brain structures; if it is insufficient, the child’s neuropsychic development is disrupted. It has been established that in children who had iron deficiency anemia in infancy, at the age of 3–4 years, disturbances in the transmission of nerve impulses from the centers of the brain to the organs of hearing and vision are determined due to impaired myelination and, as a consequence, impaired nerve conduction.

The causes of iron deficiency in children are very diverse. The main cause of IDA in newborns is considered to be the presence of IDA or hidden iron deficiency in the mother during pregnancy. Antenatal causes also include complicated pregnancy, impaired uteroplacental circulation, fetomaternal and fetoplacental bleeding, fetal transfusion syndrome in multiple pregnancies. Intrapartum causes of iron deficiency are: fetoplacental transfusion, premature or late ligation of the umbilical cord, intrapartum bleeding due to traumatic obstetric care or abnormal development of the placenta or umbilical cord. Among the postnatal causes of sideropenic conditions, the first place is taken by insufficient intake of iron from food. In this case, newborns who are bottle-fed with unadapted milk formulas, cow's and goat's milk suffer the most. Other postnatal causes of IDA are: increased body need for iron; iron losses exceeding physiological ones; gastrointestinal diseases, malabsorption syndrome; deficiency of iron stores at birth; anatomical congenital anomalies (Meckel's diverticulum, intestinal polyposis); consumption of foods that inhibit iron absorption.

Premature children and children born with a very large weight, children with a lymphatic-hypoplastic type of constitution are always at risk.

In children of the first year of life, iron deficiency is most often caused by an unbalanced diet, in particular, feeding exclusively with milk, vegetarianism, and insufficient consumption of meat products.

Bleeding of various etiologies can lead to sideropenia. The source of this may be: hiatal hernia, esophageal varices, gastrointestinal ulcers, tumors, diverticula, ulcerative colitis, hemorrhoids, as well as bleeding from the genitourinary tract and respiratory tract. Taking certain medications, such as nonsteroidal anti-inflammatory drugs, salicylates, coumarins, and glucocorticosteroids, can also lead to iron loss. Iron deficiency always accompanies diseases accompanied by impaired intestinal absorption (enteritis, Crohn's disease, parasitic infestations, etc.). Intestinal dysbiosis also interferes with normal digestion of food and thereby reduces the body's ability to absorb iron. In addition, there may be a disruption in iron transport due to insufficient activity and decreased transferrin levels in the body.

It is extremely important to recognize the cause of the development of IDA in each specific case. Focus on nosological diagnosis is necessary, since in most cases, when treating anemia, it is possible to influence the underlying pathological process.

IDA manifests itself with general symptoms. One of the main and visible signs is pallor of the skin, mucous membranes, and conjunctiva of the eyes. Noteworthy are general lethargy, moodiness, tearfulness, easy excitability of children, decreased overall body tone, sweating, lack or decreased appetite, shallow sleep, regurgitation, vomiting after feeding, decreased visual acuity. Changes in the muscular system are detected: the child has difficulty overcoming physical activity, weakness and fatigue are noted. In children of the first year of life, regression of motor skills may be observed.

In the second half of life and in children older than one year, signs of damage to epithelial tissue are observed - roughness, dry skin, angular stomatitis, painful cracks in the corners of the mouth, glossitis or atrophy of the oral mucosa, fragility and dullness of hair, hair loss, dullness and brittleness of nails, tooth decay (caries), retardation in physical and psychomotor development.

Depending on the severity of the disease, symptoms of damage to organs and systems are identified: cardiovascular - in the form of a functional heart murmur, tachycardia; nervous system - in the form of headaches, dizziness, fainting, orthostatic collapse. Possible increase in the size of the liver and spleen. From the gastrointestinal tract, there is difficulty swallowing, bloating, diarrhea, constipation, perversion of taste - the desire to eat clay, earth.

The diagnosis of IDA is made based on the clinical picture, laboratory signs of anemia and iron deficiency in the body: hypochromic (color index < 0.85) anemia of varying severity, hypochromia of erythrocytes, decrease in the average hemoglobin concentration in erythrocytes (less than 24 pg), microcytosis and poikilocytosis of erythrocytes (in peripheral blood smear); decrease in the number of sideroblasts in bone marrow aspirate; decrease in iron content in blood serum (<12.5 µmol/l); an increase in the total iron-binding capacity of serum (TIBC) of more than 85 µmol/l (an indicator of “starvation”); an increase in the level of transferrin in the blood serum, with a decrease in its saturation with iron (less than 15%); decreased serum ferritin levels (<15 µg/L).

Treatment of IDA

Treatment of IDA in young children should be comprehensive and based on four principles: normalization of the child’s regimen and nutrition; possible correction of the cause of iron deficiency; prescription of iron supplements; concomitant therapy.

The most important factor in correcting iron deficiency is a balanced diet, and primarily breastfeeding. Breast milk not only contains iron in a highly bioavailable form, but also increases the absorption of iron from other foods consumed at the same time. However, intense metabolic processes in infants lead to the fact that by the 5th–6th month of life, antenatal iron reserves are depleted even in children with a good perinatal history and babies fed with breast milk.

Among other foods, the greatest amount of iron is found in pork liver, beef tongue, veal kidneys, egg yolk, oysters, beans, sesame seeds, seaweed, wheat bran, buckwheat, pistachios, chick peas, peaches, oatmeal, spinach, hazelnuts and etc. (table).

Iron absorption is inhibited by tannins contained in tea, carbonates, oxalates, phosphates, ethylenediaminetetraacetic acid used as a preservative, antacids, and tetracyclines. Ascorbic, citric, succinic and malic acids, fructose, cysteine, sorbitol, nicotinamide enhance iron absorption.

Long walks in the fresh air, normalization of sleep, a favorable psychological climate, prevention of acute respiratory viral infections (ARVI), and limitation of physical activity are necessary. The child's diet should be balanced and include foods rich in iron and substances that enhance its absorption in the intestines. Children suffering from IDA need to be introduced to complementary foods 2–4 weeks earlier than healthy ones. It is advisable to start introducing meat complementary foods at 6 months. You should avoid introducing cereals such as semolina, rice, and bearberry into your child’s diet, giving preference to buckwheat, barley, and millet.

However, these measures are insufficient and do not lead to the cure of IDA, so the basis of therapy is iron supplements. The main ones used orally include: ferric iron compounds - hydroxide-polymaltose complex (iron polymaltose), maltofer, maltofer foul, ferrum lek and iron-protein complex (iron protein succinylate) - ferlatum; divalent iron compounds - actiferrin, ferroplex, tardiferon, hemofer, totema, ferrous fumarate, ferronate.

Therapy should be started with drugs for oral administration and only if they are poorly tolerated (nausea, vomiting, diarrhea), malabsorption syndrome, resection of the small intestine, etc. - iron supplements are prescribed parenterally. When prescribing oral forms, preference should be given to nonionic iron compounds - protein (ferlatum) and hydroxide-polymaltose Fe3+ complexes (maltofer, maltofer foul, ferrum lek). These compounds have a large molecular weight, which makes it difficult for them to diffuse across the intestinal mucosal membrane. They enter the blood from the intestines as a result of active absorption. This explains the impossibility of overdosing on drugs, unlike iron salt compounds, the absorption of which occurs along a concentration gradient. There is no interaction between them and food components and medications, which allows the use of non-ionic iron compounds without disturbing the diet and treatment of concomitant pathologies. Their use significantly reduces the incidence of side effects usually observed when prescribing oral iron supplements (nausea, vomiting, diarrhea, constipation, etc.). In addition, in young children, the dosage form of the drug is of great importance. At this age, it is convenient to use drops and syrups, which also provides the possibility of precise dosing of drugs and does not cause a negative attitude from the child.

When prescribing any iron supplements, it is necessary to calculate the individual need for it for each patient, based on the fact that the optimal daily dose of elemental iron is 4–6 mg/kg. The average daily dose of iron in the treatment of IDA is 5 mg/kg. The use of higher doses does not make sense, since the amount of iron absorption does not increase.

The use of parenteral iron supplements is indicated to quickly achieve an effect in severe anemia; gastrointestinal pathology combined with malabsorption; nonspecific ulcerative colitis; chronic enterocolitis; with severe intolerance to oral forms of drugs. Today in the Russian Federation, only one drug is approved for intravenous administration - venofer (iron sucrose), while ferrum lek can be used for intramuscular administration.

It must be remembered that in young children, iron deficiency is never isolated and is often combined with a deficiency of vitamins C, B12, B6, PP, A, E, folic acid, zinc, copper, etc. This is due to the fact that nutritional deficiency and impaired intestinal absorption, leading to iron deficiency, also affects saturation with these micronutrients. Therefore, it is necessary to include multivitamin preparations in complex therapy for IDA.

The effectiveness of IDA therapy can be judged after 7–10 days by an increase in reticulocytes by 2 times compared to the initial number (the so-called reticulocyte crisis). The increase in hemoglobin is also assessed, which should be 10 g/l or more per week. Accordingly, achievement of the target hemoglobin level is observed on average 3–5 weeks from the start of therapy, depending on the severity of anemia. However, treatment with iron supplements should be carried out in sufficient doses and for a long time (at least 3 months) even after normalization of hemoglobin levels in order to replenish iron reserves in the depot.

If within 3-4 weeks there is no significant improvement in hemoglobin levels, then it is necessary to find out why the treatment was ineffective. Most often we are talking about: an inadequate dose of iron supplement; ongoing or unknown blood loss; the presence of chronic inflammatory diseases or neoplasms; concomitant vitamin B12 deficiency; incorrect diagnosis; helminthic infestation and other parasitic infections.

Contraindications to the use of iron supplements are:

• lack of laboratory confirmation of iron deficiency;
• sideroachrestic anemia;
• hemolytic anemia;
• hemosiderosis and hemochromatosis;
• infection caused by gram-negative flora (enterobacteria, Pseudomonas aeruginosa, Klebsiella).

With the development of severe anemia, accompanied by inhibition of erythropoiesis and a decrease in erythropoietin production, the administration of recombinant human erythropoietin (rhEPO) preparations is indicated. The use of rhEPO is of particular importance in the development of early anemia of prematurity, which develops in the second month of life and occurs, according to various authors, in 20–90% of cases. The administration of rhEPO drugs (Recormon, Eprex, Epocrine) leads to a sharp activation of erythropoiesis and, as a consequence, to a significant increase in iron requirements.

Therefore, the use of rhEPO is an indication for the administration of iron supplements, usually parenteral. Currently, a- and b-epoetins are approved for use in the Russian Federation and are included in the list of additional medicinal products. Prescribing rhEPO allows, in most cases, to avoid blood transfusions, in which there is a high probability of complications (transfusion reactions, sensitization, etc.). The preferred route of administration of rhEPO preparations, especially in early childhood, is subcutaneous. The subcutaneous route of administration is safer and more economical, since smaller doses are required to achieve an effect than with intravenous administration. Until recently, in the countries of the European Union and in the Russian Federation, mainly β-erythropoietins were used for the treatment of hyporegenerative anemia in children, which, when administered subcutaneously, did not cause significant adverse reactions, unlike a-erythropoietins, when administered subcutaneously, there was a high risk of developing red cell aplasia. The most widely used drug among β-erythropoietins is Recormon (F. Hoffmann-La Roche), which is easy to use and leads to a rapid increase in the level of erythrocytes and reticulocytes without affecting leukopoiesis, increases the level of hemoglobin, as well as the rate of incorporation of iron into cells.

Since 2004, European countries have allowed subcutaneous administration of a-erythropoietins, among which in our country the most commonly used are Eprex (Jansen-Silag) and Epocrine (Sotex-GosNII OCHB).

The goal of rhEPO treatment is to achieve hematocrit levels of 30–35% and eliminate the need for blood transfusions. The target hemoglobin concentration values ​​may vary depending on the days and months of the child’s life, but cannot be lower than 100–110 g/l. Depending on the dose, target hemoglobin concentrations and hematocrit are achieved after approximately 8–16 weeks of rhEPO treatment.

To prevent iron deficiency anemia, rhEPO is prescribed to premature newborns born weighing 750–1500 g before the 34th week of pregnancy.

Treatment with erythropoietin should begin as early as possible and continue for 6 weeks. The drug Recormon is administered subcutaneously at a dose of 250 IU/kg 3 times a week. However, it must be taken into account that the younger the child is, the higher doses of erythropoietin he requires, so the dose can be increased.

As mentioned above, rhEPO therapy leads to a sharp increase in iron intake, therefore, in most cases, especially in premature infants, along with an increase in hematocrit, serum ferritin levels decrease. Rapid depletion of iron reserves in the body can lead to IDA. Therefore, all patients receiving rhEPO therapy are prescribed iron supplements. Therapy with iron supplements should continue until serum ferritin levels are normalized (at least 100 mcg/ml) and transferrin saturation (at least 20%). If serum ferritin concentration remains persistently below 100 mcg/ml or there are other signs of iron deficiency, the dose of iron should be increased, including the use of parenteral drugs.

Prevention of IDA in young children includes: antenatal (correct regimen and nutrition of the pregnant woman, timely detection and treatment of anemia in the pregnant woman, preventive administration of iron supplements to women at risk for developing IDA); postnatal (observance of hygienic living conditions for the child, long-term breastfeeding and timely introduction of complementary foods, adequate choice of formula for children on mixed and artificial feeding, prevention of the development of rickets, malnutrition and ARVI in the child). The following people need prophylactic administration of iron supplements:

• women of reproductive age suffering from heavy and prolonged menstrual bleeding;
• regular donors;
• pregnant women, especially repeat pregnancies following a short interval;
• women with iron deficiency during lactation.

Preventive administration of iron supplements is indicated for children at risk for developing IDA:

• premature babies (from 2 months of age);
• children from multiple pregnancies, complicated pregnancies and childbirths;
• large children with high rates of weight gain and height;
• children with constitutional anomalies;
• suffering from atopic diseases;
• those who are artificially fed with unadapted formulas;
• with chronic diseases;
• after blood loss and surgical interventions;
• with malabsorption syndrome.

The dose of iron prescribed for preventive purposes depends on the degree of prematurity of the child:

• for children with birth weight less than 1000 g - 4 mg Fe / kg / day;
• for children with birth weight from 1000 to 1500 g - 3 mg Fe/kg/day;
• for children with birth weight from 1500 to 3000 g - 2 mg Fe/kg/day.

The significance of the problem of IDA in young children is due to its high prevalence in the population and its frequent development in various diseases, which requires constant vigilance among doctors of all specialties. Nevertheless, at the present stage, the doctor’s arsenal has enough diagnostic and therapeutic capabilities for early detection and timely correction of sideropenic conditions.

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L. A. Anastasevich , Candidate of Medical Sciences A. V. Malkoch , Candidate of Medical Sciences, Russian State Medical University, Moscow